A cutoff thyroglobulin value suggestive of distant metastases in differentiated thyroid cancer patients

Serum thyroglobulin is used as part of the early postoperative assessment of differentiated thyroid cancer (DTC) since there is a clear relationship between an increased risk of recurrence and persistent disease after initial treatment and high postoperative stimulated thyroglobulin (ps-Tg) values. Thus, although ps-Tg above 10-30 ng/mL is considered an independent predictor of worse prognosis, the value that is associated with distant metastases is not defined. Thus, this was our objective. We selected 655 DTC patients from a nuclear medicine department database (Irmandade Santa Casa de Misericórdia de São Paulo, Brazil). All patients had received total thyroidectomy and radioactive iodine (RAI) therapy and had ps-Tg values higher than 10 ng/mL with negative anti-thyroglobulin antibodies. Then, we selected patients who presented post-therapy whole-body scan with pulmonary and/or bone uptake but with no mediastinum or cervical uptake. Patients with negative findings on functional imaging or any doubt on lung/bone uptake were submitted to additional exams to exclude another non-thyroid tumor. Of the 655 patients, 14.3% had pulmonary and 4.4% bone metastases. There was a significant difference in ps-Tg levels between patients with and without metastases (P<0.001). The cutoff value of ps-Tg was 117.5 ng/mL (sensitivity: 70.2%; specificity: 71.7%) for those with lung metastasis, and 150.5 ng/mL (sensitivity: 79.3%; specificity: 85%) for those with bone metastasis. The cutoff value for patients with eitherpulmonary or bone metastasis was 117.5 ng/mL (sensitivity: 70.2%; specificity: 83.7%). Our findings demonstrated that ps-Tg could predict distant metastasis in DTC patients. We identified a cutoff of 117.5 ng/mL with a high negative predictive value of 93.7%.

Quality control of 188W/188re generators

Quality control of 188W/188Re generators from two different manufacturers and two levels of activity each, was carried out.Elution yields, chemical as well as radionuclidic and radiochemical purities, elution profiles along six months, were evaluated.Broad elution profile, high efficiency, with tandem alumina column added, ionic exchange column needed for increase of radionuclidic concentration were characteristics of type I generators.Easy handling with slightly lower yields and high concentrations of activity were observed in type II generators. Similar radionuclidic impurities namely 192Ir, 191Os, 188W, 110mAg, 54Mn, 134Cs and 60Co as well as similar radiochemical yields obtained in the labelling of 188 Re-HEDP were observed with eluates of both generator types.Absorbed doses to radiopharmacy staff were less important in type II generators.

Plasmaferese sem imunossupressao concomitante em miastenia grave. Relato de um caso. / Plasmapheresis without concomitant immunosuppression in myasthenia gravis. Report of a case

Os autores apresentam caso de uma paciente, de 23 anos de idade, com miastenia grave, severa, com insuficiencia respiratoria mista e tetra paresia. Foi tratada inicialmente com anticolinesterasicos e corticosteroide, sem resposta. Em seguida submetida a plasmaferese com melhora importante da fraqueza muscular e da insuficiencia respiratoria restritiva. A melhora clinica, o valor do tratamento e os niveis de imunecomplexos circulantes no plasma (ClqBA) sao discutidos