Disfunción tiroidea por I131-Metayodo Benzilguanidina en pacientes con neuroblastoma / Thyroid dysfunction due to 131I-metaiodobenzylguanidine in patients with neuroblastoma

Resumen: Introducción: El tratamiento del neuroblastoma en estadios avanzados incluye quimioterapia, cirugía y terapia con I131-Metayodo benzilguanidina (I131-MIBG). La disfunción tiroidea se reporta entre 12 y 85% a pesar de la protección tiroidea. Objetivo: Identificar la frecuencia de disfunción tiroidea en casos de neu roblastoma tratados con I131-MIBG. Pacientes y Método: Estudio transversal. Se incluyeron todos los casos con diagnóstico de neuroblastoma que recibieron I131-MIBG en el periodo de 2002-2015, a los cuales se les realizó antropometría completa, perfil de tiroides: hormona estimulante de tiroides (TSH), Triyodotironina total y libre (T3t y T3l), tiroxina total y libre (T4t, T4l), y anticuerpos antitiroglobulina y antiperoxidasa. Resultados: Se identificaron un total de 27 pacientes; once fallecieron (40%). De los 16 casos sobrevivientes, 9 (56%) presentaron disfunción tiroidea: 2 (13%) casos con hipotiroidismo subclínico y 7 (44%) casos con hipotiroidismo clínico (3 casos por retraso en el desa rrollo psicomotor y 4 por desaceleración del crecimiento). Los pacientes presentaron manifestaciones clínicas a los 16,1 meses (1,2-66,3 meses) de recibir el radiofármaco a una dosis acumulada de 142 mCi (96-391.5 mCi). No se logró evidenciar diferencias en la edad al diagnóstico, la edad al inicio del tratamiento con el I131-MIBG, la dosis acumulada del I131-MIBG y el tiempo trascurrido entre la dosis y el perfil tiroideo entre los casos con o sin disfunción tiroidea. Conclusiones: El 56% de los pacientes con neuroblastoma presentaron disfunción tiroidea. La mayoría de los casos con hipotiroidismo fue ron referidos cuando los datos de disfunción tiroidea eran clínicamente evidentes. Se propone en esta poblacion realizar perfil tiroideo semestral y valoración anual por un endocrinólogo pediatra durante los primeros 5 años posteriores al diagnóstico oncológico.

Abstract: Introduction: The treatment of advanced neuroblastoma includes chemotherapy, surgery, and radiotherapy with 131-I-Metaiodobenzylguanidine (131-I-MIBG). Despite strategies to protect thyroid function, its dysfunction is reported between 12 and 85%. Objective: To identify the frequency of thyroid dys function in cases of neuroblastoma treated with 131-I-MIBG. Patients and Method: Cross-sectional study. We included all the cases with neuroblastoma treated with 131-I-MIBG between 2002 and 2015, with complete somatometry, and complete thyroid profile (TSH, free and total T3 and T4, and anti-thyroglobulin and antiperoxidase antibodies). Results: 27 patients were identified out of which eleven died (40%). Out of the 16 surviving cases, 9 (56%) presented thyroid dysfunction: 2 (13%) cases with subclinical hypothyroidism and 7 (44%) cases with clinical hypothyroidism (3 cases due to psychomotor developmental delay and 4 due to growth deceleration). The patients presented cli nical manifestations at 16.1 months (1.2-66.3 months) after receiving the radiopharmaceutical at acumulative dose of 142 mCi (96-391.5 mCi). No differences were found in the age at diagnosis, age at the start of treatment with 131-I-MIBG, the cumulative dose of 131-I-MIBG, and the time elapsed between the dose and the thyroid profile among the cases with or without thyroid dysfunction. Con clusions: 56% of patients with neuroblastoma had thyroid dysfunction. Most of the cases with hypothyroidism were referred when thyroid dysfunction was clinically evident. A thyroid profile should be performed every 6 months, along with an annual endocrinological evaluation during the next 5 years in these patients.

