Experience of using solutions for tumescent anesthesia with endovenous radiofrequency obliteration: a comparative study

2020 ◽  
Vol 21 (3) ◽  
pp. 59-64
Author(s):  
L. N. Komarova ◽  
◽  
Keyword(s):  
Comparative Study ◽  
Endocrine System ◽  
Venous Disease ◽  
Tumescent Anesthesia ◽  
Group Iii ◽  
The Third ◽  
Group I ◽  
Radiofrequency Obliteration ◽  
Group Ii ◽  
Descriptive Scale

The incidence of varicose disease of the lower extremities throughout the world remains at a fairly high level. Given its socio-economic significance, low-impact surgical treatment methods continue to improve, as well as methods of anesthesia for them. In most cases, the mixtures used for infiltration anesthesia during endovenous surgery include lidocaine and adrenaline. The active substance of adrenaline, epinephrine hydrochloride, has a direct stimulating effect on α- and β-adrenergic receptors, and can cause serious disturbances in the cardiovascular system. It is not recommended for patients with CVD and endocrine system pathologies. Aim. minimize pain when performing tumescent anesthesia during endovenous radiofrequency obliteration of veins. Material and Methods. A comparative study was performed in which 192 patients with clinical forms of chronic C2-C6 venous disease took part. All patients using the envelope method were divided into three groups: patients of the first group (I) planned to perform RFO and miniphlebectomy using Klein mixture for tumescent anesthesia, the pH of which was 6.6, lidocaine concentration 0.04%. Patients of the second group (II) planned anesthesia using a solution, the pH of which was 7.3, the concentration of lidocaine was 0.02%. In patients of the third group (III), a solution with a pH of 7.4 was used, the concentration of lidocaine was 0.08%. The level of pain during the administration of the anesthetic was evaluated using two scales – the verbal descriptive scale of pain assessment (VASOB) and the visual analogue scale (VAS). Results. Patient groups were comparable in age, sex, clinical form of the disease. When assessing pain on a verbal descriptive scale, 50% of patients (27) in group II noted a complete absence of pain during tumescent anesthesia, in group III – 54.5% (48). Very severe pain (8 points) was noted by 4 patients from Group I, who were anesthetized by administering a Klein mixture, which constituted 8%; unbearable pain (10 points) also noted two patients from this group (4%). According to YOUR, the average pain in the first group was 3.02 ± 1.07, in the second – 1.13 ± 0.23, in the third – 0.93 ± 0.27 (p = 0.05). Pronounced pain (more than 5 cm according to YOUR) was noted only in the first group in 12 patients (24%). Conclusion. None of the test solutions completely removed pain during tumescent paravasal anesthesia. But the use of a solution with a pH of 7.3-7.4 is less painful when administered and significantly reduces pain during tumescent anesthesia, which was used in patients of groups II and III.

Androgen secretion in women with threatened miscarriage

2020 ◽  
Vol 19 (5) ◽  
pp. 22-28
Author(s):  
М.М. Amiraslanova ◽  
◽  
I.V. Kuznetsova ◽  
E.P. Gitel ◽  
◽  
...  
Keyword(s):  
Pregnancy Outcomes ◽  
First Trimester ◽  
Total Testosterone ◽  
Third Trimester ◽  
Group Iii ◽  
The Third ◽  
Threatened Miscarriage ◽  
Group I ◽  
Androgen Secretion ◽  
Group Ii

