Symptom comorbidity in anxiety and depressive disorders.

The ability of the Hamilton Rating Scale for Anxiety, the Hamilton Rating Scale for Depression, and 50 items from the self-rated Hopkins Symptom Checklist to discriminate generalized anxiety disorder from major depressive disorder was examined for over 3,000 patients entering studies in three drug development projects at Bristol-Myers Squibb Company. Discriminant analysis models using stepwise procedures were developed for each scale separately, combining both Hamilton scales, and combining all three scales. The statistical model using both Hamilton scales produced the best discrimination. Items from the Hopkins Symptom Checklist scale did not improve the ability to discriminate patients by diagnosis correctly. The generalizability was tested by applying the discriminant models to new data sets or subsets of the data sets used in the model-building process. Correct classification rates for differentiating the two disorders ranged from 87-99% for the final model.

Iodine-131 metaiodobenzylguanidine for the locating of suspected pheochromocytoma: experience in 400 cases.

The efficacy of the newly developed pheochromocytoma-seeking radiopharmaceutical, [131I]MIBG, was examined in the first 400 patients (441 studies) investigated for suspected pheochromocytoma at our institution. The results of [131I]MIBG scintigraphy were classified as true positive, false positive, true negative, and false negative. Using this classification the sensitivity was found to be 78.4% in primary, sporadic pheochromocytoma, 92.4% in malignant pheochromocytoma, and 94.3% in familial pheochromocytoma giving an overall sensitivity of 87.4%. The specificity was 98.9% in primary, sporadic pheochromocytoma, 100% in malignant pheochromocytoma, and 100% in familial pheochromocytoma. The overall specificity was 98.9%. Iodine-131 MIBG scintigraphy was thus found to be a safe, noninvasive, and efficacious technique for the location of pheochromocytomas, especially for those arising from nonadrenal sites, recurring postoperatively, and exhibiting malignant metastatic disease. We find that, where available, [131I]MIBG scintigraphy is the study of choice to initiate the location of suspected pheochromocytoma.

131I-MIBG--a new agent in diagnosis and treatment of pheochromocytoma.

The newly developed radiopharmaceutical, 131I-metaiodobenzylguanidine (131I-MIBG), has been shown to be efficacious for the location of intra- and extra-adrenal, primary pheochromocytomas and metastatic, malignant pheochromocytomas (11.4% false-negative and 1.8% false-positive in patients with proven pheochromocytomas). Preliminary experience in selected patients with malignant pheochromocytoma suggest that therapy using large doses of 131I-MIBG results in partial tumor regression and improvement in catecholamine hypersecretion in some cases.

Locating pheochromocytomas by scintigraphy using 131I-metaiodobenzylguanidine.

Scintigraphy with 131I-MIBG has located most pheochromocytomas. The detected tumors have been intra-adrenal, extra-adrenal, malignant, and familial in type. The method is safe, but requires images taken over three days to attain optimal results. Because of its ability to screen all sites where primary pheochromocytomas may reside, scintigraphy should be employed as the initial procedure in the search for these tumors. It may be the only technique that will locate extra-adrenal pheochromocytomas. The rate of false-negative results is about 10 percent; therefore, other techniques such as computed tomography will be necessary to help find the few elusive pheochromocytomas.

Radiopharmaceutical treatment of malignant pheochromocytoma.

Apart from relieving effects of secreted catecholamines, treatments of malignant pheochromocytoma have achieved little success. When the radiopharmaceutical, meta-[131I] iodobenzylguanidine (I-131 MIBG ), was found to concentrate in some malignant pheochromocytomas, we calculated that this agent could impart therapeutic doses of radiation to these tumors. We therefore treated five patients with two to four doses of I-131 MIBG prepared in high specific activity, 8-11 Ci/mmol. Individual doses were given at 3- to 10-mo intervals and in 97- to 197-mCi amounts. Two patients exhibited subjective and objective benefits. Their tumors declined in size (to 28% and 30% of original volumes) and in hormone secretion (to 50% or less of baseline rates). The other three patients manifested few symptoms before treatment and showed few or no objective improvement afterward. The tumors of the patients who responded to I-131 MIBG (a) appeared to be more rapidly growing, (b) received more cumulative rads, and (c) were more predominantly in soft tissues (in contrast to bone) than those in the patients who obtained little benefit. No toxic effects were encountered during the treatments, and only minor and temporary untoward responses were seen later.

Survival time and "cure" in papillary and follicular thyroid carcinoma with distant metastases: statistics following University of Michigan therapy.

Between 1947 and 1980, 103 patients with well-differentiated thyroid carcinoma with metastases outside the neck were treated with sodium iodide (I-131) after surgical treatment. Forty-one patients had distant metastases first detected an average of 7.44 yr after the initial operation establishing the diagnosis of thyroid carcinoma. Follicular and papillary carcinomas gave the same survival time in patients, matched for age and sex, who had metastases outside the neck. Those considered to be free of their metastatic disease after I-131 therapy survived three times as long as those with persistent disease. Patients freed of their metastases had a higher conformity rate with half of our ten procedures of "ideal" treatment, compared with patients not freed of their metastases.