Clinical outcomes of low and intermediate risk differentiated thyroid cancer patients treated with 30mCi for ablation or without radioactive iodine therapy

ABSTRACT Objective To retrospectively evaluate the outcomes of patients with low and intermediate risk thyroid carcinoma treated with total thyroidectomy (TT) and who did not undergo radioiodine remnant ablation (RRA) and to compare them to patients receiving low dose of iodine (30 mCi). Subjects and methods A total of 189 differentiated thyroid cancer (DTC) patients treated with TT followed by 30mCi for RRA or not, followed in two referral centers in Brazil were analyzed. Results From the 189 patients, 68.8% was ATA low-risk, 30.6% intermediate and 0.6% high risk. Eighty-seven patients underwent RRA and 102 did not. The RRA groups tended to be younger and had a higher frequency of extra-thyroidal extension (ETE). RRA did not have and impact on response to initial therapy neither in low (p = 0.24) nor in intermediate risk patients (p = 0.66). It also had no impact on final outcome and most patients had no evidence of disease (NED) at final follow-up. Recurrence/persistence of disease was found in 1.2% of RRA group and 2% in patients treated only with TT (p = 0.59). Conclusions Our study shows that in low and intermediate-risk patients, RRA with 30 mCi seems to have no major advantage over patients who did not undergo RRA regarding response to initial therapy in each risk group and also in long term outcomes.

Production, quality control, biodistribution assessment and preliminary dose evaluation of [177Lu]-tetra phenyl porphyrin complex as a possible therapeutic agent / Produção, controle de qualidade, avaliação de biodistribuição e avaliação da dose preliminar de [177Lu] -tetra complexo fenil porfirina como um possível agente terapêutico

Due to interesting therapeutic properties of ¹⁷⁷Lu and tumor avidity of tetraphenyl porphyrins (TPPs), ¹⁷⁷Lu-tetraphenyl porphyrin was developed as a possible therapeutic compound. ¹⁷⁷Lu of 2.6-3 GBq/mg specific activity was obtained by irradiation of natural Lu₂O₃sample with thermal neutron flux of 4 × 10¹³ n.cm^-2.s^-1. Tetraphenyl porphyrin was synthetized and labeled with ¹⁷⁷Lu. Radiochemical purity of the complex was studied using Instant thin layer chromatography (ITLC) method. Stability of the complex was checked in final formulation and human serum for 48 h. The biodistribution of the labeled compound in vital organs of wild-type rats was studied up to 7 d. The absorbed dose of each human organ was calculated by medical internal radiation dose (MIRD) method. A detailed comparative pharmacokinetic study was performed for ¹⁷⁷Lu cation and [¹⁷⁷Lu]-TPP. The complex was prepared with a radiochemical purity: >97±1% and specific activity: 970-1000 MBq/mmol. Biodistribution data and dosimetric results showed that all tissues receive approximately an insignificant absorbed dose due to rapid excretion of the complex through the urinary tract. [¹⁷⁷Lu]-TPP can be an interesting tumor targeting agent due to low liver uptake and very low absorbed dose of approximately 0.036 to the total body of human...

Devido às propriedades interessantes do ¹⁷⁷Lu e da avidez tumoral das tetrafenil porfirinas (TPP), desenvolveu-se a ¹⁷⁷Lu-tetrafenil porfirina como composto terapêutico potencial. ¹⁷⁷Lu de atividade específica de 2,6-3 GBq/mg foi obtido por irradiação de amostra de Lu₂O₃ com fluxo térmico de nêutrons de 4 × 10¹³ n.cm^-2.s^-1. Sintetizou-se a tetrafenil porfirina e marcou-se com ¹⁷⁷Lu. A pureza radioquímica do complexo foi estudada usando método de Cromatografia Instantânea de Camada Delgada ( ITLC). A estabilidade do complexo foi checada na formulação final e no ser humano por 48 h. A biodistribuição do composto marcado em órgãos vitais de ratos do tipo selvagem foi estudada por mais de 7 dias. A dose absorvida para cada órgão humano foi calculada pelo método da Dose Médica de Radiação Interna (MIRD). Estudo farmacocinético comparativo detalhado foi efetuado para o cátion ¹⁷⁷Lu e para o [¹⁷⁷Lu]-TPP. O complexo foi preparado com pureza radioquímica >97±1% e atividade específica de 970-1000 MBq/mmol. Os dados de biodistribuição e os resultados dosimétricos mostraram que todos os tecidos receberam uma dose absorvida aproximadamente insignificante devido à rápida excreção do complexo pelo trato urinário. O [¹⁷⁷Lu]-TPP pode ser um agente interessante de direcionamento do tumor devido à baixa captação pelo fígado e pela dose bem baixa absorvida, de, aproximadamente, 0,036 do corpo humano total...

Sterilizing elastomeric chains without losing mechanical properties. Is it possible?

