79 research outputs found
Effect of short-term treatment with low dosages of the proton-pump inhibitor omeprazole on serum chromogranin A levels in man.
No full textBACKGROUND:
Measurement of chromogranin A (CgA) levels in blood can be used to monitor neuroendocrine tumors (NETs). CgA levels may also be elevated in several other endocrine and non-endocrine diseases. It is well known that drugs affecting acid gastric secretion can increase gastrin. Proton-pump inhibitors are extensively used but only a few data have been reported on their effects on CgA secretion.
DESIGN:
The aim of the study was to evaluate the short-term effect of low dosages of omeprazole (OM) on CgA levels and to sensitize endocrinologists to possible false positive values of CgA in order to prevent expensive diagnostic work-up in searching for NETs.
SUBJECTS AND METHODS:
Thirty-five female and nine male in-patients (18-81 years) were studied. Mild or severe hypertension in 20 patients needed therapy. Endocrine and metabolic diseases were diagnosed in the majority of patients. CgA levels were evaluated before and during OM therapy (10 mg/day, orally).
RESULTS:
Without OM therapy, CgA levels were 64+/-6 microg/l. Elevated baseline CgA levels were found in nine subjects. CgA levels were significantly related to age (P<0.001), creatinine levels (P=0.03) and the severity of hypertension (P=0.002). On short-term OM therapy (n=42; 18.8+/-2.4 days; range 5-90 days) a significant (P<0.001) increase in CgA (145+/-22 microg/l) from baseline (63+/-7 microg/l) levels was found. The average net CgA increase on short-term OM therapy was 93+/-20 microg/l. There was a significant correlation between baseline CgA levels and CgA increase on short-term OM therapy (P=0.004) but not between the increase in CgA and the duration of the therapy.
CONCLUSIONS:
An increase in CgA levels quickly follows the start of low dosages of OM. This release is more pronounced when the baseline CgA levels are already increased by slight renal insufficiency or severe hypertension. In this common clinical situation an intensive work-up for NETs is not justified before reassessment of CgA after the withdrawal of OM
Safety and efficacy of administering 0.2 mg of recombinant human TSH for two consecutive days as an adjuvant to low-dose radioiodine therapy in out-patients with large non-toxic multinodular goitre.
No full textRecombinant human TSH (rhTSH) has recently been used as an adjuvant to the treatment of non-toxic multinodular goitre (MNG) by means of 131I. The aim of our study was to evaluate the efficacy of 0.2 mg rhTSH or placebo administered im on 2 consecutive days before a fixed therapeutic dose of 14 mCi of 131I. Thirteen elderly patients (71±7 years) with large non-toxic MNG (group 1) were treated with rhTSH plus 131I. While a control group of 8 patients, matched for age and non-toxic MNG volume, was treated with placebo plus 131I (group 2)
Safety and efficacy of administering 0.2 mg of recombinant human TSH for two consecutive days as an adjuvant to therapy with low radioiodine doses in elderly out-patients with large nontoxic multinodular goiter
No full textAIM: The aim of this study was to evaluate the efficacy of recombinant human TSH (rhTSH) as an adjuvant to radioiodine therapy for nontoxic multinodular goiter (MNG) in elderly subjects.
METHODS: Twelve elderly out-patients with large MNG (group 1) were studied. The effect of adjuvant rhTSH administration (0.2 mg i.m. on 2 consecutive days) before low-dose (131)I was compared with that of radioiodine alone in 8 out-patients matched for age and MNG volume (group 2). The follow-up period was similar in both groups.
RESULTS: The number and severity of side-effects during the first month of treatment were similar in both groups. On final examination, the number of patients symptomatic for goiter was significantly lower in group 1 than in group 2 (P=0.03). In group 1, TSH levels peaked at 40.3+/-9.5 mU/L on day 3, from the baseline value of 0.5+/-0.1 mU/L (P<0.001). In group 2, baseline TSH was 0.4+/-0.1 mU/L. Although a marked increase in f-T3, f-T4 and Tg (P<0.001) was noted in both groups during the first 2 weeks of treatment, peak values were much higher in group 1 than in group 2. On final examination, a slightly significant increase (P=0.01) in TSH levels from the baseline was noted in both groups (group 1: 1.2+/-0.2 mU/L; group 2: 1.4+/-0.3 mU/L). The percentage of patients who did not need therapies to control TSH secretion at the last examination was higher in group 1 (83%) than in group 2 (38%). Only in group 1, a significant reduction was noted in mean anterior-posterior lobar width (31+/-1.7 mm) from the baseline value (24.5+/-1.7 mm, P=0.04). Thyroid volume was reduced from 78.1+/-11.7 mL to 49.4+/-13.4 mL (P=0.001) in group 1 and from 89.8+/-25.2 mL to 67.1+/-20.5 mL (P=0.04) in group 2. Six months after (131)I therapy, slight changes in thyroid length and tracheal lumen were noted in both groups.
CONCLUSIONS: This long-term controlled study demonstrates that 0.2 mg of rhTSH on 2 consecutive days increases the efficacy of ambulatory (131)I dosages in treating nontoxic MNG in elderly subjects. Adequate drug preparation generally prevents side-effects due to short-term but marked thyrotoxicosis that is aggravated by rhTSH administration. An increase in thyroid volume reduction seems to be the most important effect of rhTSH administered before (131)I
Radiochemical purity and stability of 99mTc-HMPAO preparations:the influence of pH, volume recovery, and storage conditions
No full textSUMMARY: OBJECT. The aim of this work was to study the influence of the nature (pH, plastic or glass ampoules) of 0,9% NaCl sodium chloride injection used to dilute generator produced sodium pertechnetate at 1, 2 , 5 mL for CeretecTM (GE Healthcare, UK) reconstitution on the radiochemical purity (RCP) stability and pH of Technetium-99m-d,l-hexameththylpropyleneamineoxime (99mTc-d,l-HMPAO).
