Thyroid Peroxidase Antibodies in Non-Autoimmune Hyperthyroidism Treated with Radioactive Iodine.

Introduction: Earlier studies suggest increased serum levels of thyroid peroxidase antibodies (TPOAb) in some cases with non-autoimmune hyperthyroidism. The aim of the study was to assess the incidence of hypothyroidism in patients with nodular toxic goitre and toxic adenoma at 12 months after radioactive iodine therapy in the relation to TPOAb levels. Patients & Measurements: The study comprised 100 patients (83 females; 17 males) treated with radioactive iodine therapy. Serum concentrations of thyrotropin, free thyroxin, TPOAb, and anti-TSH receptor antibodies were assessed at baseline and 12 months after radioactive iodine therapy. Results: High TPOAb level (>60.0 IU/mL) was found in 27% of patients at baseline and 32% at the follow-up. Baseline TPOAb values were higher in subjects with coexisting non-thyroid autoimmune disease (p=0.041). After radioactive iodine therapy, the mean TPOAb level increased in patients with normal baseline TPOAb (p=0.03) and the rates of euthyroidism and hypothyroidism were 61 and 34%, respectively. The rate of hypothyroidism after radioactive iodine therapy was not significantly different in groups with normal and high baseline TPOAb. Conclusions: 27% of patients with non-autoimmune hyperthyroidism were positive for TPOAb. However, baseline TPOAb level did not influence the rate of hypothyroidism at 12 months after radioactive iodine therapy. Our results suggest a more close surveillance after radioactive iodine therapy of patients harboring these antibodies.

The penetration of topically applied ointment containing hyaluronic acid in rabbit tissues.

The properties of hyaluronic acid used for treatment of acute and chronic joint disease are known for many years and this compound is widely used both in humans and animals. To obtain a therapeutic effect of a certain drug, the appropriate concentration in the target organ or tissue is important. The application of labeled compounds is one of the frequently applied techniques to estimate drug penetration into the skin and other body tissues or organs. The aim of the study was to evaluate the penetration of hyaluronic acid labeled with I-131 through the skin and its distribution within the knee joint and other internal organs in rabbits after a topical application of an ointment containing hyaluronic acid. The experiment was performed on 22 albino rabbits divided into control and examined groups. Fifteen rabbits were exposed to the multicomponent ointment containing hyaluronic acid labeled with I-131. Time of exposure was 48 hours. Hyaluronate penetrated to a high degree into the examined tissues. No significant differences in terms of leg tissue activity were observed between a leg tissue exposed to labeled ointment and that unexposed, suggesting that after topical administration, the active component of the ointment is delivered to the joint via the blood stream. Hyaluronate applied topically penetrates through the skin into the rabbit tissues and organs and into the joint fluid of both legs (exposed and not exposed). This route of administration seems to be useful for this drug delivery and allows to avoid unnecessary side effects.

Long-term monitoring of radiation exposure of employees in the department of nuclear medicine (Szczecin, Poland) in the years 1991-2007.

Occupational radiation exposure is a hazard that should be avoided or at least minimised. This study aimed to evaluate the radiation exposure of nuclear medicine department employees monitored during the 1991-2007 period, and to investigate the relationship between the annual effective doses of the personnel and the number of radioisotope procedures performed. Overall, 2014 quarterly effective whole-body doses, categorised into six occupational groups, monitored with personal dosemeters, were analysed statistically. There was a wide variation in the average annual doses among the different occupational groups. During the 17 years covered by this study, there was no incidence of a dose exceeding the annual dose limit of 20 mSv. There was a weak correlation between the average annual dose for monitored employees and the number of nuclear medicine procedures performed. Apart from exposure, personal skill in dealing with radioactive substances, compliance with radiation protection rules is an important factor to minimise the effective dose.

Cytogenetic and array-CGH characterization of a complex de novo rearrangement involving duplication and deletion of 9p and clinical findings in a 4-month-old female.

