小剂量^131碘治疗儿童Graves病42例疗效观察

目的 探讨小剂量^131碘(^131I)治疗儿童Graves病的疗效。方法 ^131I剂量降至常规计算用量的1／2～2／3，1次顿服，3个月为1个疗程，进行疗效复查，总剂量37～185MBq。结果 42例患儿中，痊愈38例，治愈率为90．5％；显效2例，占4．8％；无效1例，占2．4％；1例出现早发甲状腺功能低下(甲低)，经治疗后恢复。治愈总疗程1～3个，时间3～9个月。痊愈病例中，服药1个疗程治愈17人(44．8％)，2个疗程治愈16人(42．1％)，3个疗程治愈5人(13．1％)，观察3～5年，38例治愈患者中未出现甲状腺功能亢进症复发或晚发甲低。结论 小剂量^131I是治疗儿童Graves病安全、有效的方法。     

131I治疗非毒性甲状腺肿的临床评价

目的 对^131I治疗非毒性甲状腺肿(NTG)进行临床评价。方法 对35例经临床确诊的NTG患者，采用^131I治疗，随访1年以上，观察临床疗效及近期副作用。结果 35例NTG患者，治愈14例，有效19例，无效2例，甲低15例；治愈率和总有效率分别为40％和94．3％，甲低发生率为42．9％；治疗1年后甲状腺平均缩小60．2％。治疗后除部分患者出现一过性的颈部肿胀及甲亢表现外，未见其他明显的近期不良反应。结论 ^131I治疗NTG疗效肯定、简便、相对安全。对甲状腺肿大明显，甲状腺制剂治疗无效，且不愿接受手术的NTG患者，^131I治疗是值得推荐的方法。     

小剂量131碘分次疗法治疗Graves病327例疗效分析

目的探讨小剂量^131碘分次疗法治疗Graves病的疗效。方法^131碘剂量降至常规计算用量的1／2-2／3，1次顿服，3个月为1疗程，进行疗效复查，如此重复分次治疗直至Graves病治愈。结果治疗后5年，327例患者中，痊愈309例，治愈率94．5％，未愈14例，占4．3％，4例出现暂时性甲低，经治疗或观察半年后恢复。治愈总疗程1—3个，时间3—9个月。痊愈病例中，1疗程服药治愈为98人(31．7％)，2疗程治愈182(58．9％)，3疗程治愈29人(9．4％)，观察期间无一例出现甲亢复发或晚发甲低。结论小剂量^131碘是治疗Graves病安全、有效的方法。     

Graves’病患者^131I治疗前口服他巴唑效果观察

^131I是治疗Graves’病(GD)的首选药物，但部分患者用药后症状反而加重。为预防此现象发生，有学者采用^131I治疗前口服他巴唑。2002年10月～2004年7月，我们对^131I治疗前口服他巴唑的临床效果进行了观察，现将结果报告如下。     

165例甲状腺硬度不同的Graves病患者^131I治疗效果观察

目的观察^131I治疗Graves病的效果及甲状腺硬度对其的影响。方法对165例甲状腺硬度不同的Graves病患者[质地为软65例（质软组）、韧70例（质韧组）、硬30例（质硬组）]行^131I治疗,^131I治疗剂量按个体计算法确定;治疗后6个月根据游离三碘甲腺原氨酸（FT3）、游离甲状腺素（FT4）、促甲状腺激素（TSH）水平判定甲状腺功能减退症（甲减）发生率及疗效,并采用Spearman相关分析法对甲状腺硬度与治愈率、甲减率行相关分析。结果治愈率及甲减发生率在质软组、质韧组、质硬组均逐渐降低（P〈0.01、0.05）,甲状腺硬度与治愈率、甲减率均呈高度负相关（r均=-1,P=0.000）。结论 131I治疗Graves病效果确切,随甲状腺硬度增加治愈率和甲减发生率均下降;临床可根据甲状腺硬度调节^131I治疗剂量。     