Objective. To assess androgen secretion and its possible effect on pregnancy in women with threatened miscarriage in the first trimester. Patients and methods. This prospective observational study included 120 pregnant women divided into four groups. Group I comprised 32 patients with threatened miscarriage and hyperandrogenism who received corticosteroids; Group II was composed of 28 patients with threatened miscarriage and hyperandrogenism who did not receive corticosteroids; Group III included 30 patients with threatened miscarriage and no hyperandrogenism; and Group IV comprised 30 women with normal pregnancy. Serum levels of dehydroepiandrosterone sulfate (DHEA-S), 17-hydroxyprogesterone (17-OHP), and total testosterone were measured on the following weeks of gestation: 5–8, 9–12, 13–18, 19–24, and 25–32. We also evaluated clinical outcomes of pregnancy. Results. We observed no significant differences in 17-ОНР and DHEA-S secretion between women from Group III and controls. Patients from Group II demonstrated higher hormone levels than controls; however, their dynamics of 17-ОНР and testosterone secretion was similar to that in women without hyperandrogenism, so their DHEA-S levels decreased and reached control values by the third trimester. Corticosteroids reduced 17-ONR secretion in the second and third trimesters and DHEA-S secretion in the third trimester. Women receiving corticosteroids demonstrated the poorest clinical pregnancy outcomes. Conclusion. Hyperandrogenism should be considered as one of the risk factors for poor pregnancy outcomes. Administration of corticosteroids to reduce androgen levels impairs normal dynamics of their secretion, does not improve pregnancy outcomes, and is potentially harmful; therefore, these drugs should not be used for such purposes. Key words: pregnancy, hyperandrogenism, corticosteroid therapy, pregnancy outcomes, pregnancy loss, androgen secretion, threatened miscarriage

RESULTS OF MONITORING OF REPEATED DISABILITY DUE TO THYROID CANCER IN THE ADULT POPULATION IN MOSCOW

2020 ◽  
Vol 3 ◽  
pp. 38-46
Author(s):  
G.E. Pogosyan ◽  
Keyword(s):  
Thyroid Cancer ◽  
Adult Population ◽  
Age Groups ◽  
Malignant Neoplasm ◽  
Endocrine System ◽  
Malignant Neoplasms ◽  
Group Iii ◽  
Group I ◽  
Disability Group ◽  
Group Ii

Among socially significant diseases that are characterized by high prevalence rates, malignant neoplasms occupy the leading positions. Thyroid cancer is the most common malignant neoplasm of the endocrine system. Purpose of the study. Analysis of recurrent disability due to thyroid cancer in the adult population in Moscow (2015–2019). Materials and research methods. The structure of repeated disability due to thyroid cancer by sex, age and disability group was studied. The dynamics of the number of the PPI contingent was traced and the level of repeated disability due to this pathology was determined. The number of observations was 4660 PPI. Research results. It was found that in the structure of repeated disability due to thyroid cancer, women predominated by gender. The trend towards an increase in the number of PPI took place in all major age groups of the adult population. The prevalence of PPI with group III disability, the proportion of which was 66.0% (PPI with group II – 32.5%, PPI with group I – 1.5%). The visibility indicator in 2019 in relation to 2015 (taken as 100%) was equal in the general contingent of PPI among disabled people of group I – 142.9%, group II – 374.1%, group III – 249.3% ...

scholarly journals THE INFLUENCE OF THE INTENSITY OF BREEDING OF HEIFERS OF UKRAINIAN BLACK-AND-WHITE DAIRY BREED IN DIFFERENT AGE PERIODS ON THE FUTURE DAIRY PRODUCTIVITY

2020 ◽  
Vol 59 ◽  
pp. 17-25
Author(s):  
S. F. Antonenko
Keyword(s):  
Live Weight ◽  
State Enterprise ◽  
Milk Productivity ◽  
Group Iii ◽  
Black And White ◽  
The Third ◽  
Group I ◽  
Animal Number ◽  
Group Ii ◽  
The Difference