OBJECTIVE: To investigate the effects of different sterilization/disinfection methods on the mechanical properties of orthodontic elastomeric chains. METHODS: Segments of elastomeric chains with 5 links each were sent for sterilization by cobalt 60 (Co60) (20 KGy) gamma ray technology. After the procedure, the elastomeric chains were contaminated with clinical samples of Streptococcus mutans. Subsequently, the elastomeric chains were submitted to sterilization/disinfection tests carried out by means of different methods, forming six study groups, as follows: Group 1 (control - without contamination), Group 2 (70°GL alcohol), Group 3 (autoclave), Group 4 (ultraviolet), Group 5 (peracetic acid) and Group 6 (glutaraldehyde). After sterilization/disinfection, the effectiveness of these methods, by Colony forming units per mL (CFU/mL), and the mechanical properties of the material were assessed. Student's t-test was used to assess the number of CFUs while ANOVA and Tukey's test were used to assess elastic strength. RESULTS: Ultraviolet treatment was not completely effective for sterilization. No loss of mechanical properties occurred with the use of the different sterilization methods (p > 0.05). CONCLUSION: Biological control of elastomeric chains does not affect their mechanical properties. .

OBJETIVO: verificar os efeitos de diferentes métodos de esterilização/desinfecção nas propriedades mecânicas de elásticos ortodônticos em cadeia. MÉTODOS: segmentos de elástico em cadeia com 5 elos cada foram enviados para esterilização em radiação gama com cobalto 60 (20 KGy). Após esterilização, esses foram contaminados com amostras clínicas de Streptococcus mutans. Passado esse período, foram submetidos aos testes de esterilização/desinfecção por diferentes métodos, formando seis grupos de estudo, assim denominados: Grupo 1 (controle - sem ter sido contaminado), Grupo 2 (álcool 70°GL), Grupo 3 (autoclave), Grupo 4 (ultravioleta), Grupo 5 (ácido peracético) e Grupo 6 (glutaraldeído). Após esterilização/desinfecção, avaliou-se a efetividade desses métodos, por meio de contagem de unidades formadoras de colônias por mL (UFC/mL), e as propriedades mecânicas desses materiais. Utilizou-se o teste t de Student para avaliar o número de UFC, além do ANOVA e, posteriormente, do teste de Tukey para avaliação da força. RESULTADOS: verificou-se que o ultravioleta não obteve eficácia total quanto à esterilização. E não ocorreu perda das propriedades mecânicas dos elásticos, com os diferentes métodos de esterilização utilizados (p > 0,05). CONCLUSÃO: o controle biológico de elásticos em cadeia não interfere nas suas propriedades mecânicas. .

Role of vaginal pallor reaction in predicting late vaginal stenosis after high-dose-rate brachytherapy in treatment-naive patients with cervical cancer / 부인종양

OBJECTIVE: To assess actual rates of late vaginal stenosis and identify predisposing factors for complications among patients with previously untreated cervical cancer following high-dose-rate brachytherapy. METHODS: We performed longitudinal analyses of 57 patients using the modified Dische score at 6, 12, 18, 24, 36, and 60 months after treatment, which consisted of 15 interstitial brachytherapys and 42 conventional intracavitary brachytherapys, with a median follow-up time of 36 months (range, 6 to 144 months). RESULTS: More than half of the patients developed grade 1 (mild) vaginal stenosis within the first year of follow-up, and grade 2 (97.5%, moderate) to grade 3 (severe) stenosis gradually increased with time. Actual stenosis rates for grade 1, 2, and 3 were 97.5% (95% confidence interval [CI], 92.7 to 97.5), 60.7% (95% CI, 42.2 to 79.3), and 7.4% (95% CI, 0 to 18.4) at 3 years after treatment. Pallor reaction grade 2-3 at 6 months was only a statistically significant predisposing factor for grade 2-3 late vaginal stenosis 3 years or later with a hazard ratio of 3.48 (95% CI, 1.32 to 9.19; p=0.018) by a multivariate Cox proportional hazard model. Patients with grade 0-1 pallor reaction at 6 months showed a grade > or =2 vaginal stenosis rate of 53%, whereas the grade 2-3 pallor reaction group achieved a grade > or =2 vaginal stenosis rate at 3 years at 100% (p=0.001). CONCLUSION: High-dose-rate brachytherapy was associated with high incidence of late vaginal stenosis. Pallor reaction grade 2-3 at 6 months was predictive of late grade 2-3 vaginal stenosis at 3 years after treatment. These findings should prove helpful for patient counseling and preventive intervention.