131I治疗甲亢性心脏病106例分析

目的观察甲状腺功能亢进症并发甲亢性心脏病的临床特点，探讨甲心的发病相关因素及有效治疗方法。方法选择106例甲心患者观察^131I治疗前后的临床表现，甲状腺激素水平的变化及门诊随访情况。结果^131I治疗后多数患者3个月内甲亢治愈，甲心伴随甲亢好转而好转，甲心治愈率为86．8％(92例)。结论甲心根本的治疗是病因治疗，对并发症进行对症治疗，早期采用^131I根治是有效的病因治疗，对甲心更有临床意义。     

131碘联合碳酸锂治疗青少年毒性弥漫性甲状腺肿的临床疗效分析

目的探讨碳酸锂在^131碘（^131I）治疗青少年毒性弥漫性甲状腺肿（Graves病）时对甲状腺激素、甲状腺容积、治愈率等的影响。方法将96例青少年Graves病患者随机分为两组：治疗组在vI治疗的同时服用碳酸锂（250mg，3次／d），共7d；对照组仅给予^131I治疗。分别于^131I治疗前及治疗后7、14、30d随访，以后每3～6个月随访1次，每次均测定FT，、n、TsH和甲状腺容积，了解并评价患者治疗后的疗效概况。结果^131I治疗后，对照组FT3、FT4水平7d时升高，以后逐渐下降；治疗组FT3、FT4水平则逐渐下降且较对照组下降更明显，未出现短期升高现象。对照组和治疗组甲状腺容积均逐渐缩小，但在30d内两组比较差异无统计学意义（P〉0．05）。1年以上随访，两组甲状腺容积分别较治疗前缩小44．2％（22．5／50．9）、63．7％（37．3／58．6），差异有统计学意义（t=2．64，P〈0．01）；对照组治愈率62．5％（30／48）、有效率72．9％（35／48），治疗组治愈率81.3％（39／48）、有效率89．6％（43／48），治愈率及有效率后者均高于前者，差异有统计学意义（x^2值分别为4．17、4．38，P〈0．05）。结论碳酸锂能够抑制甲状腺激素的合成和释放，减轻^131I治疗后由于甲状腺激素升高引起的症状和体征．有助于较大甲状腺肿的缩小，远期效果明显，同时可提高患者的治愈率，是一种经济、有效的治疗方法，值得临床推广应用。     

甲亢~(131)碘治疗后永久性甲低发生规律的探讨

本文随访了甲亢~(131)碘治疗后11～24年的患者1411例,按全国第一次核素来治疗质控会议诊断标准,共发现永久性甲低209例,总发病率为14.81％。对其中甲低发生时间确切的189例进行了逐年统计,发现甲低发生率在6～10年有一个高发的峰期,平均逐年递增     

不同抗甲状腺药物对^131Ⅰ治疗Graves病近期疗效的比较

目的探讨Graves病患者使用不同抗甲状腺药物后再行^131Ⅰ治疗的疗效比较。方法随访Graves病经抗甲状腺药物治疗后再行^131Ⅰ治疗的患者98例,按治疗前分别使用丙基硫氧嘧啶、他巴唑、碳酸锂分为3组,前两组在^131Ⅰ治疗前停用抗甲亢药物15天,碳酸锂组使用至治疗当日,采用个性化^131Ⅰ治疗后6个月复查并评价治疗效果。结果使用丙基硫氧嘧啶组在^131Ⅰ治疗6月后仍有38％患者甲状腺功能亢进,使用他巴唑组甲亢比例为23％,而碳酸锂组仅为9．6％,3组间比较均有显著性差异（α〈0．05）;3组间发生甲减例数比较无显著性差异（P〉0．05）。结论在^131Ⅰ治疗Graves病前使用丙基硫氧嘧啶会降低^131Ⅰ治疗甲亢的疗效,其影响高于他巴唑组及碳酸锂组,3组中碳酸锂组对^131Ⅰ治疗甲亢的疗效影响最小。     

