The role of technetium-99m methoxyisobutylisonitrile scintigraphy in the planning of therapy and follow-up of patients with differentiated thyroid carcinoma after surgery

The aim of this study was to investigate the possible role of technetium-99m methoxyisobutylisonitrile (MIBI) scan in planning post-surgical therapy and follow-up in patients with differentiated thyroid carcinoma (DTC). Four groups of DTC patients were considered: Group 1 comprised 122 patients with high serum thyroglobulin (s-Tg) levels and negative high-dose iodine-131 scan during follow-up who had previously undergone total thyroidectomy and ¹³¹I treatment. Group 2 consisted of 27 patients who had previously undergone total thyroidectomy and ¹³¹I treatment but were now considered disease-free; this group was considered as controls. Group 3 comprised 49 patients studied after total thyroidectomy but prior to ¹³¹I scan. Finally, group 4 consisted of 21 patients who had previously undergone partial thyroidectomy alone. MIBI scan, neck ultrasonography (US), and s-Tg measurements during suppressive hormonal therapy (SHT) were obtained in all patients. Neck and chest computed tomography (CT) or magnetic resonance imaging (MRI) was also performed in group 1 patients. In group 1, MIBI scan and US were very sensitive in detecting cervical lymph node metastases (93.54% and 89.24%, respectively). Furthermore, MIBI scan and US played a complementary role in several patients, yielding a global sensitivity of 97.84%. In contrast, CT/MRI sensitivity for cervical lymph node metastases was very low (43.01%). MIBI scan also showed a higher sensitivity than CT/MRI in detecting mediastinal lymph node metastases (100% vs 57.89%). Regarding distant metastases, MIBI scan provided results similar to those of conventional imaging (CT, MRI, ^99mTc-methylene diphosphonate bone scan). In group 2, no false-positive cases were observed with MIBI scan (100% specificity). In group 3, MIBI scan correctly identified all the ¹³¹I-positive metastatic foci, except in two patients with micronodular pulmonary metastases that were visualised with ¹³¹I scan. In contrast, both MIBI scan and US showed low sensitivity (46.15% and 61.53%, respectively) compared with ¹³¹I scan in detecting thyroid remnants. s-Tg was increased in all patients with distant metastases but only in 56% of those with lymph node metastases. Furthermore, s-Tg was increased in 21.42% of patients with thyroid remnants alone (false-positive results). In group 4, MIBI scan was the only examination capable of detecting at an early stage a mediastinal lymph node metastasis in one patient. We conclude that the integrated MIBI scan/neck US protocol: (a) can be proposed as a first-line diagnostic procedure in the follow-up of DTC patients with high s-Tg levels and negative high-dose ¹³¹I scan, and (b) may be helpful in the follow-up of DTC patients who undergo partial thyroidectomy alone. Moreover, the combined MIBI scan/neck US/s-Tg protocol appears to be highly sensitive in identifying patients with metastatic disease after total thyroidectomy and prior to ¹³¹I scan; consequently, it may play a prognostic role in distinguishing high-risk from low-risk DTC patients. However, due to the low sensitivity of MIBI scan and neck US in detecting thyroid remnants, this diagnostic approach cannot be used as a predictor of ¹³¹I scan results. Lastly, because of the high sensitivity of MIBI scan and neck US in revealing both functioning and non-functioning metastases, this integrated protocol might be helpful in the follow-up of high-risk DTC patients, particularly for the early detection of lymph node metastases in patients with undetectable s-Tg during SHT. Received 21 October and in revised form 20 December 1999     

Endocrine therapy for hormone treatment-naïve advanced breast cancer

A proportion of patients with hormone receptor-positive locally advanced or metastatic breast cancer will not have received prior endocrine therapy. However, there are limited clinical data specifically in these patients. We conducted a review of randomized phase II and III clinical studies of anastrozole, letrozole, exemestane, palbociclib, and fulvestrant to determine the evidence base supporting use of specific endocrine therapies in this patient population. From our findings, there is a paucity of clinical studies in patients with endocrine therapy-naïve disease; however, it appears that first-line treatment effects are consistent between patients who have and have not received prior endocrine treatment.     

Isolated Hepatic Perfusion for the Treatment of Patients With Colorectal Cancer Liver Metastases After Irinotecan-Based Therapy