The scientific experiment was carried out in two stages at State enterprise pilot farm “Hontarivka”, Vovchansk district, Kharkiv region. First stage. In a retrospective analysis of the rearing calf intensity from 3 to 6 months revealed that the highest live weight at 6-month age had animals of group III, .which is probably 47.0 kg or 34.6% and 23.0 kg or 14.4% (P < 0.001 in both comparison cases) outperformed peers I and II groups. A similar trend was observed in the analysis of live weight of heifers at 9 and 12-month age. Live weight at insemination in the higher growth group also had better rates of 4.0 and 3.7%, respectively, in animals of groups I and II (P < 0.001–0.05). It should be noted that the required live weight for insemination at heifers at growth rates of up to 500 g was reached in only 20.3 months, however, in the other two groups, the insemination age decreased by 1.5 and 1.7 months. Firstcalf heifers from group III also had the highest milk expectancy of 170.0 and 123.0 kg, or 3.1 and 2.3%, respectively, then animals in groups I and II. In the age period from 6 to 9 months it was found that at 9-month age heifers of group III had a higher live weight against animals of I and II groups respectively by 39.0 and 16.0 kg or 18.8 and 7.0% (P < 0.001 in both comparison cases). Intergroup differences by this indicator at 12-month age hiefers decreased to 35.0 and 8.0 kg, respectively, or 13.0 and 2.7% (P < 0.001 in both cases of comparison), which provided an advantage for the live weight of group III over I and II groups during the first fruitful insemination. Whereas the age of first fruitfull insemination, on the contrary, was lower at heifers of group III at 49 and 34 days than at groups I and II heifers. The highest milk productivity was also found at firstcalf heifers of group III at 634 kg or 12.3% (P < 0.001) and at 137 kg or 2.5% against animal I and II groups. The heifer live weight at the period from 9 to 12 months corresponded to the established differences at other age periods generally. And 12-month age calves of group III also significantly exceeded the analogues of group I by 38.0 kg or 14.0% (P < 0.001) and peers of group II – by 23.0 kg or 8.0% (P < 0.001). The live weight at fruitfull insemination of group III heifers was the largest and the difference compared with animals of group I was 21.0 kg or 5.3% (P < 0.01) and group II – 19.0 kg or 4.8% (P < 0.001). Group III animals also had the highest milk productivity, which is likely to be higher than group I peers by 751 kg or 14.5% (P < 0.001) and group II animals by 552 kg or 10.3% (P < 0.001). Second stage. It was found that during the experiment, live weight of free-stall keeping heifers were outnumbered by peers. In particular, the live weight of group I animals at the first month of the experiment was less by 8.0 kg or 2.9%, the second by 15.0 kg or 4.7% (P < 0.05) and the third by 19.0 kg or 5.4% against peers of group II. A similar pattern was observed in the estimation of intensive growth of these animals. However, at the end of the experiment, the heifers of the experimental group were 7.0 cm or 5.9% (P < 0.001) higher in the withers, 7.0 cm or 5.6% (P < 0.001) in the back, and the sacrum – 6.0 cm or 4.7% (P < 0.001). They showed deeper breasts by 3.0 cm or 4.9% (P < 0.01), larger breast widths – by 2.0 cm or 5.4% (P < 0.01), width in macaques – by 2.0 cm or 4.9% (P < 0.01), oblique torso length – 8.0 cm or 5.8% (P < 0.001), chest circumference 9.0 cm or 5.6% (P < 0.001) and girth – 1.0 cm or 6.1% (P < 0.01). It should be noted that from the second month of the research the animal number the free-stall keeping animal number, which ready for insemination, was more at 2.3 times or 5 goals than stall keeping heifers, and their live weight was more at 8 kg or 3.0%. With age, the differences between the groups gradually increased and by the third month reached 8 goals or 2.6 times and 19.0 kg or 5.7%.

scholarly journals THE PREVALENCE OF DENTOALVEOLAR ANOMALIES AND DEFORMITIES IN PATIENTS WITH DENTAL DEFECTS.

2018 ◽  
pp. 20-25
Author(s):  
B.M. Mirchuk ◽  
Y.V. Maksymov
Keyword(s):  
Age Groups ◽  
Group Iv ◽  
Adult Patients ◽  
Dental Anomalies ◽  
Group Iii ◽  
Functional Changes ◽  
The Third ◽  
Group I ◽  
Mandibular Position ◽  
Group Ii