^131I治疗非毒性甲状腺肿的新认识

非毒性甲状腺肿因甲状腺肿大压迫颈部及上胸部重要组织结构及影响容貌等原因常需治疗。外科手术、甲状腺素抑制疗法和^131碘(^131I)治疗是目前主要的措施。^131I治疗甲状腺体积平均缩小率为30％-70％，主要副作用有放射性甲状腺炎、Graves甲亢、永久性甲状腺功能减退。与其他方法相比，安全、有效、易行。重组人促甲状腺激素(TSH)的应用，有望达到减少剂量，增加疗效的目的。     

A reappraisal of the role of methimazole and other factors on the efficacy and outcome of radioiodine therapy of Graves' hyperthyroidism

The outcome of radioiodine therapy of Graves' hyperthyroidism was retrospectively evaluated in 274 consecutive patients treated from 1975 to 1984. At 1-yr follow-up, permanent hypothyroidism occurred in 36.9% of patients and the cumulative incidence of hypothyroidism progressively increased up to 79.3% after 7-10 yr. At the end of the follow-up period, 148 patients (54%) were hypothyroid, 115 (42%) euthyroid and 11 (4%) still hyperthyroid. The prevalence of hypothyroidism was significantly higher in patients with small goiters (less than or equal to 50 g) than in those with large goiters (greater than 90 g). Moreover, hypothyroidism was more frequent in patients with high thyroglobulin antibodies titers (greater than or equal to 1:25,600) than in those with low titers or negative tests, and occurred earlier in the former group than in the latter ones Correction of thyrotoxicosis was obtained after the administration of a single dose of 131I in 187 patients (63.6%); 69 patients required two doses and 11 three or more doses. Seven patients refused further treatment with 131I after the first dose. In an effort to identify possible factors affecting the efficacy of 131I therapy, we evaluated the results obtained after the administration of the first dose of radioiodine. We found that large goiters, rapid iodide turnover and adjunctive therapy with methimazole shortly after radioiodine were associated with a higher rate of persistence of thyrotoxicosis, whereas an increased prevalence of hypothyroidism was observed in patients with small goiters and in those not treated with methimazole up to one week after 131I.(ABSTRACT TRUNCATED AT 250 WORDS)     

Harken caged-disc mitral valve replacement, 1969-1975: analysis of late mortality, thromboembolism, and valve failure

We evaluated the long-term outcome of mitral valve replacement with a Harken caged-disc prosthesis for up to 11 years (range, 50 to 130 months; mean, 81 months) in 170 patients whose mean age was 55 years. The early (30-day) mortality was 11.2% (19 out of 170 patients). Late follow-up information was obtained for 144 (95%) of the 151 survivors. The actuarial survival was 57% at 5 years and 40% at 10 years. Overall mortality was associated with advanced age, male sex, an ischemic origin for the mitral valve disease, and nonuse of warfarin anticoagulation. Late deaths (n=59) were valve-related in 46%, cardiac but non-valve-related in 44%, and noncardiac in 10% of the cases. One thromboembolic event or more occurred in 41 patients (incidence, 5.7% per patient year), 14 of whom died (24% of the late deaths). All four patients who were not on warfarin, aspirin, or other antithrombotic therapy experienced thromboemboli. This complication was correlated with the nonuse of warfarin-type anticoagulation, with mitral regurgitation, and with late cardiac death. Mechanical prosthetic failure resulted in reoperation or death in 7.6% of the late survivors (1.5% per patient year). In 75 patients with normally functioning prostheses, the disc-to-sewing ring ratio was established by means of cinefluoroscopy (0.93 +/- 0.04, mean +/- 25D). Because of the high proportion of cardiac valve-related deaths (46%), the high incidence of late mortality due to thromboembolic events (24%), and the 7.6% incidence of reoperation or death resulting from mechanical valve failure, close follow-up with cinefluoroscopy and continued warfarin anticoagulation (alone or in combination with dipyridamole) are essential after mitral valve replacement with the Harken caged-disc prosthesis.     