The Effectiveness of Recombinant Human Thyroid-Stimulating Hormone versus Thyroid Hormone Withdrawal Prior to Radioiodine Remnant Ablation in Thyroid Cancer: A Meta-Analysis of Randomized Controlled Trials

We evaluated the efficacy of recombinant human thyroid-stimulating hormone (rhTSH) versus thyroid hormone withdrawal (THW) prior to radioiodine remnant ablation (RRA) in thyroid cancer. A systematic search of MEDLINE, EMBASE, the Cochrane Library, and SCOPUS was performed. Randomized controlled trials that compared ablation success between rhTSH and THW at 6 to 12 months following RRA were included in this study. Six trials with a total of 1,660 patients were included. When ablation success was defined as a thyroglobulin (Tg) cutoff of 1 ng/mL (risk ratio, 0.99; 95% confidence interval, 0.96-1.03) or a Tg cutoff of 1 ng/mL plus imaging modality (RR 0.97; 0.90-1.05), the results of rhTSH and THW were similar. There were no significant differences when ablation success was defined as a Tg cutoff of 2 ng/mL (RR 1.03; 0.95-1.11) or a Tg cutoff of 2 ng/mL plus imaging modality (RR 1.02; 0.95-1.09). When a negative 131I-whole body scan was used solely as the definition of ablation success, the effects of rhTSH and THW were not significantly different (RR 0.97; 0.93-1.02). Therefore, ablation success rates are comparable when RRA is prepared by either rhTSH or THW.

Gastrectomy for the treatment of refractory gastric ulceration after radioembolization with 90Y microspheres

Transcatheter arterial radioembolization (TARE) with Yttrium-90 (90Y)-labeled microspheres has an emerging role in treatment of patients with unresectable hepatocellular carcinoma. Although complication of TARE can be minimized by aggressive pre-evaluation angiography and preventive coiling of aberrant vessels, radioembolization-induced gastroduodenal ulcer can be irreversible and can be life-threatening. Treatment of radioembolization-induced gastric ulcer is challenging because there is a few reported cases and no consensus for management. We report a case of severe gastric ulceration with bleeding that eventually required surgery due to aberrant deposition of microspheres after TARE.

Newer treatments for advanced hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide. The only curative treatment modalities for HCC are surgery, percutaneous ablation, and liver transplantation. Unfortunately, the majority of patients have unresectable disease at diagnosis. Therefore, effective treatment options are needed for patients with advanced HCC. The current standard treatment for patients with advanced HCC, according to the Barcelona Clinic Liver Cancer staging system, is the multikinase inhibitor sorafenib. Other alternative therapies are required, due to the limited treatment response to, and tolerance of, this molecular target agent. Clinical trials of hepatic artery infusion chemotherapy, radioembolization, and multimodal treatments have shown favorable results in advanced HCC patients. This article introduces new treatment modalities for advanced HCC and discusses future therapeutic possibilities.

Radiosinovectomía terapéutica en pediatría / Therapeutic radiosynoectomy in pediatrics

Se recibe en la Unidad Coordinadora de Evaluación y Ejecución de Tecnologías en Salud (UCEETS) una solicitud de evaluación de la efectividad de radiosinovectomía terapéutica, por parte de la Secretaría de Políticas Públicas Regulación e Institutos. El pedido se refiere al uso de la mencionada tecnología en la población pediátrica, por lo que se anexa la siguiente búsqueda específica para esta población. Se realizó una búsqueda en las bases de datos bibliográficas detalladas a continuación, en buscadores genéricos de Internet como google, Agencias de Evaluación de Tecnologías Sanitarias y Agencias nacionales e internacionales reguladoras de alimentos y medicamentos, las que se detallan más abajo. Se utilizaron como criterios de inclusión textos en inglés, español o francés a los que se pueda tener acceso a texto completo, publicados entre 2000 y 2013. Las palabras claves utilizadas se detallan a continuación en cada sitio de búsqueda. Se excluyeron textos en otro idioma y a los que no se pudiera acceder a texto completo. Fueron excluidos los ECCA en población adulta. Se priorizó la inclusión de revisiones sistemáticas y metanálisis, evaluaciones de tecnologías sanitarias, informes de seguridad y ECCA. La calidad de la evidencia existente hasta la fecha impide extraer evidencia confiable como para formular una recomendación en relación a la tecnología evaluada. Los estudios evaluados consisten en series de casos, que son estudios de índole descriptiva sin grupos comparadores, lo que hace que la calidad de la evidencia sea muy baja y no puedan ser incluídos en una Evaluación de Tecnología Sanitaria. No existe evidencia suficiente de estudios de buena de calidad para poder avalar la efectividad del tratamiento con radiosinovectomía en hemartrosis hemofílica en la población pediátrica. Por otro lado existen riesgos teóricos sobre su seguridad, al utilizar material con actividad radiante en una población especialmente susceptible como es la pediátrica. Se sugiere realizar ensayos clínicos controlados aleatorizados de buena calidad metodológica con el fin de evaluar la efectividad y la seguridad de la Tecnología solicitada para contar con evidencia suficiente como para aseverar que en la mayoría de los pacientes el beneficio del tratamiento superará los potenciales riesgos. En el momento actual no se puede realizar esta recomendación.

