Low iodine diet does not improve the efficacy of radioiodine for the treatment of Graves’ disease

Objective Consuming a low-iodine diet (LID) is a widely accepted practice before administering radioiodine (131I) to evaluate and to treat thyroid disease. Although this procedure is well established for the management of patients with differentiated thyroid cancer, its use in patients with benign disease is unclear. So, we aimed to evaluate the influence of a LID on the outcome in patients with Graves’ disease (GD) treated with131I. Subjects and methods We evaluated 67 patients with GD who were divided into 2 groups: one group (n = 31) consumed a LID for 1-2 weeks, and the second group (n = 36) was instructed to maintain a regular diet (RD). Results The LID group experienced a 23% decrease in urinary iodine after 1 week on the diet and a significant 42% decrease after 2 weeks on the diet. The majority (53%) of the patients in the LID group had urinary iodine levels that were consistent with deficient iodine intake. However, there was no difference in the rate of hyperthyroidism’s cure between the LID and the RD groups 6 months after 131I therapy. Furthermore, the therapeutic efficacy did not differ in patients with varying degrees of sufficient iodine intake (corresponding urinary iodine levels: < 10 μg/dL is deficient; 10-29.9 μg/dL is sufficient; and > 30 μg/dL is excessive). Conclusion In the present study, we demonstrated that although a LID decreased urinary iodine levels, those levels corresponding with sufficient or a mild excess in iodine intake did not compromise the therapeutic efficacy of131I for the treatment of GD.

Doença veno-linfática: alterações linfocintilográficas nas úlceras venosas / Venous-lymphatic disease: lymphoscintigraphic abnormalities in venous ulcers

Contexto: O sistema linfático tem papel relevante em qualquer tipo de edema periférico. Atualmente, a linfocintilografia é considerada o principal exame para diagnóstico da doença linfática das extremidades. Embora haja associação entre edema linfático e úlcera de estase venosa crônica, a fisiopatologia dessas alterações permanece indefinida. Objetivo: Verificar as alterações linfocintilográficas qualitativas que ocorrem em pacientes portadores de úlceras de estase dos membros inferiores. Métodos: Quarenta pacientes portadores de úlcera de estase venosa crônica ou cicatriz unilateral foram submetidos a linfocintilografia de ambos os membros inferiores. Foram estudados 25 mulheres e 15 homens, com média de idade de 53,7 anos (28 a 79 anos) e tempo médio de úlcera de 71,5 meses (3 a 240 meses). Foram comparados qualitativamente os parâmetros linfocintilográficos dos membros inferiores, previamente classificados em três grupos de acordo com a classificação clínica, etiológica, anatômica e patológica (CEAP): I, membros sem sinais clínicos de doença venosa ou com telangiectasias e veias reticulares (classes 0 e 1); II, membros inferiores com veias varicosas, edema e/ou alterações de pele e subcutâneo (classes 2, 3 e 4); III, membros inferiores com úlcera e/ou cicatriz (classes 5 e 6). Resultados: Quando foi comparada a presença de alterações linfocintilográficas dos membros com úlcera ou cicatriz (grupo III - classes 5 e 6) com as dos membros sem úlcera (grupos I e II - classes 0, 1, 2, 3 e 4), houve diferença significativa (p < 0,001). Estratificando os membros inferiores de acordo com a classificação CEAP, também foi observada diferença estatisticamente significante (p < 0,001), sendo as alterações linfocintilográficas presentes em 72,5 por cento no grupo III (classes 5 e 6), 30,8 por cento no grupo II (classes 2, 3 e 4) e 7,1 por cento no grupo III (classes 0 e 1). Em relação aos parâmetros analisados na linfocintilografia, ocorreu diferença...

