Comparison of the effect of knee synovectomy in haemophilic patients with 153Sm- and 90Y-labelled hydroxyapatite 1 year after.

To compare the use of 740 Mbq (20 mCi) of (153) Sm and 185 Mbq (5mCi) of (90) Y, both labelling hydroxyapatite (HA), for knee synovectomy in haemophilic patients, 1 year after the intervention. Thirty three men (36 knees) were studied, divided into two groups: 1 - treatment using 740 Mbq of (153) Sm-HA: 20 knees of 18 patients, with mean age of 21.4 ± 13.3 years (ranging from 7 to 56 years) and mean Pettersson score of 5.3; 2 - treatment using 185 Mbq of (90) Y-HA: 16 knees of 15 patients, with mean age of 26.3 ± 10.3 (ranging from 7 to 51 years) and mean Pettersson score of 6.3. The following criteria were adopted for the evaluation before and 1 year after synovectomy: reduction in haemarthrosis episodes and pain using a visual analogue scale, as well as improved joint mobility. The occurrence of adverse events in the treatment was also considered. The chi-square, Wilcoxon and Mann-Whitney tests were used with P ≤ 0.05 set as significant. The occurrence of haemarthrosis declined by 65.7% with the use of (153) Sm-HA and 82.6% for (90) Y-HA, with no statistical difference between the groups (P = 0.632); pain reduction was 42.5% in group 1 and 30.7% in group 2, once again with no statistical difference (P = 0.637). Improvement in joint mobility was not significant for both groups. Two cases of mild reactive synovitis were observed in group 1 and one in group 2, which cleared up without medical intervention. Although the beta energy from (90) Y is the gold standard for knee synovectomy, higher activities of (153) Sm may be used in places which have only production of this material.

The use of 185 MBq and 740 MBq of 153-samarium hydroxyapatite for knee synovectomy in haemophilia.

The penetration of beta energy of 153-samarium ((153) Sm) (0.8 MeV) is not only appropriate for synovectomy of median articulations but is possible to improve the radiobiological effect using increased activities. The aim of this study was to assess the effectiveness of 185 MBq and 740 MBq of 153-samarium hydroxyapatite ((153) Sm-HA) in knees of haemophilic patients. Thirty-one patients--36 knees, 30 males, were divided into two groups without coinjection of corticosteroid: A - 14 patients (17 knees) treated with intra-articular dose of 185 MBq of (153) Sm-HA, average age 23 years; B--17 patients (19 knees) with 740 MBq of (153) Sm-HA, average age 21.3 years. The evaluation before and after 1 year of synovectomy used the following criteria: reduction in the number of haemarthroses and use of the coagulation factor and improvement in articular motility. Adverse-effects occurrence was considered too. Early and late scintigraphic studies were performed after synoviorthesis and no joint immobilization was recommended. The reduction in haemarthrosis and use of coagulation factor were: group 1--31.3% and 25%; group 2--81.5% and 79% with P < 0.001 respectively; no significant improvement in knees motility was noted for both groups. Four cases of mild reactional synovitis were observed in each group. The scintigraphic control showed homogenous distribution of the radiopharmaceuticals with no articular escape; the material was considered safe by its permanence in the articulation. We have significant improvement in the synovectomy of haemophilic knees with 740 MBq of (153) Sm-HA; the less penetration of its beta radiation was compensated by the increased biological effect with the higher used activity.

Clinical evaluation after 1 year of 153-samarium hydroxyapatite synovectomy in patients with haemophilic arthropathy.

The aim is to evaluate the efficiency of the treatment with 153-samarium hydroxyapatite (153-Sm-HA) in haemophilic arthropathy. Thirty-one patients (30 males) with ages ranging from 8 to 34 years (average age = 20.6 years) were treated with fixed intra-articular dose of 185 MBq (5 mCi) and divided into two groups: infantile-juvenile (13 patients with up to 18 years of age, an average age of 12.7 years and arthropathy evolution of 7.8 years), and adult (18 patients older than 18 years, an average age of 24 years and arthropathy evolution of 18.7 years). The clinical evaluation before and after 1 year of synovectomy used the following criteria: subjective (pain through visual scale, articulation inspection), objective (articular movement through flexion level, sensitivity to palpation and leakage through joint circumference), reduction on the use of the coagulation factor, number of haemarthrosis, and the occurrence of adverse effects. The results were classified as: 1, good (remission from 70% to 100% of manifestations); 2, moderate (remission from 40% to 69%); and 3, poor (remission from 0% to 39%). Seventy-eight joints were tested: 15 knees, 36 elbows, 24 ankles, 1 shoulder and 2 hips. Early scintigraphic (1-2 h) and late scintigraphic (24-72 h) studies were performed after synoviorthesis. The cost of the procedure per joint was also estimated. No significant difference in the synoviorthesis result between groups was observed. The results were good for 75% of elbows, 87.5% of ankles and 40% of knees; the reduction in haemarthrosis and use of the coagulation factor was respectively 78% and 80% for elbows, 82% and 85% for ankles and 30% and 35% for knees. Four cases of reactional synovitis were observed in the 31 patients. The scintigraphic control showed homogeneous distribution of the material with no articular escape. The use of 153 Sm-HA in the treatment of the haemophilic arthropathy is effective for intermediate-size joints (elbows and ankles), but less effective for knees. Moreover, this treatment presents an excellent safety profile and accessible cost.