Changes in Quality of Life and Related Factors in Thyroid Cancer Patients with Radioactive Iodine Remnant Ablation

PURPOSE: To investigate changes in Quality of life (QOL) and related factors in patients with thyroid cancer undergoing Radioactive Iodine remnant ablation (RAI). METHODS: Data were collected longitudinally 3 times for 6 months (2 weeks post-surgery, post RAI, 3 months post RAI) in a hospital located in Seoul. Questionnaires were used to measure levels of physical symptoms, anxiety, depression, and QOL. Ninety-eight patients with thyroid cancer who had RAI were included in the analysis. Data were analyzed using SPSS (18.0). RESULTS: Findings for the three data collection times respectfully were: mean scores for physical symptoms, 0.53, 1.21 and 0.62, patients with depression, 47%, 36.7% and 37.7%, patients with anxiety, 18.4%, 19.4% and 20.4%, mean scores for QOL, 7.06, 7.01 and 7.28. QOL score was highest 3 months post RAI (p=.031). In the stepwise multiple regression analysis, depression and fatigue were predicting factors for low QOL at all data collection times. Dysponia was a predicting factor for low QOL post RAI and 3 months post RAI. CONCLUSION: To increase QOL, it is necessary to provide information in advance regarding physical & psychological symptoms and to develop nursing intervention programs to decrease depression and fatigue.

Empleo de la medicina nuclear y las técnicas de imágenes en las afecciones del sistema óseo / Emploi de la médicine nucléaire et des techniques par image dans les affections du système osseux / Use of nuclear medicine and imaging techniques in disorders of the bone system

La medicina nuclear es la especialidad médica que se ocupa del diagnóstico, tratamiento e investigación médica mediante el uso de radioisótopos como fuentes abiertas. A menudo, las personas presentan diferentes condiciones patológicas óseas como la osteoporosis, el cáncer de hueso primario, las metástasis óseas, la artrosis y la artritis. Como objetivo de esta revisión se presentaron estadísticas internacionales y nacionales, y se evaluó la incidencia de esas afecciones. Además, se identificaron los radiofármacos más empleados en la actualidad para el diagnóstico y tratamiento de las enfermedades óseas, así como el uso combinado con las técnicas de imagen más utilizadas mediante la revisión de diferentes estudios clínicos. Se expuso la utilidad de la gammagrafía ósea para el diagnóstico y la confirmación de las afecciones estudiadas. Igualmente, se presentó el empleo de nuevas técnicas como las tomografías por emisión de fotón único o por emisión de positrones. Se observó que el radioisótopo más empleado para el diagnóstico de enfermedades del sistema óseo es el 99mTc por sus características físicas y químicas, mientras que para terapia se emplean 186Re, 188Re, 153Sm, 177Lu, 32P, 89Sr, 85Sr, 117mSn, según el tipo, ubicación y magnitud de las lesiones y la disponibilidad del radioisótopo. En la actualidad, el desarrollo de los radiofármacos se ha centrado en la combinación de estos radioisótopos con diferentes biomoléculas para mejorar sus propiedades y ampliar su campo de aplicaciones(AU)