As result of the presence of defects in the dentition, a range of morphological, aesthetic and functional changes arises, which considerably complicates the process of diagnosis and treatment of this pathology. Defects in the dentition, in combination with a variety of anomalies and deformations, often impede the implementation of rational prosthetics, and occasionally make it, impracticable at all one to this reason, one of the urgent problems in modern dentistry, which requires further, is the study of adverse factors that arise in the prosthetics of dental defects in adult patients with dentoalveolar anomalies and deformations of different etiologies. The aim is to investigate the prevalence of dental anomalies and deformities in adult patients’ prosthetic treatment. Materials and methods. 83 patients aged 20-60 and older were involved in prosthetic treatment. The diagnosis was based on classification have been of surveyed on Kennedy and D.A. Calveliss. Patients were divided into 4 age groups: Group I included 49 patients aged 20 to 30 years; Group II included 10 patients aged 31 to 40 years; Group III included 13 patients aged 41 to 50 years; IV group contained 11 patients aged 51 to 60 years and older. Results. In the 1st group, with coverage of 49 persons aged 20 to 30 years 12,5% of women suffered from defects of dentition which was under half the size of that of men (29,4%).All patients with dental defects needed prosthetic treatment. The prevailing majority of the surveyed-96,9% of females and 100% of males were diagnosed with dental anomalies. In group II, with 10 patients being examined in the 31-40 aged bracket, a significant increase in the number of persons with dental defects was observed: in women by 5.7 times up to 71,4% and in men-by 2.7 times up to 66,7% in comparing with those in Group I. Each of the examined patients with dental defects needed protection and orthodontic treatment. All patients in the third group (41-50 years) and the in IV group ( 51-60 years and older) of defects of dentitions were 50.0% women and 57.1% men of the third group and 71,4% of women and 75,0% of men of the IV group needed prosthetics of secondary dentition of teeth. Al l women of both subgroups have been diagnosed with dental anomalies, whereas in men. Orthodontic pathology was detected in 85,7% of individuals of group III and 75,0% of individuals group IV. Conclusions. Prosthetic treatment with restoration of the integrity of the dentition is one of the reasons for the significant growth of secondary deformations and the formation of dentoalveolar anomalies. According to our observations, patients 30 years of age or older who seek orthopedic help have defects in the dentition. Most often, these patients are diagnosed with included dentition defects in the lateral areas (from 35.3% to 63.6%), which are complicated by secondary deformations of the dentition (from 33.3% to 100%). The results of the studies confirm the need for further study of the state of the dentoalveolar system in patients with dentition defects, namely: the formation of secondary deformations, occlusion disorders, changes in the shape and size of the dentition, decrease in occlusion height, temporomandibular joint dysfunction, blockage or forced mandibular position etc.

TRANSIENT BONE LOSS OF DISTAL RADIUS AND ULNA FOLLOWING CLEAN-CUT TENDON INJURIES, REPAIR AND PASSIVE MOBILISATION

2007 ◽  
Vol 32 (3) ◽  
pp. 320-325 ◽  
Author(s):  
E. KEKILLI ◽  
K. ERTEM ◽  
C. YAGMUR ◽  
A. ATASEVER ◽  
N. ELMALI ◽  
...  
Keyword(s):  
Bone Loss ◽  
Distal Region ◽  
Tendon Injuries ◽  
Mineral Density ◽  
Group Iii ◽  
The Third ◽  
Group I ◽  
Forearm Bones ◽  
Group Ii ◽  
Early Passive

The aim of this study was to investigate whether there is any significant bone loss of the ulna and radius following acute tendon-artery-nerve clean-cut injuries at the wrist level which were repaired and rehabilitated by early passive mobilisation. Fifty-eight patients who underwent such operation were enrolled in this study. Patients in Group I ( n = 28) had primary tendon repairs alone, in Group II ( n = 15) primary tendon and nerve repairs and in Group III ( n = 15) primary tendon, nerve and artery repairs. Bone mineral density (BMD) measurements of the ulna and radius were obtained during the first week, the sixth week, the third month and the 12th month after operation. The results demonstrated that BMD decrease in the ulna was more common than in the radius. When compared with the first week BMD measurements, the highest reduction was seen in the sixth week in Group I and during the third month, when bone loss of both the radius and ulna was considerable in Group II. The bone loss in all groups and subgroups were found to have recovered at the 12th month measurements, except in the distal region of the ulna in Group I. This study suggests that passive immobilisation is deleterious in respect of demineralisation of the forearm bones.