Background Irinotecan given with 5-fluorouracil and leucovorin is currently used as first-line therapy for patients with metastatic colorectal cancer (CRC). However, the response duration is <1 year, and second-line systemic chemotherapy has limited efficacy. We analyzed the efficacy of isolated hepatic perfusion (IHP) for patients with progressive CRC liver metastases after irinotecan.Methods Between March 1993 and February 2003, 124 patients with CRC liver metastases underwent IHP on institutional review board–approved protocols. The overall treatment mortality was 4% (5 of 124). Twenty-five patients (10 women and 15 men; mean age, 53 years) were identified who had progressive liver metastases by carcinoembryonic antigen, imaging studies, or both after irinotecan. A 1-hour hyperthermic IHP (mean hepatic temperature, 40.0°C) with melphalan 1.5 mg/kg (mean total dose, 100 mg) was administered via laparotomy. Perfusion with an oxygenated extracorporeal circuit was established with inflow via a cannula in the gastroduodenal artery and common hepatic artery inflow occlusion. Outflow was via a cannula in an isolated segment of the inferior vena cava. During IHP, portal and inferior vena caval flow were shunted to the axillary vein. Patients were assessed for radiographical response, recurrence pattern, and survival.Results The mean number of prior irinotecan cycles in 25 patients was 6 (range, 2–14), and it was given primarily as second-line therapy. The median number of liver metastases before IHP was 10 (range, 1–50), and the median percentage of hepatic replacement by tumor was 25%. The mean operative time was 9 hours (range, 6–12 hours), and the median hospital stay was 11 days (range, 8–76 days). There was 1 complete response and there were 14 partial responses in 25 patients (60%), with a median duration of 12 months (range, 5–35 months). Disease progressed systemically in 13 of 25 patients at a median of 5 months (range, 3–16 months). The median overall survival was 12 months (range, 1–47 months), and the 2-year survival was 28%.Conclusions For patients with progressive CRC liver metastases after irinotecan, IHP has good efficacy in terms of response rate and duration. Continued evaluation of IHP with melphalan as second-line therapy in this clinical setting is justified.     

国人成年男性胸腰椎椎弓根径线和偏角与脊椎节段序数的相关性研究

目的:探讨胸腰椎椎弓根的径线和偏角与脊椎节段序数的相关性.方法:46具国人成年男性脊柱标本,拍胸椎及腰椎侧位X线片,并进行CT扫描.测量每个椎体椎弓根钉道长度、椎弓根内径宽度、椎弓根间距、椎弓根与矢状面夹角(e角)和椎弓根与横断面夹角(f角).将T1～L5脊椎节段序数按照1～17进行编号.应用SPSS 11.5软件进行统计分析.结果:T1-L4椎弓根钉道长度与脊椎节段序数呈正的直线相关(R2＝0.716);T2～T3椎弓根宽度与脊椎节段序数呈负的直线相关(R2=0.792);T8～L5椎弓根宽度与脊椎节段序数呈正直线相关(R2=0.673).T1～T4椎弓根间距与脊椎节段序数呈负直线相关(R2=0.866);T4-L5椎弓根间距与脊椎节段序数呈正的直线相关(R2＝0.771).T1～T2椎弓根f角与脊椎节段序数呈正直线相关(R2=0.767);T2～T4椎弓根f角与脊椎节段序数呈正直线相关(R2=0.908);T7～L5椎弓根f角与脊椎节段序数呈负的直线相关(R2=0.931);T1～T6椎弓根e角与脊椎节段序数呈负的直线相关(R2=0.774),T12～L5椎弓根e角与脊椎节段序数呈正的直线相关(R2=0.710).而T1～T2及T4～T7椎弓根宽度、T4～T6椎弓根f角以及T6-T12椎弓根e角与脊椎节段序数之间无显著相关性.结论:除T1～T2和T4～T7椎弓根宽度、T4～T6椎弓根f角以及T6～T12椎弓根e角外,国人成年男性胸腰椎椎弓根径线和偏角与脊椎节段序数之间有线性相关性,其回归方程有显著性意义.     

微针联合硬化剂对鸡冠毛细血管网作用的实验研究

目的探讨微针联合不同种类硬化剂对浅表血管性病变作用的特点。方法选择1．5～2．0kg雄性莱航鸡30只作为研究对象。随机分成3组：A组微针＋聚桂醇,B组微针＋无水乙醇,以及C组正常鸡冠,每组均为10只。分别在微针联合硬化剂干预鸡冠后第7、14、21、28天切取鸡冠组织,进行HE染色和免疫组化染色,分别计算毛细血管数目及Ⅰ型、Ⅲ型胶原纤维面积。结果肉眼观察：鸡冠组织颜色随时间的推移而变浅;HE染色显示：两实验组鸡冠组织毛细血管数目均明显随时间的延长而减少,且A组减少更明显;Ⅰ型胶原纤维及Ⅲ型胶原纤维面积计算结果显示：A、B、C组各时段组间对比,差异无统计学意义（P〉0．05）。结论动物实验结果显示,微针联合两种硬化剂均可显著减少鸡冠组织的毛细血管数量,最终导致鸡冠颜色变浅,其中以微针＋聚桂醇效果更明显;Ⅰ型、Ⅲ型胶原纤维未见增生,所以微针联合硬化剂干预鸡冠组织后不会导致局部纤维化。     