Nuclear medicine is the medical specialty that deals with clinical diagnosis, treatment and research through the use of isotopes as open sources. Bone diseases such as osteoporosis, primary bone cancer, bone metastases, arthrosis and arthritis are common among the population. The objective of this review was to present international and national statistics, and evaluate the incidence of these disorders. Additionally, a review was conducted of various clinical studies to identify the radiopharmaceuticals most frequently used to diagnose and treat bone disease, and their combination with the most common imaging techniques. A presentation was made of the usefulness of bone gammagraphy and the confirmation of the disorders studied. Reference was also made to the use of new techniques such as single photon emission tomography or positron emission tomography. It was found that the radioisotope most commonly used to diagnose diseases of the bone system was 99mTc, due to its physical and chemical characteristics, whereas 186Re, 188Re, 153Sm, 177Lu, 32P, 89Sr, 85Sr, 117mSn are used for therapeutic purposes, depending on the type, location and magnitude of the lesions and the availability of the radioisotope. At present, radiopharmaceutical development centers on combining these radioisotopes with various biomolecules to improve their properties and broaden their field of application(A)

La médecine nucléaire est la spécialité médicale s'occupant du diagnostic, du traitement et de la recherche médicale au moyen de radioisotopes comme sources ouvertes. Les personnes sont souvent touchées par différentes conditions pathologiques osseuses telles que l'ostéoporose, le cancer d'os primaire, les métastases osseuses, l'arthrose, et l'arthrite. Le but de cette révision est de présenter des statistiques internationales et nationales, et d'évaluer l'incidence de ces affections. Grâce à la révision de différentes études cliniques, on a également identifié les traceurs isotopiques les plus souvent utilisés de nos jours pour le diagnostic et le traitement des maladies osseuses, ainsi que l'emploi combiné des techniques par image les plus fréquentes. L'utilité de la gammagraphie osseuse pour le diagnostic et la confirmation des affections étudiées a été mise en évidence. De nouvelles technologies telles que les tomographies par émission de photon unique ou par émission de positons a été également présentées. On a trouvé que le radioisotope le plus souvent utilisé pour le diagnostic des maladies du système osseux est le 99mTc, dû à ses caractéristiques physiques et chimiques, tandis que pour la thérapie, les 186Re, 188Re, 153Sm, 177Lu, 32P, 89Sr, 85Sr, et 117mSn sont utilisés selon le type, la localisation et la magnitude des lésions, et la disponibilité du radioisotope. Aujourd'hui, le développement des traceurs isotopiques est axé sur la combinaison de ces radioisotopes avec différentes biomolécules pour améliorer leurs propriétés et élargir leur champ d'applications(AU)

Fosfato de cromo (III) marcado con diferentes radionúclidos para uso en radiosinoviortesis / Chromium (III) labelled with several radionuclidesphosphate for use in radiosynoviothersis

Introducción: la radiosinoviortesis se utiliza en el tratamiento de la sinovitis crónica, complicación frecuente en enfermedades sistémicas como artritis reumatoide y hemofilia. En la práctica clínica internacional se emplean diferentes coloides y suspensiones radiactivas, pero su número es reducido y su disponibilidad limitada. Objetivo: obtención y caracterización físico-química de suspensiones de fosfato de cromo (III) marcadas con radionúclidos como potenciales radiofármacos para uso en radiosinoviortesis. Métodos: las suspensiones se obtuvieron por síntesis química, los radionúclidos se añadieron al inicio de la reacción o después de finalizada esta. El tamaño de partículas se estimó mediante microscopia óptica y filtración por membranas. Asimismo se evaluó por espectrofotometría la estabilidad de la suspensión al ser resuspendida en distintos medios. La pureza radioquímica se determinó por cromatografía de papel. Resultados: se obtuvo y caracterizó una suspensión de fosfato de cromo (III). El producto obtenido presentó un tamaño de partículas predominante entre 0,8-5 µm y que al ser suspendidas en solución de gelatina al 2 por ciento en tampón acetato 1 mg/mL no sedimentó en menos de 3 h. Se estableció la tecnología para la obtención de formulaciones de fosfato de cromo (III) marcado con 32P e 90Y y se demostró la factibilidad de marcar la suspensión obtenida con otros radionúclidos trivalentes como 177Lu y 68Ga. Conclusiones: los resultados permiten considerar al fosfato de cromo (III) una suspensión base para la obtención de radiofármacos para uso en radiosinoviortesis en diferentes articulaciones, en función de las características físico-nucleares de los radionúclidos que se empleen