Efficacy of synovectomy in haemophilic patients with 153Sm-hydroxyapatite

Introduction - We preconized the use of 153Sm-Hydroxyapatite (HYP) in the synoviorthesis of haemophilic patients (pts) by physical, chemical and biological characteristics. The real efficacy is beeing confirmed by the actual experience over the previous results. These are the first results with 153Sm-HYP in our literature review. Material and Methods - Fiftheen pts. were treated, all males, with ages between 15 and 31 years (average = 22,8 years old), with an intraarticular injection of 185MBq (5mCi) of 153Sm-HYP, totalizing 29 joints: 12 knees, 11 elbows, 4 ankles and 2 shoulders. The 153Sm, produced by IPEN/CNEN - São Paulo, targeted hydroxyapatite particles with a diameter between 1-10µm, radiochemical purity superior to 95 percent and stability of 96,6 percent 1440min after the labeling process. The intraarticular punction was made after local antiseptic, aspirating synovial fluid, injecting 0,5 ml of radioactive solution and flushing the tract with a saline with a total volume no greater than 1,5 ml. The images were obtained 2 and 24h after injection in all pts in a large field of view gamma-camera. The clinical evaluation was made before and one year after it, using objective (range of motion, joint tenderness, degree of joint effusion) and subjective criteria (joint pain by visual scale and joint aspect). The response were graded: 1 - Excellent (E); 2 - Good (G); 3 - Mild (M); 4 - Bad (B); 5 - Worse (W). The reduction in clotting factor use and heamarthroses were others aspects evaluated. Results - The scintigrafies showed homogeneous distribution of the material in joints (2h) and no articular scape (24h). The was a reduction of 34 percent in the clotting factor use and of 51,4 percent in haemarthroses including the poor responses in knees. The results by patients were: 53,3 percent E, 20 percent G, 13,3 percent M, 13,3 percent B, 0 percent W and by joints were 47,75 with excellent and good responses and 84,75 percent when included the mild group. The...

One-year follow-up of Graves' disease treatment by four different protocols of radioiodine administration.

BACKGROUND: Studies have been performed in order to assess a treatment with 131I able to induce a consistent improvement in Graves' hyperthyroidism. EXPERIMENTAL DESIGN: For this purpose, four different protocols based on four different doses of radioiodine have been tested in Graves' disease patients. Patients never submitted previously to antithyroid drug treatment were given 1 mCi/10 gm of the estimated thyroid weight (group I; n = 50). Group II (n = 48) included patients not previously treated with antithyroid drugs and who were given doses of iodine based on a formula taking into account the rate of thyroid iodine uptake, i.e. 131I dose = microCi/gm of the estimated thyroid weight x 100/24 hrs 131I uptake (%). Patients previously submitted to antithyroid drug therapy were treated with radioiodine whose dose was calculated according to the formula reported above, but the dose was increased in order to overcome the possible resistance of this kind of patients to the effect of 131I. One group (group III; n = 24) received the calculated dose plus 1 microCi/gm of the estimated thyroid weight. Finally, group IV (n = 27) received the calculated dose plus 0.25 microCi/gm of the estimated thyroid weight. RESULTS: The analysis of the patients one year later demonstrated that groups I and II presented the higher percent of euthyroid patients (60% and 58%, respectively) followed by group IV (37%) and group III (29.2%). The percent of patients still exhibiting hyperthyroidism was 28% in group I, 26% in group IV, 12.5% in group III and 8.3% in group II. The highest number of hypothyroid patients was present in group III (58.3%) followed by group IV (37%), group II (33.3%) and group I (12%). CONCLUSIONS: The data here presented suggest that protocols I and II based on relatively low doses of radioiodine are rather effective in reducing Graves' hyperthyroidism in patients not submitted previously to antithyroid drug therapy. The most satisfactory therapy seems that utilized in protocol II, that in front of a fair amount of euthyroid patients (58.3%) presents a very low number of subjects still hyperthyroid (8.3%). However, the number of patients who became hypothyroid (33.3%) as a consequence of the therapy was too high. Hopefully, a better design of the protocol will reduce this figure. The high incidence of hyperthyroidism observed in groups III and IV submitted to a therapy with 131I doses consistently higher than those utilized in groups I and II seems to confirm the hypothesis that hyperthyroid subjects submitted to a therapy with antithyroid drugs become rather resistant to a radioiodine treatment.