Approximately 15 patients with partial trisomy 9p involving de novo duplications have been previously described. Here, we present clinical, cytogenetic, FISH and aCGH findings in a patient with a de novo complex rearrangement in the short arm of chromosome 9 involving an inverted duplication at 9p24-->p21.3 and a deletion at 9pter-->p24.2. FISH probes generated from BACs selected from the UCSC genome browser were utilized to verify this rearrangement. It is likely that some previously described duplications of 9p may also be products of complex chromosomal aberrations. This report in which FISH and aCGH were used to more comprehensively characterize the genomic rearrangement in a patient with clinical manifestations of 9p duplication syndrome underscores the importance of further characterizing cytogenetically detected rearrangements.

Myocardial and coronary sinus purines as indicators of pig heart energy metabolism during reperfusion after extracorporeal circulation.

AIM: The precise understanding of myocardial metabolism is crucial for the optimization of cardiosurgical procedures. We attempted to gain a comprehensive insight into the purine metabolism of the porcine heart during reperfusion by measuring concentrations of nucleotides, nucleosides and oxypurines simultaneously in the myocardium and coronary sinus. METHODS: Twenty-five pigs were subjected to sham cardiosurgery with extracorporeal circulation and cold cardioplegic arrest of 60 min. Myocardial biopsies, as well as coronary sinus and arterial blood samples were taken before aortic clamping and at 5, 20, 60 and 120 min of reperfusion. HPLC was used to measure concentrations of 17 purines in the bioptates and of 5 in plasma. RESULTS: Reperfusion rapidly normalized the ischaemic decrease in the adenylate energy charge of the myocardium, but during 120 min failed to restore the reduced adenylate pool, because of irreversible loss of nucleosides by cardiomyocytes. Low adenylate energy charge and depletion of the adenylate pool were accompanied by analogous changes in the guanylates and growing deficit of NAD and NADP. Reperfusion was marked by significant release of inosine and guanosine from the heart, without any noticeable effect on hypoxanthine and xanthine. CONCLUSIONS: Coronary sinus concentrations of purines provide only a limited insight into the metabolism of the porcine heart. Repeated biopsies of the heart muscle and HPLC determinations of purine profiles represent a comprehensive and unique method for the study of purine metabolism during ischaemia and reperfusion. Future research on myocardial metabolism in disease and during cardiosurgical procedures should additionally be oriented to deficits in guanine and pyridine nucleotides.

[An influence of cardiovascular risk factors and pharmacotherapy on the long-term results in women undergoing coronary artery bypass]. / Analiza wplywu czynników ryzyka i leczenia farmakologicznego na odlegle wyniki pomostowania tetnic wiencowych u kobiet.

This study aimed at analysing an effect of the coronary risk factors and pharmacotherapy on the long-term outcome in women following the coronary artery by-pass. In 1004-1997, 253 female patients, aged between 33 and 82 years (mean [+/- SD] 57.0 +/- 8 years) were treated surgically. The follow-up period lasted for 7 to 60 months (mean 32.0 +/- 14 months). Ten patients (3.9%) died. Answers to the questionnaire and personal interviews assessed physical fitness based on CCS classification, pharmacotherapy, and presence of risk factors. According to CCS scale, significant improvement has been seen in 195 (82.6%; p < .0001) patients. Health state did not change in 34 (14.4%) patients, and deteriorated in 7 (3.0%). Analysisn coronary risk factors, hypertension proved prevailing (60.3%), followed by diabetes mellitus (25.5%) and obesity (22.9%). Eleven percent of patients returned to cigarettes smoking after surgery. Postoperatively, 74.1% of patients received nitrates as a constant, medication, 58.2%--beta-blockers, 53.4%--ACE inhibitors, and 19.8% of patients received calcium antagonists. Lipid abnormalities have been treated in 49.1% of patients whereas antiplatelet therapy has been carried out in 74.1%. Only 9.9% of patients received hormones. The lower CCS class before surgery, the more significant improvement after it. As pharmacotherapy was used according to the European guidelines, an improvement in the long-term outcome required some modifications in patients' life style.

[Analysis of factors affecting treatment results for toxic goiter with radioactive 131I]. / Analiza czynników wplywajacych na wynik leczenia wola wieloguzkowego toksycznego jodem radioaktywnym 131I.