scholarly journals Experimental intoxication of pregnant goats with Tetrapterys multiglandulosa A. Juss. (Malpighiaceae)

2001 ◽  
Vol 53 (1) ◽  
pp. 58-65 ◽  
Author(s):  
M.M. Melo ◽  
A.C. Vasconcelos ◽  
G.C. Dantas ◽  
R. Serakides ◽  
F. Alzamora Filho
Keyword(s):  
Congenital Malformations ◽  
Fetal Death ◽  
Coagulation Necrosis ◽  
Control Group ◽  
Group Iii ◽  
The Third ◽  
Green Leaves ◽  
Group I ◽  
Group Ii ◽  
Fetal Malnutrition

Green leaves of Tetrapterys multiglandulosa A. Juss were fed to pregnant goats from day 35 of pregnancy. Five goats received 10g/kgBW (group I), five received 20g/kgBW (group II) and five were used as control (group III), and received only hay, fresh grass and commercial ration. All animals were clinically examined daily and submitted to ultrasonography every three days. Fetal death and vulvar catarrhal discharge with subsequent abortion were observed at the end of the second month of pregnancy in group II and at the third month of pregnancy in group I. Animals from groups I and II were slaughtered after abortion and necropsied. Goats from the control group were necropsied at the same time. The main lesions in the aborted goats were focal placentitis with early involution (apoptosis) and placentary coagulation necrosis, acute focal endometritis and vulvo-vaginal petechiae. All aborted fetuses were underdeveloped when compared to control fetuses, probably due to fetal malnutrition, since no congenital malformations could be noted. The majority of aborted fetuses showed some degree of autolysis, as fetal death occurred five and three days before abortion, in groups I and II, respectively. The most remarkable fetal lesions were focal or diffuse hemorrhages in the skin, meninges and visceral serosae.

scholarly journals Malignant Degeneration of Gastric Ulcer

1939 ◽  
Vol 32 (3) ◽  
pp. 183-196 ◽  
Author(s):  
H. Finsterer
Keyword(s):  
Gastric Ulcer ◽  
Mucous Membrane ◽  
Early Stage ◽  
Radical Resection ◽  
Malignant Degeneration ◽  
Primary Cancer ◽  
Group Iii ◽  
The Third ◽  
Group I ◽  
Group Ii

Malignant degeneration is the most serious complication of gastric ulcer. Its recognition is difficult both in the early stage and in advanced cases in which only the evidence of a previous ulcer-cavity, and the radiating folds of the mucous membrane indicate progressive development of carcinoma from an original ulcer. It is impossible to say how often gastric ulcer becomes malignant; one can only state the frequency of ulcer-carcinoma, found in gastric resections. One hundred and forty-one personal cases of ulcer-carcinoma are recorded, and are divided into three groups. Group I: 41 which were diagnosed clinically and at operation as cases of ulcer, but in which histological examination showed incipient cancer. Group II: 55 diagnosed clinically as cases of ulcer, but in which a diagnosis of ulcer-carcinoma was made during operation and afterwards histologically confirmed. Group III: 45 diagnosed both clinically and macroscopically (from the typical folding of the mucous membrane) as cases of ulcer-cancer, in which the cancer had entirely overgrown the ulcer. Therefore in the series of 532 resections for gastric ulcer the frequency of ulcer-carcinoma was 20.9%, or 15.2% if the third group is omitted. In a series of 718 resections for gastric cancer, the frequency of ulcer-carcinoma was 19.6% (or 14.2% if the third group is omitted). The mortality in simple two-third resection of the stomach is low (four deaths in 99 cases = 4%). When the pancreas, liver, colon, or œsophagus, is involved, the resection mortality is high (14 deaths in 42 cases = 33.3%), but even in these cases the operation is justifiable because permanent cures were achieved in a number of cases. The prognosis in cases of ulcer-cancer is very grave. In many cases, judging from the author's own experience, patients suffering from incipient ulcer-cancer—only histologically diagnosed as cancer—die from liver metastases, in spite of radical resection. It will thus be seen that the end-results of resection for ulcer-carcinoma are actually worse than those of resection for primary carcinoma. A. Ulcer-cancer: In Group I, 35 cases were operated on before 1933, and in 18 of these (51.4%) the patients have been free from symptoms for more than five years; in Group II, 27 cases were operated on before 1933, and in four of these (14.8%) the patients are still symptom-free. In Group III, out of 37 cases operated on, only two patients (5.4%) have been symptom-free for the same period. B. Primary cancer: Out of 260 cases of resection for primary cancer before 1933, 77 patients (29.6%) are permanently cured. If the ulcer-cancer is so far advanced that the diagnosis can be made clinically, or during operation, the prognosis is extremely bad (permanent cures having been only 9.3% in the series). In cases of gastric ulcer the best plan is to carry out resection before malignant degeneration begins. The result would then be that not merely 51% but at least 90% of the patients would be alive and well after five years.