Utilidade do 67 Ga na febre reumática: dados preliminares / Usefullness of 67 Ga in rheumatic fever: preliminary data

Foram estudados retrospectivamente 18 pacientes com febrereumática (FR), sendo 9 do sexo masculino, com idade média de 14,1 anos, tendo 16 cardite, 1 coréia e 1 FR sem cardite, sob regime de internamento hospitalar, com avaliaçäo clínica, laboratorial, radiológica, eletrocardiográfica e cintilográfica (67-Ga) extensiva. Dos 16 casos de cardite, 5 correspondiam ao 1§ surto da FR, 7 à recorrência e 4 à doença inativa. Os pacientes foram divididos em dois grupos: a) tratados clincamente, b) tratados cirurgicamente. No primeiro grupo de 13 pacientes (11 com cardite) efetuou-se correlaçäo clínica, eletro, eco e cintilográfica que resultou concordante, tendo 6 casos provas reumáticas negativas. No 2§ grupo (5 pacientes) a correlaçäo clínico-cintilográfico-histológica foi concordante em 4 e discordante em 1 (cuja intervençäo ocorreu 2,5 meses após estudo com 67-Ga). Houve acompanhamento terapêutico em 6 pacientes coincidindo a evoluçäo clínica com imagens de 67-Ga em todos, embora as provas reumáticas fossem negativas em 3. Estes resultados sugerem que os estudo com 67-Ga sejam úteis para caracterizar atividade de cardite reumática, como elemento de acompanhamento terapêutico e definir sua inatividade nos casos cirúrgicos

[Gallium-67 in rheumatic fever: preliminary report]. / Gálio67 na febre reumática: experiência preliminar.

PURPOSE: To validate the importance of 67Ga imaging to diagnose activity in rheumatic fever carditis and in the follow-up of treated patients with the disease. PATIENTS AND METHODS: Thirty patients with rheumatic fever were studied. Fifteen males and 15 females aged 7 to 39 years old (median 16 years), were submitted to 67Ga imaging. The patients were divided into two groups: GA--20 patients who received only clinical treatment and GB--11 patients (one from group A) submitted to surgical biopsy. In 12 patients from GA, sequential 67Ga imaging were also realized for the therapeutic follow-up. Fifty-five 67Ga images were reviewed subjectively by experienced observers and a semi-quantitative analysis processed in a dedicated computer was performed with ROI's of 10 x 20 pixels over the projection of the heart and right lung in 22 negative and 33 positive studies. RESULTS: Group A--In 19 patients (95%) the 67Ga uptake matched with the clinical evidence, EGC and echocardiogram results. In one patient (5.0%) the 67Ga study was negative, but there were clinical and EKG evidence of activity of the disease; from these data this case was then considered as false negative. Group B--In 11 patients submitted to surgical biopsy, the clinical-scintigraphic-histologic correlation matched in 10 cases and mismatched in one. The semi-quantitative analysis of the 67Ga uptake with ROI's over the topography of the heart and right lung showed an percentage index heart x right lung of 114.5 +/- 17.5% (2 s.d.) in normals and 158 +/- 30% (2 s.d.) in patients with active carditis: these data had value in the therapeutic follow-up of 12 patients from GA, where occurred good correlation, in every case, of the 67Ga uptake index and clinical evolution and EKG findings. CONCLUSION: The 67Ga imaging is a non invasive diagnostic method with a good sensitivity to the diagnosis of activity in rheumatic carditis, to evaluate the therapeutic results and to define inactivity for surgical cases.

67-Ga na blastomicose: nossa experiência / 67-Ga in blastomycosis: our experience

O estudo de imagens com 67-Ga foi realizado em 14 pacientes (8 tratados e 6 virgens de tratamento) com blastomicose sul-americana (paracoccidioidomicose) confirmada pela histologia. Todos os pacientes eram masculimos, com idades entre 20 e 68 anos, com evoluçäo de doença entre 2 meses e 18 anos. A avaliaçäo sorologica foi efetuada foi em 12 pacientes. As imagens com 67-Ga foram correlacionadas com o estudo radiologico em todos eles e mostraram evidencias de lesöes näo suspeitadas pelo exame clínico ou näo mostradas pela radiologia em nove casos: parótidas em 4 casos; testículos em 2; ossos em 1; gânglio mediastinal em 1 e gânglio cervicalmediano profundo ( que causou obstruçäo do ducto toraxixo) em outro. Em contrapartida, 2 casos com lesöes clinicamente evidentes no tegumento näo foram mostrados no estudo com Ga-67. No acompanhamento após tratamento especifico em 4 pacientes, houve concordância entre os estudos radiologicos ecom 67-Ga enquanto a sorologia continuava positiva. Esta avaliaçäo inicial demonstrou que as imagens com 67-Ga säo úteis na detecçäo de lesöes suspeitas e, nas insuspeitas da blastomicose, bem como para avaliar a resposta de doença ao tratamento especifico.