UNLABELLED: The aims of the study were to estimate the optimal dose (Gy) absorbed by pathological tissue and to establish factors influencing the results of treatment of hyperthyroidism. Data from 188 patients who underwent treatment with 131I between July 1991 and July 1994 were retrospectively analyzed. Thyroid status was examined after 1, 2.5, 6, 12, and 24 months. Following a thyroid scan, the whole group was divided into two subgroups: 72 cases of multifocal autonomy and 116 cases of solitary autonomous adenoma. The planimetric phantom for the whole thyroid or for nodules only was respectively used for unification of scintigraphic data. Administered dose (MBq) was converted into absorbed dose according to the Marinelli formula. The absorbed dose ranged between 11 and 1250 Gy (mean = 290 Gy). The results of treatment confirmed with laboratory tests were correlated with the absorbed dose, initial thyroid or nodular volume, initial level of free thyroxine, age, sex, and presence in the scintigram of active extranodular tissue. Two years after administration of radioiodine, 45 out of 72 patients with multifocal autonomy (62.5%) had normal thyroid status, 5 (6.9%) were hypothyroid and 22 (30.6%) remained hyperthyroid. For the group of 116 patients with solitary autonomous adenoma the respective result was 84 (72.4%), 16 (13.8%) and 16 (13.8%). When the absorbed dose in multifocal autonomy was less than 250 Gy the respective result was 27 (52.9%), 2 (3.9%), and 22 (43.1%). For a dose of 250 Gy or more the result was 18 (85.7%) patients with normal thyroid status, 3 (14.3%) hypothyroid, and none hyperthyroid (Tab. 2). The differences were statistically significant (p < 0.001). In the subgroup with solitary autonomous adenoma, for an absorbed dose of less than 350 Gy, 60 (71.5%) patients had normal thyroid status, 8 (9.5%) were hypothyroid, and 16 (19%) remained hyperthyroid. For a dose of 350 Gy or more, 24 (75%) patients had normal thyroid status, 8 (25%) were hypothyroid and none remained hyperthyroid (Tab. 3). The differences were statistically significant (p < 0.00025). The relationship between persistence of hyperthyroidism and thyroid (or nodular) volume or level of free thyroxine was directly proportional (p < 0.000001 and p < 0.00006). Superior results were obtained when the dose of radioiodine was calculated relative to the nodular rather than thyroid volume (p < 0.002). There was no correlation with active extranodular tissue, age or sex. CONCLUSIONS: 1. Treatment with radioiodine is a safe method offering good clinical results in 90% of patients. 2. The more accurate is the calculated dose, the better and faster is the result. 3. The optimal absorbed dose for multifocal autonomy is 250 Gy. 4. The optimal absorbed dose for solitary toxic adenoma is 350 Gy. 5. The greater is the thyroid or nodule volume and level of free thyroxine, the greater is the probability of persistent hyperthyroidism. 6. In case of persistent hyperthyroidism an additional radioiodine dose is recommended after six months. 7. Age, sex and presence of active extranodular tissue have no influence on the results of treatment.

[A case of centroblastic lymphoma of the thyroid gland]. / Przypadek chloniaka centroblastycznego tarczycy.

A case of a 49-year male patient with centroblastic lymphoma of the thyroid gland is presented. Centroblastic lymphoma was diagnosed with cytological and immunocytochemical examination of the biopsy specimen, and verified with histological examination of tumor section collector intraoperationally. Diagnosed tumor was classified as II AE degree. No signs of lymphocytic thyroiditis co-existing with centroblastic lymphoma were noted. The patient was treated chemically with CBVPM/AVBP regimens for 8 months. Complete remission still lasting, i.e. 96 months after completion of chemotherapy, was achieved.

Asymptotic parathyroid cyst--diagnostic difficulties (a case report).

The case of a 70-year-old female with asymptotic parathyroid cyst is presented. It was not possible to make a proper diagnosis preoperatively. The correct diagnosis was based on the result of the postoperative microscopic examination of the resected tissues. The diagnostic difficulties are discussed.

[Scintigraphic method in the quantification of morphological and functional changes of thyroid autonomy before and after iodine radiotherapy]. / Szintigraphisches Verfahren zur Quantifizierung der morphologischen und funktionellen Veränderungen der thyreoidalen Autonomie vor und nach Radiojodtherapie.