Introduction: radiosynoviorthesis is used in treating chronic synovitis, a frequent complication of some systemic diseases as rheumatoid arthritis and hemophilia. There are different colloids and radioactive suspensions recommended in the international clinical practice, but the number is reduced and the availability limited. Objective: obtaining and physical-chemical characterization of suspensions of chromium phosphate (III) labeled with several radionuclides as potential radiopharmaceuticals for using in radiosynoviorthesis. Methods: the suspensions were obtained by chemical synthesis. Radionuclides were added at the beginning or after concluding the reaction. The particle size was estimated by means of optic microscopy and membrane filtration. Similarly, the stability of suspension when re-suspended in several media was evaluated by spectrophotometry. The radiochemical purity was determined by paper chromatography. Results: a suspension of chromium (III) phosphate was obtained and characterized. It was found that the obtained product had a predominant particle size range of 0,8 to 5 µm and that when suspended in 2 percent gelatin solution in 1mg/ml acetate buffer, it settled in no less than 3 hours. Technologies for the preparation of radiopharmaceuticals of Chromium (III) Phosphate labeled with 32P and 90Y were described. There was demonstrated the feasibility of labeling the obtained suspension with other trivalent radionuclides such as 177Lu and 68Ga. Conclusions: the results allow considering the obtained Chromium (III) Phosphate suspension as a matrix for the preparation of radiopharmaceuticals to be used in radiosinoviorthesis aimed at various joints, depending on the physical and nuclear characteristics of the radionuclides

Radiosinovectomía de muñeca guiada por ultrasonido: experiencia de un caso clínico y revisión del tema / Ultrasound-guided wrist radiosynovectomy: case report and topic review

Radiosynovectomy is a local form of radiotherapy used as second-line treatment in the management of inflammatory and non-inflammatory arthropathies with unsatisfactory response to local or systemic corticosteroid therapy. Its efficacy is similar to that of surgical synovectomy, with the advantages of being a low-cost and minimally- invasive treatment that requires a shorter recovery time. Its efficacy is greater in the treatment of inflammatory arthritis characterized by synovitis, such as rheumatoid arthritis and juvenile chronic arthritis with mono/oligoarticular involvement, especially in upper extremity joints. A number of isotopes can be used in colloidal suspensions. Rhenium-186-sulphide colloid is currently indicated for the treatment of medium-sized joints. The ultrasound-guided injection is suitable for small joints, such as wrist. For proper and safe use and administration of this technique the collaboration of a trained and experienced radiologist is critical to successful treatment.

La radiosinovectomía es una forma local de radioterapia utilizada como tratamiento de segunda línea en el manejo de artropatías inflamatorias y no inflamatorias con respuesta insatisfactoria a la terapia sistémica o local con corticoesteroides. Tiene una eficacia similar a la sinovectomía quirúrgica, con las ventajas de ser un tratamiento de menor costo, menos cruento y con menor tiempo de convalecencia. Su eficacia es mayor en artropatías inflamatorias caracterizadas por sinovitis, como la artritis reumatoide y artritis crónica juvenil, con compromiso mono u oligoarticular y en articulaciones de extremidades superiores. Existen múltiples isótopos que se pueden utilizar en suspensiones coloidales, siendo el sulfuro coloidal de renio-186 el utilizado para la articulación radiocarpiana. Una técnica de administración adecuada es fundamental para el éxito del tratamiento, siendo la inyección con guía ultrasonográfica adecuada para articulaciones de volumen pequeño, instancia en la que la colaboración del médico radiólogo entrenado es fundamental.

Tratamiento de tumores neuroendocrinos (TNE) con péptidos análogos de la somatostatina marcados con radionucleidos / Treatment of neuroendocrine tumors (NET) with radiolabelled somatostatin analogues

Propósito. Los TNE avanzados tienen escasa respuesta a radioterapia o quimioterapia, el tratamiento sistémico con análogos de la SST radiactivos es una herramienta promisoria en su tratamiento. Presentamos nuestra experiencia, pionera en Latinoamérica, utilizando análogos de SST marcados con 90Y ó 177Lu. Material. Evaluamos 40 pacientes (50.3 años, rango 12-74) con TNE confirmados histológicamente y sobre-expresión de receptores de SST demostrada mediante imágenes. SPECT (111In-DOTATOC) ó PET/CT (68Ga-DOTATATE). Se evaluó respuesta clínica, laboratorio, imágenes con 111In-DOTATATE, post-terapia con 90Y ó 177Lu, 68Ga-DOTATATE PET/CT o TAC. Resultados. Observamos progresión de enfermedad en 10 (25.0 por ciento), remisión parcial en 25 (62.5 por ciento), enfermedad estable en 3 (7.5 por ciento) y remisión completa en 2 (5.0 por ciento). Hubo escasa toxicidad sin deterioro renal significativo. Observamos reducción tumoral y mejoría de calidad de vida en la mayoría de los pacientes. Conclusión. La terapia con radiopéptidos es un procedimento seguro y efectivo en el tratamiento de TNE avanzados.