STANDARD DOSE 131I THERAPY FOR HYPERTHYROIDISM CAUSED BY AUTONOMOUSLY FUNCTIONING THYROID NODULES

Thirty-one patients with hyperthyroidism shown on scintigram to have autonomously functioning thyroid nodules were treated with a standard dose of 15 milliocuries (mCi) of 131I. Of thirty patients who have been followed up for a least 6 months to over 3 years, all but one patient were euthyroid after a single dose. Repeat scintigram and Thyrotropin Releasing Hormone (TRH) test after therapy confirmed that twenty-five patients were cured of the disease. Only one patient developed hypothyroidism. This simplified standard dose regimen of radioiodine is effective in the treatment of hyperthyroidism caused by autonomously functioning nodules and is not complicated by the high incidence of hypothyroidism that is observed following radioiodine therapy of Graves' disease.     

Long-term follow-up of HCV-infected hematopoietic SCT patients and effects of antiviral therapy

This prospective study was initiated in 1993 with the aim to study late effects and responses to antiviral therapy in a cohort of hepatitis C virus (HCV)-infected patients. A total of 195 patients were included from 12 centers. In all, 134 patients had undergone allogeneic and 61 autologous hematopoietic SCT (HSCT). The median follow-up from HSCT is currently 16.8 years and the maximum 27.2 years. Overall 33 of 195 patients have died of which 6 died from liver complications. The survival probability was 81.6% and the cumulative incidence for death in liver complications was 6.1% at 20 years after HSCT. The cumulative incidence of severe liver complications (death from liver failure, cirrhosis and liver transplantation) was 11.7% at 20 years after HSCT. In all, 85 patients have been treated with IFN; 42 in combination with ribavirin. The sustained response rate was 40%. The rates of severe side effects were comparable to other patient populations and no patient developed significant exacerbations of GVHD. Patients receiving antiviral therapy had a trend toward a decreased risk of severe liver complications (odds ratio=0.33; P=0.058). HCV infection is associated with morbidity and mortality in long-term survivors after HSCT. Antiviral therapy can be given safely and might reduce the risk for severe complications.     

Incidence of therapy-related myeloid neoplasia after initial therapy for chronic lymphocytic leukemia with fludarabine-cyclophosphamide versus fludarabine: long-term follow-up of US Intergroup Study E2997

Chemotherapy-related myeloid neoplasia (t-MN) is a significant late toxicity concern after cancer therapy. In the randomized intergroup phase 3 E2997 trial, initial therapy of chronic lymphocytic leukemia with fludarabine plus cyclophosphamide (FC) compared with fludarabine alone yielded higher complete and overall response rates and longer progression-free, but not overall, survival. Here, we report t-MN incidence in 278 patients enrolled in E2997 with a median 6.4-year follow-up. Thirteen cases (4.7%) of t-MN occurred at a median of 5 years from initial therapy for chronic lymphocytic leukemia, 9 after FC and 4 after fludarabine alone. By cumulative incidence methodology, rates of t-MN at 7 years were 8.2% after FC and 4.6% after fludarabine alone (P = .09). Seven of the 9 cases of t-MN after FC occurred without additional therapy. Abnormalities involving chromosomes 5 or 7 were found in 10 cases, which suggests alkylator involvement. These data suggest that FC may induce more t-MN than fludarabine alone.     