Avid thallium-201 uptake in hepatic carcinoid metastases

While radiolabelled somatostatin analogues sensitively detect extrahepatic carcinoid tumour, intrahepatic metastases are frequently not visualised due to somatostatin accumulation in normal hepatic tissues. We report a case of avid thallium-201 uptake in multiple hepatic carcinoid metastases using single-photon emission tomography (SPET) and compare this to a SPET technetium-99m sulphur colloid scan in the same patient. The ^99mTc sulphur colloid images demonstrate multiple focal defects at the site of known metastases in the hepatic right lobe (confirmed on both CT and surgery). However, there is avid uptake of thallium in the metastases on comparative SPET slices. ²⁰¹Tl may be a useful agent for the detection and localisation of carcinoid tumour and in particular of intrahepatic carcinoid metastases. Correspondence to: R.J. Quinn     

Transperitoneal laparoscopical iliac lymphadenectomy for treatment of malignant melanoma

Background: Current treatment for melanoma of the lower limb includes excision of the primary tumor with ilioinguinal lymphadenectomy in the case of lymph node metastases. The standard surgical approach includes sectioning of the inguinal ligament to gain access to the iliac nodes. More recently, some authors have reported that extraperitoneal laparoscopically assisted ilioinguinal lymphadenectomy for the treatment of malignant melanoma is feasible and less aggressive than standard open surgery. So far, no publications have described transperitoneal laparoscopic iliac lymphadenectomy (TPLND). Methods: From November 2001 to June 2002, 13 patients with ilioinguinal node melanoma metastases underwent TPLND (stage IIIA in 1 case, IIIB in 5 cases, IIIC in 4 cases, and IV in 3 cases). Results: In all 13 cases, the TPLND and groin dissection was performed correctly. Operative time, intra- and postoperative complications, number of lymph nodes retrieved, immediate morbidity, hospital stay, and feasibility of TPLND were evaluated. Conclusions: This study was conducted to evaluate the feasibility and the preliminary results of TPLND used to manage malignant melanoma of the lower limb. This approach has many advantages over the traditional procedure: less surgical trauma, no incision of the abdominal muscles or the inguinal ligament, and less postoperative pain. Moreover, as compared with extraperitoneal laparoscopically assisted ilioinguinal lymphoadenectomy, it provides an improved view of the operative area, dissection zone, and surrounding structures. Further research is needed to confirm these preliminary results regarding the potential applications of this method for treating malignant metastasis to the lower limb.     

July 2003

The effect of the Prandtl number (Pr) and the Reynolds number (Re) on the behaviour of weak laminar axisymmetric and plane fountains has been studied using dimensional and scaling analyses and direct numerical simulation. For Fr 1.0 and assuming viscous effects are important, the analysis shows that for both the axisymmetric and plane fountains, y_mFrRe^–1/2, where Fr is the Froude number defined at the fountain source and y_m is the non-dimensionalized fountain height. These scalings are also valid for the non-dimensionalized fountain width. The analyses also shows _msFr², where _ms is the non-dimensionalized time scale for the fountain flow in the fountain core to reach steady state, and using this time scale y_TFr(RePr)^–1/2, where y_T is the non-dimensionalized thickness of the temperature layer on the symmetry axis over which the fountain fluid temperature changes from the inlet value to that of the ambient fluid. All these scalings have been quantified by the direct numerical simulations, hence confirming in certain ranges the phenomenological scaling obtained in this paper. The financial supports from the National Natural Science Foundation (grant numbers 19872059 and 10262003) and Yunnan Province of the People's Republic of China to W. Lin and the Australian Research Council are gratefully acknowledged.     

某铜矿山巷道内气溶胶浓度与粒径分布的测量和分析

目的 定性了解矿山巷道内气溶胶的浓度和粒径分布特性。方法 在巷道内的不同区间,分别用凝结核颗粒计数器和个人气溶胶测量仪巡测气溶胶的粒子数和质量浓度,并通过质量浓度的分级测量定性评价微米级气溶胶的粒径分布;在调度室内外,用金属丝网筛扩散法测量亚微米级气溶胶的粒径分布。结果 巷道内可吸入颗粒物(PM10)的平均质量浓度为0.42 mg/m³,其量值大小因工作断面而异,且受人工活动影响变化较大;巷道内粒径大于1.0 μm的颗粒物广泛存在,而粒子直径小于5 nm的气溶胶基本上未被检出。结论 矿山巷道内气溶胶特性因工作断面、人工活动和通风条件的不同而变化明显,在开展内照射剂量评价时应考虑粒径大于1.0 μm放射性气溶胶粒子的剂量贡献。     

彩色多普勒超声对原发性及转移性肝癌血供情况的对比分析

目的：研究分析彩色多普勒超声对原发性及转移性肝癌血供情况的鉴别诊断要点。方法回顾性分析该院肝胆外科64例原发性肝癌患者和64例转移性肝癌患者血供情况的超声影像学表现。结果原发性肝癌患者肿瘤周围的血供显著强于转移性肝癌患者(P=0.007,P<0.01),且原发性肝癌患者的肝动脉内径、峰值流速均明显大于转移性肝癌(P=0.013,P<0.01)。结论彩色多普勒超声在鉴别原发性与转移性肝癌中具有重要的临床应用价值。