Therapeutic 131I in outpatients: a simplified method conforming to the Code of Federal Regulations, title 10, part 35.75.

UNLABELLED: The Code of Federal Regulations, title 10, part 35.75 (10CFR35.75), provides greater latitude and flexibility in the dosing and management of outpatients treated with therapeutic 131I than did preceding regulations. Prescribing physicians should consider applying these new regulations to enhance patient convenience and lower the cost of managing appropriate outpatients. Managed care organizations and third-party payers may require that all eligible patients be treated as outpatients or that justification for hospital admission be specifically documented. To facilitate application of the code and guidelines, maximum 131I doses for patients undergoing thyroid remnant ablation, therapy for metastatic or recurrent thyroid cancer, or therapy for hyperthyroidism have been calculated and summarized in tables. METHODS: A model was developed that calculates the maximum dose of 131I that may be dispensed to an outpatient. This model complies with 10CFR35.75. The maximum dose is calculated as a function of 5 variables: the occupancy factors for 3 periods after dose administration, the fractional uptake of 131I by residual thyroid tissue or metastasis, and the duration of constrained activity. Occupancy factor, a key new concept in the regulatory guidelines, is a physician estimate of the time that a treated patient will be near the individual with whom the patient will spend the most time after treatment. The model also considers 3 constants: the effective half-life of 131I during the preequilibrium period, and the effective half-lives of 131I in both the thyroidal component and the extrathyroidal component during the equilibrium period. Tables for maximum allowable patient 131I doses were derived on the basis of this model. RESULTS: Through dosing charts, maximum 131I therapy doses may easily be calculated. Most outpatients undergoing thyroid remnant ablation, therapy for metastatic or recurrent thyroid cancer, or therapy for hyperthyroidism may be treated with 7400 MBq (200 mCi) 131I or more. CONCLUSION: If the prescribing physician understands the concept of occupancy factor and how to use the dosing charts, our model facilitates application of and adherence to 10CFR35.75.

Permanent iatrogenic vocal cord paralysis after I-131 therapy: a case report and literature review.

A patient who underwent I-131 therapy for a solitary toxic thyroid nodule subsequently experienced vocal cord paralysis, a rare complication. The patient was examined because of hoarseness 1 week after treatment. Indirect laryngoscopy at the time confirmed right vocal cord paralysis. When the examination was repeated in 6 months, no improvement was noted; vocal cord paralysis was then declared permanent. Surprisingly, 11 months after the onset of symptoms, the patient observed improvement in her voice. At 14 months, she experienced complete vocal recovery. However, a computed tomography performed after this showed that her right vocal cord paralysis was unresolved. The apparent complete recovery of her voice is believed to be a result of adaptive compensatory mechanisms. Patients who recover from hoarseness after injury to the recurrent laryngeal nerve should have cord function documented by indirect laryngoscopy or other means before the physician performs a procedure that could harm the contralateral nerve, because damage to this nerve could result in devastating consequences.

The Chicago Asthma Consortium: a community coalition targeting reductions in asthma morbidity.

The problem of asthma in Chicago remains a complex one, and it is too early to know whether any programs and efforts have had a discernible effect, but the Chicago Asthma Consortium continues to expand its membership and to define its mission. The successes have come from harnessing the passion of the individual members to move the projects forward. As the focus of the consortium moves to addressing system-wide problems in asthma care and the delivery of that care, the consortium is undertaking the construction of a guide for future efforts. In this way, the consortium will fulfill its vision of creating a comprehensive, community-wide plan for the management of asthma, impacting on the unacceptable current levels of morbidity and mortality of the disease.

Chicago community-based asthma intervention trial: feasibility of delivering peer education in an inner-city population.

The most effective means of educating children with asthma and their families has not been clearly demonstrated in previous studies. Peer education is uniquely suited to the complex problems encountered in underserved populations. The purpose of this study was to show the feasibility of delivering a peer education program for children with asthma and the effect of the program on indoor allergen levels in an inner-city population in Chicago. Overall, the program was well received. Baseline allergen levels were consistent with some previous studies in showing low levels of mite allergens and high levels of cockroach allergens, with 79.6% of samples having levels > 8 U/g. A total of 28.2% of samples had cat allergen levels > 2 microg/g, although only 9.7% of homes had cats, confirming previous reports that cat allergen is ubiquitous. Mold levels were seasonal, with the highest levels in the summer. Results from this study suggest that intervention programs should focus more on elimination of cockroaches than was previously appreciated, while minimizing the use of pesticides, and on identification of the sources of cat allergen. Structural and psychosocial issues in homes need to be addressed in future studies. This study has demonstrated the feasibility of delivering peer education in a inner-city population and highlighted the need for comprehensive intervention strategies addressing complex issues facing underserved neighborhoods.

Validation of the Brief Pediatric Asthma Screen.

STUDY OBJECTIVES: The purpose of this study was to confirm the validity of a brief screen for pediatric asthma in schools. BACKGROUND: Asthma is the most common chronic disease of childhood, yet the frequency with which this condition is recognized among school-aged children varies widely. Several methods are used to increase the accuracy of detection of asthma, but many are cumbersome and difficult to apply on a large scale. DESIGN: We elected to validate a five-question instrument, the Brief Pediatric Asthma Screen (BPAS), to screen for the presence of asthma among children attending school in Region 5 of the Chicago school district, where the schools report a 2.7% frequency of asthma. The questionnaire was distributed to the parents of grade-school children at the time of report-card pick-up. SETTING: A clinical assessment was performed on a selected group of children whose parents completed the questionnaire in a school and in a hospital outpatient clinic. PARTICIPANTS: Of 4,147 questionnaires that we distributed, 1,796 (43%) were returned. We excluded 341 children (19% of the total sample) whose parents reported that they had been diagnosed with asthma. The remaining pool indicated that the children of 183 responders (10%) had symptoms suggestive of asthma, while 1,272 parents (71%) indicated that their children did not have symptoms of asthma. MEASUREMENTS AND RESULTS: We selected 90 of the respondents who did not indicate that their children had a diagnosis of asthma. Of this group, 81 completed the validation, in which their responses suggested symptoms of asthma (n = 34) or no asthma symptoms (n = 47). The children of these respondents were given a blinded clinical evaluation consisting of history, physical examination, and spirometry. The survey demonstrated a sensitivity of 75% and a specificity of 81.2% for the presence of asthma among those who were unaware of the diagnosis. CONCLUSIONS: The BPAS is brief, can be filled out by parents, and appears accurate in detecting asthma.

False-positive result of a total-body scan caused by benign thyroidal tissue after I-131 ablation.

This case report illustrates a false-positive result of an I-131 total-body scan caused by abnormal, noncancerous thyroid tissue. A 39-year-old woman underwent an open biopsy and thyroidectomy for a papillary thyroid carcinoma. She was treated by ablation with 150.8 mCi I-131. A follow-up total-body scan revealed a solitary focus of increased activity near the midline at the upper border of the larynx that was subsequently excised. Histologic analysis indicated a fragment of thyroid tissue with chronic inflammation, fibrosis, and squamous metaplasia. No evidence of thyroid carcinoma was present. Hypofunctioning or nonfunctioning residual tissue within the thyroglossal duct may have been suppressed under euthyroid conditions, protecting it from ablation. This tissue may have become stimulated by the high thyroid-stimulating hormone levels, accumulating I-131 and producing a false-positive result of the scan.