Our first clinical experience with radiosynoviorthesis by means of (166)Ho-holmium-boro-macroaggregates.

BACKGROUND: In this paper, we evaluate the therapeutic and adverse effects of the application of 166-holmium-boro-macroaggregates (HMBA) in radiosynovectomy (RSO) of the knees. We assessed the efficacy and safety of (166)Ho-HBMA in a prospective clinical trial in patients suffering from chronic synovitis. MATERIAL AND METHODS: An effective component of radiopharmaceutical (166)Ho-boro-macroaggregates is radionuclide (166)Ho which has both beta-emission and gamma-emission. The physical half-life time of 166 Ho is 26.8 hours. After application of the radiopharmaceutical into a joint cavity, the effect of beta-emission causes radiation necrosis of pathologically changed (inflamed) synovial membrane. From 15th April 2005, we have started RSO of knees by means of new radiopharmaceutical (166)Ho-boro-macroaggregates in patients with gonarthrosis, rheumatoid arthritis, chronic synovitis, psoriatic arthritis, gout arthropathy. Seventeen intra-articular injections were performed in fifteen patients receiving a mean activity of 972 MBq (range: 904-1,057 MBq) (166)Ho-HMBA. The patients were hospitalized for three days. Side effects were evaluated during hospital stay and after 6-8 weeks. Static scintigraphy of knee joints and measurements of blood radioactivity were performed. Therapeutic effects were evaluated after 6-8 weeks. RESULTS: In 2 hours and 2 days after application, we proved, by means of knee and inguinal scintigraphy, only insignificant radiopharmaceutical leakage from the joint cavity to the inguinal lymph nodes in four patients. In treated patients, no serious adverse effects occurred. Nine patients were without complaints; 4 patients had slight knee exsudation and 2 patients had great exsudation. Therapeutic effects after 6-8 weeks were as follows: 2 patients were without pain, 9 with lower pain, 3 with the same pain and 1 patient with increased pain. Joint motion was improved in 7 patients, remained the same in 7 patients and was impaired in 1 patient. Analgesics consumption was lower in 5 patients, the same in 9 patients and greater in 1 patient. Knee exsudation was absent in 2 patients, lower in 4 patients, the same in 6 patients and greater in 3 patients. CONCLUSIONS: We proved only insignificant radiopharmaceutical leakage from the joint cavity to the inguinal lymph nodes. Six patients had early slight or great radiation synovitis. The possible cause could be rather high applicated activity. One can take into consideration its reduction. Therapeutic effects can be precisely evaluated after a longer time interval than was possible for us (6-8 weeks after RSO). (166)Ho-boro-macroaggregates can extend the scale of clinically used radiopharmaceuticals for RSO. This paper is presented in the scope of the first stage of clinical evaluation of synovectomy application of holmium-boro-macroaggregates.

Low-level sex chromosome mosaicism in female partners of couples undergoing ICSI therapy does not significantly affect treatment outcome.

BACKGROUND: There is an increased rate of chromosomal anomalies, in particular low-level sex chromosome mosaicism, in the female partners of couples undergoing intracytoplasmic sperm injection (ICSI). METHODS: Among 811 consecutive couples presenting for pre-ICSI chromosome analysis, chromosomal abnormalities were detected in 54 individuals, of which 26 were low-level sex chromosome mosaicism in the females. Attention was focused on the treatment course and outcome of ICSI in 20 couples with low-level sex chromosome mosaicism in the females actually embarking on ICSI treatment (group I, n = 38 ICSI treatment cycles). Applying a case-control design, each of the 20 couples was matched according to female age and source of spermatozoa to couples without a chromosomal abnormality in either of the partners (group II, n = 38 ICSI treatment cycles). RESULTS: No significant differences were found between the groups in ovarian response, fertilization rate and number of embryos transferred. Pregnancy rates, as well as implantation and abortion rates did not differ significantly between the groups. CONCLUSIONS: The data suggest that low-level sex chromosome mosaicism in females has no major effect on the course and outcome of ICSI.

[Determination of differential renal function using dynamic scintigraphy]. / Problematika stanovení separované funkce ledvin pomocí dynamické scintigrafie.

By examination of 71 patients, using static and dynamic scintigraphy of the kidneys, the authors tested whether dynamic scintigraphy provides correct results of the separate renal function in case of a symmetrical localization of the kidneys. In case of slight asymmetry the error of calculation is feasible. In case of major differences in the position of the kidneys the results cannot be used for clinical purposes. In these patients static scintigraphy must be used with correction for different absorption layers.

Dynamic scintigraphy with high temporal resolution. Phase dynamic studies of rapid periodical processes.

The theory and general method of construction of the phase dynamic studies of rapid periodical processes with high temporal resolution is described briefly. Moreover, problems are discussed that are associated with the introduction of external pulses into dynamic studies in LIST-mode, the spatial and temporal reconstruction from LIST-mode, the computer's construction of phase dynamic studies, the selection of correct cycles, the creation of phase histograms and processing of the phase studies. The method is illustrated by a general program LIST leads to PHASE DYNAM. STUDY created for Clincom apparatus. In addition to the general method, there is mentioned here the modification of the simplified procedure--a well-known EKG-gated method. Some aspects of the method are documented by the results of phantom measurement and clinical examinations.

Dynamic scintigraphy: calculatiion and imaging of regional distribution of quantitative parameters.

The theory and general method of calculation of the parametric (functional) images at dynamic studies is described briefly. This method is illustrated by a general program DYNAM. PARAM. PRESENT. created for Clincom apparatus. Moreover, the selection of parameters and algorithms for calculation, the problems associated with the filtration of data, the correction for dead time and for non-homogeneity are discussed. In addition to the general method, there are presented here the possible ways of application of the simplified methods of construction of the parametric images by means of algebraic operations between images in special cases. Some aspects of that method are completed by examples of practical parametric images of some organs.

Dead-time correction in dynamic radionuclide studies by computer.

Several methods for the measurement of dead time and for evaluation of the dependencies required to correct dynamic studies for dead-time losses are described. Two program variants were written to produce time-activity curves in the selected areas of interest of the dynamic studies with computer's correction of dead-time losses; these variants are part of the system of programs for complex processing of scintigraphic studies set up for a Clincom instrument. The first variant performs correction on the basis of the registered count rate in the whole image, while the second variant makes us of the additional reference source positioned on the periphery of the camera visual field.

Quantitative evaluation of the depth effect in Muehllehner's tomographic camera.

A set of computer programs written for Clincom allow the evaluation of the depth effect in Muehllehner's tomographic camera using MTFs and specificity as well as new quantites. The depth effect of the camera is compared with that of a rectilinear scanner.