[Treatment of solitary toxic thyroid nodules with the use of percutaneous ethanol injections]. / Leczenie pojedynczych nadczynnych guzków tarczycy przezskórnymi iniekcjami etanolu.

Twenty women aged 18-76 years (mean 42 +/- 23 years) with solitary benign toxic thyroid nodule were treated with intranodular percutaneous 96%-ethanol injection, performed under ultrasound guidance. 1 ml of ethanol was instilled per 1 cm3 of nodule tissue. 2-5 (mean 3.1) sessions were conducted every month. The early follow-up evaluation of the results (the evaluation of nodule size by means of clinical and ultrasound examination) was performed in 6 months, and the long-term one in 2 years after last injection. A morphological evaluation was conducted according to the following scale: 1--nodule disappearance, 2--cicatricial nodule (solid structure and less than 0.5 cm in diameter), 3--nodule smaller by [symbol: see text] 50% of its initial dimensions, 4--nodule smaller by < 50% of its initial dimensions. A functional evaluation was carried out according to the following scale: I--permanent euthyroidism, II--permanent decrease of hyperthyroidism, III--no functional effect. A final follow-up evaluation revealed: nodule disappearance in 2 (10%) patients (Group 1), cicatricial nodule in 8 (40%) patients (Group 2), nodules smaller by [symbol: see text] 50% of its initial dimensions in 2 (10%) patients (Group 3) and nodules smaller by < 50% of initial dimensions in 8 (40%) patients (Group 4). The results in Group 1 and 2 were defined as good (50%), in Group 3 as satisfactory (10%) and in Group 4 as bad; and I--permanent euthyroidism in 16 (80%) patients, II--permanent decrease of hyperthyroidism in 1 (5%) patient, III--no functional effect in 3 (15%) patients. 2 patients in whom new nodules appeared and 1 patient with bad morphological and no functional treatment effects were operated on. A histological examination revealed haemorrhagic necrosis surrounded by fibrous tissue in removed nodules. The following complications were observed: 1) pain during and after the injection in 15 (75%) patients, 2) subfebrile body temperature in 3 (15%) patients and fever up to 39 degrees C on the 1-st day after the injection in 1 (5%) patient, 3) local ecchymosis in 1 (5%) patient, 4) temporary dysphonia in 1 (5%) patient. It seems that percutaneous ethanol injection treatment can be an useful treatment method of solitary benign toxic thyroid nodules in patients who do not give their consent to surgical or 131I treatment or with contraindications to an operation or radioiodine therapy.

Pancreatic polypeptide secretion in diabetic patients with delayed gastric emptying and autonomic neuropathy.

Measuring postprandial pancreatic polypeptide (PP) plasma concentration is a sensitive method for autonomic nervous system assessment. Delayed gastric emptying (DGE) often does not correlate clearly with cardiac autonomic neuropathy (CAN). This study was conducted to evaluate whether decreased PP secretion (PPS) accompanies DGE and CAN in diabetes. Fourteen long-standing diabetics with DGE assessed by scintigraphy (group A), 14 well-matched diabetics with normal gastric emptying (NGE) (group B), and 12 healthy controls (group C) were the study subjects. CAN and postprandial PPS at 0, 30, and 60 min after test meal ingestion were examined in all the subjects, and the area under curve of PP secretion was calculated. There was no correlation between DGE and CAN (eight diabetics with CAN in A and six in B). Basal PP values were almost the same in all the patients (mean 77.27 +/- 11.0 pg/mL). The area under curve of PP secretion values (PPAUC) after test meal ingestion were significantly higher in B (211.84 +/- 36.13 pg/mL/h; p < 0.0001) and C (233.68 +/- 23.43 pg/mL/h; p < 0.00001) than in A (147.59 +/- 31.77 pg/mL/h). Diabetics with CAN had lower PPS expressed as PPAUC than those without CAN, which was independent of gastric emptying rate (152.31 +/- 37.18 versus 207.12 +/- 39.21 pg/mL/h; p < 0.001). There were no significant differences between test meal-stimulated PPAUC in diabetics without CAN (207.12 +/- 39.21 pg/mL/h) and controls (233.68 +/- 23.43 pg/mL/h), and this was also independent of gastric emptying rate. In patients with both DGE and CAN, the PPS was completely blunt (PPAUC 124.04 +/- 5.71 versus 233.68 +/- 23.43 pg/mL/h in controls; p < 0.001). The PPS in diabetics with CAN and NGE was significantly lower than in controls (PPAUC 190.0 +/- 37.45 versus 233.68 +/- 23.43 pg/mL/h; p < 0.01). In conclusion, the PPS in diabetics with CAN was decreased significantly and independently of DGE. The PP secretion was very low in diabetics with both CAN and DGE.

Evaluation of esophageal passage in selected connective tissue diseases.

The objective of this study was to determine whether, as in with other types of connective tissue diseases, there exists esophageal passage dysfunction as it exists in systemic scleroderma. It was also interesting to establish whether there is any correlation between this kind of dysfunction and the subjective complaints connected with the esophagus as well as the occurrence of Raynaud's phenomenon. Evaluation of the esophageal passage was performed on the basis of scintigraphic examination. The delay of esophageal passage occurs, besides systemic scleroderma, in other types of connective tissue diseases. This examination is a valuable test, thanks to which changes in the esophagus can be discovered, despite the lack of subjective complaints. In addition to systemic scleroderma, there is no close correlation between dysphagia and Raynaud's phenomenon.

Diagnostic value of 169Yb-cis-dichlorodimethionine platinum scintigraphy in patients with malignant lymphomas.

Ytterbium-169 (169Yb) cis-dichlorodimethionine platinum (169Yb-PtCl2Meth2) is a new agent of low toxicity with an affinity for neoplastic tumours. The aim of this study was to assess the diagnostic value of 169Yb-PtCl2Meth2 scintigraphy in patients with malignant lymphomas. 169Yb-PtCl2Meth2 scintigraphy was performed in 67 patients with histologically proven malignant lymphoma. Liver, spleen, kidney and bone were among the normal tissues that showed uptake of the radiopharmaceutical. The compound is excreted in the main through the urinary tract. There was no significant activity in the bowels. For evaluation of the images, uptake of activity was scored according to a 5-point scale. In total, 888 sites were evaluated. The sensitivity, specificity and accuracy of lymphoma detection for the body as a whole was 80, 89 and 87%, respectively. The best results were obtained for the head (sensitivity 91%, specificity 89%), neck (sensitivity 84%, specificity 90%) and chest (sensitivity 82%, specificity 84%). In the sub-diaphragmatic region, sensitivity and specificity were 76 and 84%, respectively. Scintigraphy with 169Yb-PtCl2Meth2 appears to be a sensitive, non-invasive procedure for the staging of malignant lymphomas. The results suggest that it is possible to monitor the therapy of malignant lymphoma by means of 169Yb-PtCl2Meth2 scanning.