Purpose. Advanced NETs have little response to radiotherapy or chemotherapy, systemic treatment with radioactive SST analogous is a promissory tool in its treatment. We present our pioneering experience in Latin America using analogous of SST labeled either with 90Y or 177Lu. Materials. We evaluated 40 patients (50.3 years, range 12-74) with histological proved NET and SST receptors over-expression demonstrated by SPECT or PET/CT images with 111In-DOTATOC or 68Ga-DOTATATE. We evaluated clinical response, laboratory test, images with 111In-DOTATATE, 90Y, 177Lu, and 68Ga-DOTATATE PET/CT or CT. Results. We observed progression of disease in 10 (7,5 percent), partial remission in 25 (62,5 percent), stable disease in 3 (7,5 percent) and complete remission in 2 (5,0 percent). There was little toxicity without significant renal deterioration. We observed tumor mass reduction and improvement of quality of life in most of the patients. Conclusion. The therapy with radiopeptides is a safe and effective procedure in the treatment of advanced NET.

Aggressive form of thyroglossal duct cyst carcinoma: role of ablative dose of Iodine-131

Ectopic thyroid tissue carcinoma is very rare and has usually good prognosis. It could arise in 1 percent of thyroglossal duct cysts (TDC), the most common nonodontogenic cysts that occur in the neck, which results from a failure in obliterating the embryogenic duct produced during thyroid migration. TDC is most often diagnosed during the childhood but may be discovered later in adult age. In most of the cases reported in the literature, thyroid carcinoma arising in the TDC is limited to the cyst without local extension and its efficient treatment consist of the surgical removal of the cyst by Sistrunk's operation. However, some controversies remain regarding the indication of total thyroidectomy when thyroid investigations are normal. Cases of aggressive thyroid carcinomas of the TCD with metastatic cervical lymph nodes are exceptional, mainly when histological findings of the thyroid gland are normal. We report a case of an aggressive form of a thyroglossal duct cyst carcinoma complicated with several infiltrated cervical lymph nodes but normal thyroid gland. The therapeutic strategy adopted in this case shows the decisive role of the post-operative ablative dose of Iodine-131 both for treatment and staging of aggressive form of thyroid carcinoma arising in thyroglossal duct cyst.

Cirugía radioguiada para la extirpación de un quiste paratiroideo gigante con hiperparatiroidismo / Radio-guided surgery for removal of a giant parathyroid cyst related to hyperthyroidism

Entre los avances actuales del tratamiento quirúrgico del hiperparatiroidismo se encuentra la localización preoperatoria de la(s) glándula(s) hiperfuncionante(s) mediante gammagrafía preoperatoria e intraoperatoria, esta última a través de una sonda gamma especial. Por otro lado, los quistes paratiroideos son raros; pueden ser funcionantes o no. Se describe un nuevo caso de quiste paratiroideo hiperfuncionante, así como los hallazgos de la gammagrafía con 99mTc-MIBI y el uso intraoperatorio de la sonda gamma para evaluar todos los sitios probables donde pudieran existir glándulas hiperproductoras de hormona paratiroidea. Se describen aspectos de la manipulación, seguridad y administración del radiofármaco en el período preoperatorio inmediato, así como la utilización de la sonda gamma durante la intervención. Se informa la evolución durante el seguimiento. Este caso representa el tercer paciente intervenido por hiperparatiroidismo mediante cirugía radioguiada en nuestro centro, institución en la que se introdujo esta técnica en el país(AU)

Among present advances of surgical treatment of hyperthyroidism is the preoperative localization of hyper-functioning glands by preoperative and intraoperative scan, this later one by a special gamma probe. By the other hand, parathyroid cysts are rare; may be of functioning type or not, as well as the findings of 99mTc-MIBI, and the intraoperative use of gamma probe to assess all the possible sites where could be hyperproductive glands of parathyroid hormone. We describe features of management, safety, and administration of radiological agent during the immediate preoperative period, as well as use of gamma probe during intervention. Evolution over follow-up is reported. This case represents the third patient operated on from hyperthyroidism by radio-guided surgery in our center, which introduced this technique in our country(AU)