Fate of Starr-Edwards prostheses in the mitral position. Prognostic factors. Apropos of 309 cases

The authors report the long-term results of 309 patients undergoing isolated mitral valve replacement with a 6120 Starr Edwards mitral valve prosthesis in the great majority of cases, mainly for rheumatic mitral valve disease, with predominant mitral regurgitation. The average age was 26 +/- 14 years with 25% of children. The operative mortality was 9% and late mortality after a mean follow-up period of 4 years was 13,5% mainly due to thromboembolic complications and to myocardial dysfunction. The long-term results with an average 45 month follow-up showed a 10 year survival rate of 70,6% with an excellent clinical result in 71% of cases and an acceptable result in 10%; 20% of patients were considered poor long-term results because of myocardial dysfunction and thromboembolic complications. Endocarditis and perivalvular leaks were rarely observed (9 cases). A study of preoperative parameters which could influence long-term results showed that the quality of long-term survival was significantly correlated to age, the duration of cardiac disease before surgery, cardiomegaly and the presence of preoperative cardiac failure and tricuspid regurgitation. The incidence of thromboembolism was 4,7% patient years and the frequency of these complications was not related to the quality of anti-vitamin-K therapy. Patients under effective anticoagulant therapy had the highest incidence of haemorrhage (10%). This study confirms that the Starr Edwards 6120 prosthesis is a satisfactory choice for mitral valve replacement considering its durability (no cases of abnormal wear) and the 70% ten year survival rate. The problem of myocardial dysfunction could be resolved by earlier surgery.(ABSTRACT TRUNCATED AT 250 WORDS)     

Late ventricular arrhythmia is rare after early repair of tetralogy of Fallot

Objectives. This study was conducted to describe the incidence of ventricular arrhythmia during prospective long-term follow-up in a group of patients who had repair of tetralogy of Fallot during early childhood.Background. Ventricular arrhythmia has been a common finding in patients who have undergone repair of tetralogy of Fallot in late childhood or as adults. Whether earlier repair lowers the incidence of late ventricular arrhythmia or late sudden death is unknown.Methods. Twenty-nine asymptomatic patients who underwent repair at age 1.2 to 7.7 years (mean [±SD] age 4 ± 1.4 years) between 1979 and 1984 were studied. Twenty-one patients had simple repair (Group A), and eight had complex or multiple operations (Group B). All had ambulatory electrocardiographic monitoring preoperatively, postoperatively, at early follow-up (after 4.2 ± 1.3 years) and again at late follow-up (after 11.8 ± 1.3 years). At late follow-up, 28 subjects also underwent echocardiography, and 26 had an exercise test.Results. No patient had significant ventricular arrhythmia (≥modified Lown grade 2) before or immediately after repair. There was no significant increase in the incidence of arrhythmia at early and late follow-up (14% to 28%), but at each of these periods the incidence of ventricular arrhythmia was higher in Group B patients (3 [43%] of 7 vs. 1 [5%] of 22 with early repair, p = 0.03; 6 [75%] of 8 vs. 2 (10%) of 21 with late repair, p = 0.001). No patient had symptoms of arrhythmia, and there were no sudden deaths. Late ventricular arrhythmia did not correlate with estimated right ventricular systolic pressure, outflow tract gradient or degree of pulmonary incompetence or right ventricular dilation. On exercise, 5 (19%) of 26 patients had ventricular premature complexes at low levels of exercise that were suppressed at maximal exercise in all patients.Conclusions. Late ventricular arrhythmia is rare in patients with successful early correction of tetralogy of Fallot, unless complex or multiple operations are performed.     

Outcome of radioiodine-131 therapy in hyperfunctioning thyroid nodules: a 20 years' retrospective study