scholarly journals Relating the Marginal Fit of the Castings to the Accuracy of the Impressions made from Laminated Hydrocolloid Impression Technique: A Comparative Study

2012 ◽  
Vol 13 (2) ◽  
pp. 167-172
Author(s):  
Manish Sinha ◽  
Bhavana Thakur ◽  
Ajay Gaikwad ◽  
Lalitkumar Dnyandeo Chaudhari ◽  
Adwait Kulkarni ◽  
...  
Keyword(s):  
Comparative Study ◽  
Cost Effective ◽  
Marginal Fit ◽  
Impression Material ◽  
Group Iii ◽  
Impression Technique ◽  
Group I ◽  
Significant Difference ◽  
Group Ii ◽  
Crown Preparation

ABSTRACT Aim Relating the marginal fit of the castings, to the accuracy of the impression produced using laminated hydrocolloid impression technique, alginate and double-mixed polyvinyl siloxane. Basic objective of the study is to check the feasibility of the use of laminated hydrocolloid impression technique in the fixed partial denture. Materials and methods The precisely machined metal die was designed to simulate standard complete metal crown preparation. The preparation was mounted on cylindrical base of 20 mm length and diameter of 10 mm. Seven impressions were made from the each impression material onto the metal die, and total 21 impressions were obtained from all three impression materials, which were poured by the die stone, and stone die was prepared. Wax patterns were fabricated on stone dies obtained from each impression and then casting was done. All the castings were checked for the marginal fit on metal die after applying a uniform standardized load of 30 pounds using measuring microscope. Results Result revealed that the marginal fit of the castings obtained from group II (laminated hydrocolloid technique) and group III (double-mix polyvinyl polysiloxane) did not show the significant difference between the two of them. Marginal gap of the castings obtained from group I are significantly greater in comparison to the castings obtained from groups II and III (p < 0.01). Conclusion Group II (laminated hydrocolloid technique) impression material may be the choice of many clinicians over group III (double-mix polyvinyl polysiloxane) impression material. Group I (alginate impression material), though very cost-effective and easy to handle may not able to produce accurate results. Clinical significance The study gives overview of the best impression material that can be used clinically. Laminated hydrocolloid technique is the technique of choice. How to cite this article Sinha M, Thakur B, Gaikwad A, Chaudhari LD, Kulkarni A, Kulkarni H. Relating the Marginal Fit of the Castings to the Accuracy of the Impressions made from Laminated Hydrocolloid Impression Technique: A Comparative Study. J Contemp Dent Pract 2012;13(2):167-172.

scholarly journals A Comparative Study of Dexmedetomidine and Clonidine for Attenuation of Hemodynamic Response during Laryngoscopy and Intubation

2020 ◽  
Vol 5 (2) ◽  
pp. 49-52
Author(s):  
Sanjay Kumar Gupta ◽  
Saurabh Singhal
Keyword(s):  
Placebo Group ◽  
Comparative Study ◽  
Oxygen Saturation ◽  
Normal Saline ◽  
Hemodynamic Response ◽  
Group Iii ◽  
Group I ◽  
The Mean ◽  
Group Ii ◽  
The Difference