Background: The lymphatic system plays a relevant role in any type of peripheral edema. Lymphoscintigraphy is currently considered the primary test in the diagnosis of lymphatic disease of the lower limbs. Although there is an association between lymphatic edema and chronic venous ulcers, the physiopathology of such changes remains uncertain. Objective: To assess qualitative lymphoscintigraphic findings in patients with chronic venous ulcers of the lower limbs. Methods: Forty patients with unilateral chronic venous ulcer or scar were submitted to bilateral lymphoscintigraphy of the lower limbs. The sample was comprised of 25 women and 15 men, with a mean age of 53.7 years (28 to 79) and mean ulcer duration of 71.5 months (3 to 240 months). Lymphoscintigraphic parameters were qualitatively compared among three groups of lower limbs previously classified according to the clinical, etiologic, anatomic and pathologic classification (CEAP): I, limbs without clinical signs of venous disease or with telangiectasias and/or reticular veins (classes 0 and 1); II, limbs with varicose veins, edema and/or skin and subcutaneous alterations (classes 2, 3 and 4); III, lower limbs with ulcer and/or ulcer scars (classes 5 and 6). Results: There was a significant difference (p < 0.001) in the comparison of lymphoscintigraphic findings of the lower limbs with (group III - classes 5 and 6) and without ulcers/scars (groups I and II - classes 0, 1, 2, 3 and 4). There was also a significant difference (p < 0.001) in the comparison of groups according to the clinical CEAP classification: lymphoscintigraphic abnormalities were present in 72.5 percent in group III (classes 5 and 6), in 30.8 percent in group II (classes 2, 3 and 4), and in 7.1 percent in group I (classes 0 and 1). There was a statistically significant difference between group III and the other groups with regard to radiotracer retention, inguinal adenomegaly and dermal reflux. There was no significance...

Effectiveness of radiation synovectomy with samarium-153 particulate hydroxyapatite in rheumatoid arthritis patients with knee synovitis: a controlled randomized double-blind trial

OBJECTIVES: The aim of the present study was to investigate the effectiveness of Samarium153-particulate hydroxyapatite radiation synovectomy in rheumatoid arthritis patients with chronic knee synovitis. METHODS: Fifty-eight rheumatoid arthritis patients (60 knees) with chronic knee synovitis participated in a controlled double-blinded trial. Patients were randomized to receive either an intra-articular injection with 40 mg triamcinolone hexacetonide alone (TH group) or 40 mg triamcinolone hexacetonide combined with 15 mCi Samarium153-particulate hydroxyapatite (Sm/TH group). Blinded examination at baseline (T0) and at 1 (T1), 4 (T4), 12 (T12), 32 (T32), and 48 (T48) weeks post-intervention were performed on all patients and included a visual analog scale for joint pain and swelling as well as data on morning stiffness, flexion, extension, knee circumference, Likert scale of improvement, percentage of improvement, SF-36 generic quality of life questionnaire, Stanford Health Assessment Questionnaire (HAQ), Lequesne index, use of non-steroidal anti-inflammatory drugs or oral corticosteroids, events and adverse effects, calls to the physician, and hospital visits. RESULTS: The sample was homogeneous at baseline, and there were no withdrawals. Improvement was observed in both groups in relation to T0, but no statistically significant differences between groups were observed regarding all variables at the time points studied. The Sm/TH group exhibited more adverse effects at T1 (p<0.05), but these were mild and transitory. No severe adverse effects were reported during follow-up. CONCLUSION: Intra-articular injection of Samarium153-particulate hydroxyapatite (15 mCi) with 40 mg of triamcinolone hexacetonide is not superior to triamcinolone hexacetonide alone for the treatment of knee synovitis in patients with rheumatoid arthritis at 1 y of follow-up.

Detecção da cardiopatia isquêmica crônica na insuficiência cardíaca / Criterias for diagnosis of ischemic cardiomyopathy in heart failure