The regional excess of function and cell mass in potentially "toxic" thyroid areas with nonimmunogenic hyperthyroidism (NIH) (unifocal [UFA, previously "toxic adenoma"] and multifocal functional autonomies [MFA or "toxic goiter"]) are quantified by an enhanced diagnostic method: double isotope subtraction scintigraphy (Ssc) with radioiodine and 99mTc-MIBI. In 125 patients, a toxicity index T was derived from the Ssc (*J-*MIBI), and a cell density index Q from the *MIBI image. The median value of T, as an expression of the regional autonomous excess function (165 in UFA, 15 in MFA), by far exceeded the median value of Q (3.8 in UFA, 2.0 in MFA). The significant (p < 0.001) effects of radioiodine therapy (RIT) were monitored by the changes towards normalization of T and Q in 53 patients in follow-ups 3 and 9 months thereafter. Our aim was (a) to extend the conventional field of measurement of NIH-hyperthyroidism with the scintigraphically quantified function and morphology, and (b) to compare the return to euthyroid state with scintigraphic scarification of the functionally autonomous areas.

[Evaluation of reoperation results in patients after heart valve bioprosthesis implantation failure due to degeneration]. / Ocena wyników reoperacji u chorych po wszczepieniu bioprotez zastawek serca z powodu ich dysfunkcji spowodowanej zwyrodnieniem.

UNLABELLED: A retrospective study was conducted on 17 patients (11 female and 6 male) who underwent re-replacement of previously implanted bioprosthesis for it's structural failure in the period from 1989 until 1997. 1 of the patients was in NYHA class II, 7 in III and 9 in IV. There were 18 mechanical prostheses and 4 bioprostheses implanted during the reoperations. On 1 patient the procedure described by Geha was performed (the leaflets of damaged valve were excised and a reversed aortic St. Jude prosthesis was implanted). In almost all cases the postoperative period was complicated. There were 2 (11%) postoperative deaths. CONCLUSIONS: 1. The dysfunction of bioprosthesis is most often caused by leaflet calcification and thickening. Degeneration is faster in prostheses implanted in the mitral position. 2. The outcomes of the re-replacements are similar to those of the patients in the corresponding NYHA class after first replacement but the postoperative period may be more complicated. 3. The low prevalence of reoperation affirms the suitability of the bioprosthesis for selected patients over 65 years and for aortic valve replacement.

Separation of autonomous function from cell density in non-immunogenic hyperthyroidism--II. quantified comparison before and after radioiodine therapy.

Regional autonomous cell mass (Q: cell density ratio) and function (T: toxicity index) were compared by double isotope parametric thyroid scintigraphy (Als et al., Nucl. Med. 1995; 34) in 53 patients with non-immunogenic hyperthyroidism before and after radioiodine therapy (aRIT) and showed a break-down (medians) of Q: 4.3-->1.0 (toxic adenomas: TA), 2-->1.1 (multifocal functional autonomies: MFA)(p < 0.0001) as of T: 96-->1.7 (TA), 15-->1.1 (MFA) (p < 0.001). Five functional aRIT patterns resulted: euthyroidism (n = 37, 70%), at half with scarred/non-scarred autonomous areas (low/higher T, respectively), primary hypothyroidism (n = 4), residual hyperthyroidism (n = 7), secondary hyperthyroidism (n = 5). The last two groups with persistent subnormal TSH values were clearly separated by divergent T, thyroxine and triiodothyronine levels. A resulting T > 1 may represent a clinically sub-critical mass of residual autonomous tissue. This new technique facilitates individual pretherapeutic evaluations and aRIT quality control.

Immunogenic and non-immunogenic hyperthyroidism. Recent trends in prealpine Switzerland and in coastal Poland.

Annual occurrences of immunogenic (IH) and non-immunogenic hyperthyroidism (NIH) between Berne (1976, 1982, 1991) and Szczecin (1973, 1980, 1991) were compared. Out of 21,025 patients referred for thyroid examinations, 10.1% (average) were hyperthyroid. In Berne (former endemic goiter region) and Szczecin (without goiter endemicity) IH occurred in 41% and 68%, NIH in 59% and 32% of hyperthyroid patients, respectively. Within a stable incidence of NIH in Berne, toxic adenomas (TA) decreased from 41% (1976) to 17% (1991) (p < 0.005). In Szczecin, where iodine deficiency is in an early stage, the TA frequency did not change significantly: from 24% (1973) to 28% (1991). Increases of TA or of multifocal functional autonomy apparently "mark" incipient or, respectively, decreasing deficiencies in nutritious iodine. Hyperthyroid patients in Berne compared to Szczecin were older, both with IH (54 versus 45 y) and NIH (65 versus 52 y). Age at diagnosis was stable in Berne but increasing (p < 0.05) in Szczecin (from 43 to 52 y).

