Evaluation of radioiodine therapy in differentiated thyroid cancer subjects with elevated serum thyroglobulin and negative whole body scan using 131I with emphasize on the thallium scintigraphy in these subgroups.

OBJECTIVE: Negative diagnostic 131I whole body scans with elevated serum thyroglobulin (Tg) levels are found in 20% of patients with differentiated thyroid cancer (DTC). Empirical radioiodine treatment has been advocated by some researchers, but has had with controversial outcomes. This anterospective study was performed to examine this dilemma and also to determine the capability of thallium (201TI) scintigraphy in these patients. MATERIALS AND METHODS: A total of 21 patients who had a history of DTC and elevated serum Tg levels, together with a negative diagnostic 131I whole body scans (WBS), were included in the study. All patients underwent posttreatment 131I WBS. Patients with negative posttreatment 131I WBS then underwent 201TI scintigraphy. RESULTS: The 21 included patients (9 women and 12 men) had a mean age of 53 +/- 14.17 years. The mean pretreatment and posttreatment Tg levels were 227.23 +/- 208.50 ng/ml and 163.43 +/- 282.57 ng/ml, respectively (p value <0.05). Eleven cases showed at least a 50% decrease in Tg value (remission group), 6 patients revealed less than a 50% decrease in Tg value (stable group), while 4 subjects demonstrated an increment in posttreatment Tg relative to pretreatment Tg value (progression group). The cumulative and last 131I doses in the remission, stable, and progression groups were not significantly different (p value >0.05). In the posttreatment 131I WBS, 10 patients showed abnormal findings in their images. In a follow-up scan after 201TI treatment, 7 out of 11 patients had positive scans. CONCLUSION: The study indicates a positive effect of RAI therapy in DTC patients with elevated Tg and negative 131I WBS. In addition, 201TI scintigraphy can be useful as an alternative modality to improve tumoral detection in this situation and when access to a PET system is limited.

Furazolidone versus metronidazole in quadruple therapy for eradication of Helicobacter pylori in duodenal ulcer disease.

OBJECTIVE: Furazolidone, an old but cheap antibiotic, was shown to be a good alternative to metronidazole in triple therapy for Helicobacter pylori eradication in areas where metronidazole resistant bacteria are common, but randomized studies are lacking. AIM: A randomized controlled trial to determine the efficacy and safety of furazolidone compared to metronidazole in classic quadruple therapy for eradication of H. pylori infection in duodenal ulcer patients. METHODS: Patients with endoscopically proven duodenal ulcer and positive urease test were randomized to receive ranitidine 300 mg, amoxycillin 1000 mg and bismuth subcitrate 240 mg b.d, with either furazolidone 200 mg b.d (RABF), or metronidazole 500 mg b.d. (RABM) for 2 weeks. Compliance and side-effects were monitored and recorded by table diary. H. pylori eradication was assessed at least 4 weeks after the completion of therapy with 14C-urea breath test. RESULTS: A total of 106 patients were enrolled and 101 (59 male, 42 female, mean age=40 +/- 11 years) completed the study. Endoscopic findings and demographic data were comparable in both groups. Intention-to-treat eradication rates were 75% and 55% (P=0.03) and per protocol eradication rates were 82 and 56% (P=0. 006) in the RABF and RABM groups, respectively. Side-effects were reported by 13 patients (27%) in the RABF group (one stopped treatment) compared to five patients (10%) in the RABM group (P=0. 04). CONCLUSION: Quadruple therapy containing furazolidone, instead of metronidazole, results in a significantly higher H. pylori eradication rate in Iranian duodenal ulcer patients.

Hospital discharge policy in thyroid cancer patients treated with 131I: the effect of changing from fixed time to exposure rate threshold.

During 1981-1989, a total of 2,238 thyroid carcinoma patients were treated in limited accommodation in Iran with high-fixed ablation or therapeutic doses of 131I . For the 308 patients admitted in 1989, the external body exposure rate was measured sequentially at 2-4 d post-dose administration. Based on the exposure rate of 6.98 C kg(-1) h(-1) (1.8 mR h(-1) at 1 m, cumulative percentages of patients ablated with 3.7 GBq of 131I (268/308) and discharged from the hospital at 2, 3, and 4 d post-dose administration were 75%, 87%, and 95%, respectively. Likewise, for the group treated with 5.55 GBq (31/308), the cumulative percentages of patients discharged by day 2, 3, and 4 were 30%, 68%, and 79%, respectively. In the former, the remaining 5% (13 patients) had the external exposure rate less than 6.98 C kg(-1) h(-1) at one meter, before day seven PDA. In the latter, only 2 patients were released after day seven, that is at day 10, with the exposure rate less than 1.8 mR/hr at one meter. One patient, from the second group, with extensive metastatic disease was discharged at day 14 PDA with the external exposure rate of 5.81 C kg(-1)h(-1)(1.5 mR/hr) at one meter. By applying the above exposure rate as the requirement for the patient discharge, we changed the policy for release of patients from arbitrary 1-wk hospitalization to the discharge at the point when exposure rate dropped below 6.98 C kg(-1)h(-1)(1.8 mR h(-1)) at 1 m, which led to the significant (300%) increase in throughput of patients treated for thyroid carcinoma with 131I, within the same available space limitations.

Trends of population radiation absorbed dose from diagnostic nuclear medicine procedures in Iran: 1985-1989.

In view of the rapid expansion of diagnostic nuclear medicine procedures in Iran, this study was undertaken to examine trends of nuclear medicine practice in the country and to determine the mean effective dose equivalent per patient and per capita. Comprehensive national data covering 93% of all nuclear medicine centers in 1985-1989 were obtained. The total number of nuclear medicine examinations increased by 42% during these years. The relative frequency of thyroid investigations was 84% followed by liver/spleen and bone procedures (7% and 6%, respectively). 99mTc was the radionuclide of choice for 86% of investigation while 131I alone accounted for 59% of collective effective dose equivalent. The annual average number of nuclear medicine procedures per 1,000 people was 1.9. For the thyroid, the highest number (48%) of patients investigated was in the 15-29 y age group and the lowest (3%) was in the > 64 y age group. The male to female ratio of thyroid and cardiac patient was 0.18 and 3.64, respectively. The numbers of males and females studied for the remaining eight procedures were less frequent and about the same. The mean effective dose equivalent per patient and per capita was about 4.3 mSv and 8 microSv, respectively. 131I was responsible for most of collective effective dose equivalent produced by nuclear medicine. Therefore, future efforts should be concentrated on dose reduction for diagnostic 131I tests.