OBJECTIVE: To investigate the risk of hypothyroidism after radioiodine (131I) treatment for hyperfunctioning thyroid nodules. DESIGN: Retrospective analysis of patients treated with 131I for hyperfunctioning thyroid nodules and followed up for a maximum of 20 years. PATIENTS: A total of 346 patients treated with 131I in the years 1975-95, for a single hyperfunctioning nodule. MEASUREMENTS: Hypothyroidism was defined as TSH levels > 3.7 mU/l. Kaplan-Meier survival analysis was used to analyse permanence of euthyroidism after 131I. A stepwise Cox proportional hazard model was used to identify factors influencing the progression to hypothyroidism. RESULTS: The cumulative incidence of hypothyroidism was 7.6% at 1 year, 28% at 5 years, 46% at 10 years and 60% at 20 years. Age (P < 0.01), 24-th 131I uptake (P < 0.05) and previous treatment with methimazole (MMI, P < 0.1) were associated with a faster progression towards hypothyroidism, while thyroid and nodule size, thyroid status at diagnosis and degree of extranodular thyroid parenchymal suppression had no influence. In hyperthyroid patients with partial parenchymal suppression, however, previous MMI treatment was the most important prognostic factor (P < 0.01). CONCLUSIONS: After 20 years of follow-up, 60% of patients treated with 131I for a single hyperfunctioning nodule are hypothyroid. Factors increasing the risk of hypothyroidism are age, 131I uptake and MMI pretreatment. The prognostic value of this last factor, however, depends on the degree of suppression of the extranodular thyroid parenchyma at the scan.     

Management of hyperthyroidism in children and adolescents

Between 1961 and 1984, 262 patients with hyperthyroidism due to Graves' disease between the ages of 3 and 18 yr were treated in the author's clinic. This paper compares the results of different treatment methods. Initial treatment was surgery for 7 patients, radioiodine for 73, and an antithyroid drug for 182. Seven drug-treated patients subsequently had surgery. Of 14 surgically treated patients, 5 relapsed and received radioiodine, 5 became hypothyroid, 3 were lost to follow-up, and 1 remained euthyroid. Sixteen drug-treated patients were lost to follow-up; 7 are still taking drugs. Of the remaining 99 drug-treated patients not achieving remission, 92 received radioiodine, and 7 had surgery (1 later relapsed and received radioiodine). The principal reasons for abandoning drugs were toxicity, noncompliance, poor control, and failure to achieve sustained remissions. Of 61 drug-treated patients who achieved remission, 22 relapsed (21 were treated with radioiodine and 1 with drug). Remissions after antithyroid drug therapy persist in 39 patients, 2 of whom are now hypothyroid and 10 of whom have been in remission less than 2 yr. Of the 239 subjects whose treatment is complete, 191 (80%) ultimately had radioiodine. One radioiodine treatment eliminated hyperthyroidism in 163 patients, 2 treatments were effective in 17, and 3 treatments were effective in 1. The remaining 5 patients were lost to follow-up after radioiodine before the outcome of therapy could be determined. No increase in congenital abnormalities was found in 63 children of these patients, regardless of treatment. Radioiodine is a safe, simple, and economical therapy for patients with hyperthyroidism and is now considered the initial treatment of choice for such patients.     

Clinical value of the determination of TSH-binding inhibitory immunoglobulins (TBII) by a radioreceptor assay

The aim of the present study was to evaluate the clinical value of a commercial kit for determination of TBII. The study consisted of 50 patients with untreated Graves' disease, 21 patients with Graves' disease before und during medical therapy, 18 patients after finishing medical therapy and 10 patients after surgical treatment. Besides these, 41 patients with other thyroid diseases and 36 patients without any thyroid disorder were included. In 47 (94%) of 50 patients with untreated Graves' disease TBII were detectable in serum using a TSH-standard-curve. Binding activities exceeding 10 U/l TSH equivalents were regarded as positive. In other thyroid diseases TBII were negative with the exception of 3 of 22 patient with autonomously functioning thyroid nodules. After 12 months of antithyroid drug treatment of 19 patients the incidence of positive antibody findings was 26%. During follow-up after medical therapy (1-9 years) 7 of 18 patients had increased TBII in correlation with clinical and functional findings. The determination of TBII by TRAK-Assay proved to be a sensitive and specific method. The assay can be used to differentiate between hyperthyroidism of autoimmune or non-immunogenic origin. Even so this method seems to be helpful for the follow-up under medical treatment of patients with Graves' disease.