[Long-term results of aorto-iliac occlusive disease treatment with implantation of the Polish vascular prosthesis]. / Odlegle wyniki leczenia miazdzycy tetnic odcinka aortalno-biodrowego wszczepieniem polskiej protezy naczyniowej.

The author analyses distant results of the Polish vascular prostheses implantation to 227 patients with aorto-iliac occlusive disease. Eighty two (29.6%) patients died within 5 years following the operation. Therefore, an analysis of the distant results of therapy included 145 patients. An excellent result was achieved in 20.7% of the treated patients, satisfactory result in 53.9%, no improvement or worsening in 20.7% of cases. Statistically significant relationship between the degree of pre-operative ischemia and outcome of surgery has been noted. Considering blood hypertension, diabetes mellitus, obesity, hypercholesterolemia, and tobacco smoking prior to and after surgery as risk factors, no statistically significant relationship between the distant result of the treatment and the number of risk factor in a single patient has been observed.

[Effectiveness of iodine prophylaxis and frequency of thyroid enlargement (thyroid goiter) and clinical diagnosis of thyroid diseases in inhabitants of the Szczecin region after the Czernobyl accident]. / Efektywnosc profilaktyki jodowej oraz czestosc wystepowania powiekszenia tarczycy (wola) i klinicznego rozpoznania chorób tarczycy u mieszkanców regionu szczecinskiego po awarii elektrowni atomowej w Czarnobylu.

The study, supported by program MZ-XVII, was carried on 4567 inhabitants of the area of Szczecin (2350 females and 2217 males). The population was chosen randomly, according to a simple drawing scheme. All subjects were clinically examined using standardised questionnaires. In 3468 persons (including 1807 girls and women, 1661 boys and men) apart form clinical examination, the assessment of thyrotropin, thyroxine and triiodothyronine in serum and frequency of antithyroglobulin antibodies and antithyroid membrane antibodies were evaluated. The data indicate that 94% of children in Szczecin's region received the prophylactic dose of iodine, mostly between the 1st and the 5th of May 1986. Only 17% of the adults received iodine. The most common preparation was Lugol solution given in a single dose. Among all persons who received iodine, only in 5% of subjects the side effects were noted (mostly in children), including symptoms of gastrointestinal tract (vomiting, abdomen pain) and occasionally intrathyroid side effects (thyroid pains). In examined population the high frequency of thyroid enlargement, mainly in women (up to 43-44% at the age group 30-50 years) was found. The frequency of clinical diagnosis of thyroid disease was higher in women than in man (most often the diffuse goiter, rarely the nodular goiter). The frequency of thyroid enlargement and clinical diagnosis of thyroid disease was not dependent on prophylactic iodine intake. The iodine prophylaxis did not influence on thyroid hormones and TSH serum levels and on frequency of antithyroid antibodies.

[Study of the late results of reimplantation of heart valve prostheses based on 15-year experience]. / Odlegle wyniki reoperacji protez zastawkowych na podstawie 15-letnich doswiadczen.

Authors studied two groups of patients, in which a cardiac valvular prosthesis was reimplanted within 15 years. Data of patients reoperated on (group A) were used to estimate indications, surgical methods, postoperative course and late results. Data of patients which underwent surgery and then requiring reoperation (group B) were used to evaluate the percentage of reoperation falling to 1 patient/1 year according to a primary implanted valvular prosthesis: 42 patients were divided into two groups. 3 perioperative and 12 late deaths (totally 28.3%) were stated in the group A. 5- and 10-year survival rates were 83.3% and 65.6%, respectively. In the group B the lowest percentage of reoperation (1 patient/1 year) were stated in patients with mitral Starr-Edwards 6120 valve (029) and Björk-Shiley aortic valve (0.13). The highest percentage of reoperation was observed in patients with biological prosthetic valves (homograft or heterograft--4.64) and in comparison with patients with primary implanted mechanical prostheses (0.24). Those differences were statistically significant (p less than 0.001).