Background: The present study was conducted to compare dexmedetomidine and clonidine for attenuation of hemodynamic response during laryngoscopy and intubation. Subjects and Methods: Group I patients received 0.9% normal saline (placebo), group II patients received 0.5 µg/kg of dexmedetomidine and group III patients received 3 µg/kg of or clonidine. Each group had 15 patients. Results: The mean age in group I was 28.2 years, in group II was 32.1 years and in group III was 33.2 years, mean weight was 61.2 years, in group II was 60.4 years and in group III was 62.1 years, height was 156.2 cm, in group II was 157.1 cm and in group III was 152.8 cm. There were 8 males and 7 females in group I, 6 males and 9 females in group II and 7 males and 8 females in group III. The mean SBP (mm Hg) in group I was 121.4 and in group II was 122.6, and in group III was 127.4, DBP (mm Hg) was 76.2 in group I, 78.4 in group II and 78.2 in group III. MAP (mm Hg) was 86.7 in group I, 93.2 in group II and 92.5 in group III. HR (bpm) was 74.2 in group I, 78.4 in group II and 77.3 in group III. % oxygen saturation was 98.2in group I, 98.5 in group II and 97.9 in group III. The difference was non- significant (P> 0.05). Conclusion: Authors found that both groups were equally effective in causing attenuation of hemodynamic response to endotracheal intubation.

Radioiodine remnant ablation in differentiated thyroid cancer after combined endogenous and exogenous TSH stimulation

2012 ◽  
Vol 51 (03) ◽  
pp. 67-72 ◽  
Author(s):  
O. Schober ◽  
B. Riemann ◽  
A. Vrachimis
Keyword(s):  
Thyroid Cancer ◽  
Differentiated Thyroid Cancer ◽  
Radioiodine Uptake ◽  
Remnant Ablation ◽  
Group Iii ◽  
The Third ◽  
Group I ◽  
Group Ii ◽  
Tsh Stimulation ◽  
Radioiodine Remnant Ablation

SummaryAim: Radioiodine remnant ablation (RRA) after (near-)total thyroidectomy (TE) is a key element in patients with differentiated thyroid cancer (DTC). The use of exogenous TSH stimulation (rhTSH) prior to RRA has shown promising results as compared to conventional thyroid hormone withdrawal (THW). As yet, the efficacy of RRA after brief THW and single rhTSH administration has not been assessed. Patients, methods: The study sample comprised 147 patients with DTC referred to our center between May 2008 and September 2010. All patients received TE with subsequent RRA. None of these 147 patients had evidence of distant metastasis. 93 patients had endogenous TSH stimulation 4–5 weeks after surgery (group I) and twenty-six received two rhTSH injections (group II). 28 patients were treated with a single rhTSH injection after a brief THW (group III). RRA-Efficacy was assessed three months after therapy by diagnostic whole-body scan and measurement of the tumour marker thyroglobulin (Tg) under TSH stimulation. Results: Three categories of success were defined for remnant ablation. Based on the definition of successful remnant ablation no visible uptake and a Tg ≤ 2.0 ng/ ml (category 1) was seen in 62/93 patients in group I, in 17/26 patients in group II (p = n.s.) and in 12/28 patients in group III (p < 0.05). Visible radioiodine uptake and a Tg ≤ 2.0 ng/ml (category 2) was seen in 16/28 patients of group III and thus significantly more frequent than in group I (28/93 patients) (p < 0.01). However, patients in group III (16/28 patients) and group II (8/26 patients) showed no significant difference in this category (p = n.s.). Visible radioiodine uptake and a Tg > 2.0 ng/ml (category 3) was found in 3/93 patients in group I and 1/26 patients in group II but in no patient in group III. Conclusion: The third strategy of remnant ablation using a single injection of rhTSH after a brief THW period resulted in a significant higher rate of patients with residual uptake in the thyroid bed and a Tg level below 2 ng/ml three months after remnant ablation in comparison to THW. However, the overall efficacy of the third protocol was not significantly different as compared to two rhTSH injections. Under the aspect of the supply shortage of rhTSH the combined endogenous and exogenous TSH stimulation may be an attractive alternative for remnant ablation in differentiated thyroid cancer.

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