Objetivo: determinar os critérios capazes de diagnosticas a cardiopatia isquêmica crônica (CIC) em pacientes com insuficiência cardíaca (IC). Métodos : Estudo prospectivo transversal de série de pacientes com insuficiência cardíaca em tratamento ambulatorial. Estudaram-se 19 pacientes divididos em dois grupos, segundo a cinecoronariografia: GI-CIC,n=10,nove homens, 52 +- 6 anos, 40(por cento) em TF III, 60 por cento em TFII, 80 por cento com lesões da DA. Submeteram-se os pacientes a teste ergoespirométrico (TEE), eletrocardiografia dinâmica (ECGD), ecodopplercardiograma (ECO) e ventriculografia radioisotópica de repouso (VRR), estando os pacientes em uso da medicação habitual. RESULTADOS : TEE VO2 pico (Ml/Kg/min),15,23+- 4,69 vs 17,65 +- 3,36; limiar anaeróbio (ml/kg/min)9,59 +- 2,35 vs 11,85 +- 2,79; pulso de 027,70 +- 1,98 vs 7,10 +- 1,86; ECO DDVE (mm) 73,00 +- 7,68 vs 73,55 +- 12,57 ; DDVD (mm) 28,20 +- 9,64 vs 25,00 +- 7,46;SIV (mm) 7,0 +- 1,05 vs 8,77 +- 1,56; PPPVE (mm) 7,60 +- 0,85 vs 8,44 +- 1,13.VRR; FE (por cento) 20,00 +- 6,00 vs 19,00 +- 8,00; ECGD;EV 1145 +- 1321 vs 3898; TVNS 2,90 +- 3,57 vs 7,25 +- 9,96 ; TSV 0,7 +- 1,25 vs 1,37 +- 2,77 ; ESSV 611 +- 1308 vs 401 +- 545. As diferenças foram significativas apenas para as medidas do SIV(p<0,05). Conclusões : Os autores ressaltam as dificuldades no diagnóstico da CIC em pacientes com IC, através de procedimentos não invasivos, detectando nesta amostra valores menores do SIV na CIC, que refletiriam a presença de áreas cicatriciais secundárias a lesões coronárias.

Efeito da compressäo pneumática intermitente sequencial sobre o linfedema dos embros inferiores: avaliaçäo quantitativa pela linfocintilografia / Effect of sequential intermittent pneumatic compression (SIPC) on lymphedema of the lower extremities: quantitative evaluation by lymphoscintigraphy

Para avaliar o efeito da compressäo pneumática intermitente sequencial sobre o transporte do Dextran marcado com tecnécio 99m em pacientes com linfedema de extremidades inferiores estudamos 11 pacientes.Foram oito mulheres e três homens com idade média de 44,6 anos.Foram realizadas duas linfocintilografias: a primeira considerada o controle (sem compresäo); a segunda foi realizada com compressäo pneumática de três horas, iniciada logo após a injeçäo do radioisótopo.Antes do início da compressäo e logo após o término foram feitas medidas em seis locais marcados para verificar a efetividade da compressäo na reduçäo do volume da extremidade.A análise quantitativa foi realizada pelo cálculo do "clearance" do radioisótopo em quatro locais determinados (perna, joelho, coxa e regiäo inguinal) em ambas as linfocintilografias.Observou-se reduçäo significante entre dos diâmetros das extremidades, porém näo foi observada diferença significativa entre os valores do "clearance" sem e com compressäo.Concluímos que a compressäo pneumática intermitente sequencial foi efetiva para reduzier o diâmetro, porém näo alterou o transporte do radioisótopo nas extremidades estudadas, em três horas de compressäo.

Mapeamento radioisotópico do foco arritmogênico em portadores de cardiopatia chagásica crônica e taquicardia ventricular sustentada / Radionuclide Angiography for Localization of the Site of Origin of Sustained Ventricular Tachycardia in Chronic Chagasic Cardiomyopathy

PURPOSE--To localize the site of the origin of sustained ventricular tachycardia in chronic chagasic cardiomyopathy patients refractory to antiarrhythmic therapy by radionuclide angiography techniques. METHODS--Five patients underwent radionuclide angiography by intravenous administration of 25mCi 99mTc. The images were obtained in sinus rhythm and during sustained ventricular tachycardia induced in the electrophysiologic laboratory for endocardial mapping. Amplitude and phase images were obtained resulting in a contraction wave synchronic to ventricular dispolarization. RESULTS--All patients had haemodynamic stability during the arrhythmia. One patient had incessant ventricular tachycardia. Mean ejection fraction was 0.38. In 4 patients the site of the origin of ventricular tachycardia was posterior and in one it was localized in the interventricular septum. There was identity in the site of the origin of ventricular tachycardia obtained by endocardial mapping or radionuclide angiography in all patients. The therapy was chemical ablation in 3 patients, surgical aneurysmectomy in one and pharmacologic therapy in the last patient. CONCLUSION--The site of the origin of ventricular tachycardia can be estimated by analyzing the contraction wave obtained by radionuclide angiography techniques in patients with hemodynamic stable sustained ventricular tachycardia.