MATERIAL AND METHODS. 99mTc-d,l-HMPAO is prepared using commercially available freeze-dried kits according to the procedure specified by the manufacturer. Kits were reconstituted with 1, 2 or 5 mL of fresh (not more 2 h old) generator eluted sodium [99mTc]pertechnetate coming from a generator eluted not more than 24 h in 0,9% NaCl containing 0,074-0,22 GBq/mL. The specified radioactive concentration was obtained by diluting generator eluted sodium [99mTc]pertechnetate with 0,9% NaCl Sodium Chloride Injection coming from stored away from light sources plastic ampoules and Sodium Chloride Injection from glass ampoules. The radiochemical purity of 99mTc-d,l-HMPAO was measured at 0, 15 and 30 min after preparation and was determined by methods specified by the manufacture.
RESULTS. We found no influence on the radiochemical purity and stability ( at 30 min following the preparation) of 99mTc-HMPAO based on the type and the pH of sodium chloride injection used for pertechnetate diluting. RCP values decreased proportionally with the decrease of the final volume of preparation and in particular for 1 mL of diluted pertechnetate, the PCR at 30 minutes following the preparation is less than the required (80%). Finally we found that pH average for 99mTc-d,l-HMPAO is lower than indicated by the manufacturer (9,0-9,8).
CONCLUSION. This work revelated that instability of the neutral lipophilic 99mTc-d,l-HMPAO complex has a faster onset in reconstituted kits with volumes smaller than 2 mL of pertechnetate, as required for routine preparations for in vitro leukocyte labelling. Iin particular the 1 mL recconstitution kit should not be used beyond the 15 minutes after preparation. This suggests that any protocols that involve volumes smaller than 2 mL of pertechnetate for the CeretecTM reconstitution should be carefully evaluated in terms of stability of the product
A case-controlled study on the quality of life in a cohort of patients with history of differentiated thyroid carcinoma
No full textAlthough quality of life (QoL) has become an important aspect of cancer rehabilitation, psychometric studies on thyroid cancer patients are rare. We performed a case-controlled study on QoL in patients with differentiated thyroid carcinoma (DTC). QoL was evaluated in 61 patients with a history of DTC diagnosed from < 1 to 23 yr earlier. An undetectable thyroglobulin (Tg) level after recombinant human TSH (rhTSH) testing was considered the best predictor of cure. QoL was evaluated by means of a general psychiatric interview, the self-rating Kellner Symptoms Questionnaire (KSQ) and the Hamilton Depression Scale (HDS). QoL was also evaluated in a control group of subjects on L-T4 therapy with a non-toxic multinodular goiter diagnosed from < 1 to 25 yr earlier. DTC and control subjects were similar in age, male-female distribution and concomitant psychiatric therapies. Per-week dosage of L-T4 was higher in DTC patients than in controls (p < 0.01). In neither group of subjects was there any correlation between current TSH levels or interval from diagnosis and KSQ or HDS scores. Only in DTC patients was there a positive correlation between age and KSQ (p < 0.05) or HDS (p < 0.01) scores. There was a significant difference in overall KSQ scores between DTC (33.4 +/- 2.1) and control (24.5 +/- 1.9; p < 0.01) subjects. The subscales of KSQ showed a significant inter-group difference. HDS scores were higher in DTC subjects (35.8 +/- 1.0) than in controls (30.0 +/- 1.1; p < 0.01). HDS score was significantly (p = 0.02) higher in female than in male DTC patients. In patients with papillary carcinoma there was a positive correlation between the MACIS (metastases, age, completeness, invasiveness, size) score and KSQ (p = 0.01) or HDS (p < 0.01) scores. After rhTSH testing, detectable Tg levels were found in 13% of DTC patients. In Tg-positive patients, KSQ and HDS scores were not different from those of Tg-negative patients. After an 8-14 month period, a significant decrease in the KSQ scale somatization (p = 0.02) was found in a sub-set of 31 DTC patients. In conclusion, even in the age of rhTSH testing, DTC patients suffer an impairment of their QoL, as noted when short-term L-T4 withdrawal was the gold standard. Longitudinal evaluation seems to indicate a slight improvement in QoL when safe rhTSH testing is extensively used in the management of the disease
Preparation of 99mTc-HMPAO: influence of pH, volume recovery and storage conditions of the physiological solution on radiochemical purity and stability.
No full text99mTc-HMPAO is currently used to image cerebral blood flow and for in vitro leukocyte labeling. The jield of this liphophilic complex plays an important role in diffusion across the blood brain barrier and in cell labeling. Instability in the vial occurs relatively fast at RT and can limit the use of 99mTc-HMPAO to only a short interval following its preparation. We studied the influence, on the radiochemical purity and stability of this 99mTc complex of different characteristics of the 0,9% NaCl used to dilute generator-produced sodium pertechnetate
Evaluation of effective renal plasma flow with I-127 ortho-iodohippurate and I-123 ortho-iodohippurate in rabbits
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Pharmacokinetics of an allergen and a monomeric allergoid for oromucosal immunotherapy in allergic volunteers.
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