Мне гораздо интересней, как все это лицидейство происходит. Неужели в московском НИИ не нашлось ни одного, кто бы не сказал, что за гадость, эта ваша диссертация.
Я не удивлюсь, когда научную степень присудят программе искусственного интеллекта.
Статьи от ботов уже публикуют.
Case for thyroidologists
Модераторы: Ren_Yumi, AOkhotin, Pyankov Vasily, Алексей Живов, Alon, dr.Ira
CLINICAL THYROIDOLOGY January 2009 Volume 21 Issue 1
http://thyroid.org/professionals/public ... 1/toc.html
http://thyroid.org/professionals/public ... 1/toc.html
CLINICAL THYROIDOLOGY February 2009 Volume 21 Issue 2
http://thyroid.org/professionals/public ... 2/toc.html
Галина Афанасьевна, для Володи статейка:
http://thyroid.org/professionals/public ... 12_3_5.pdf
Он, правда, все равно будет против.
http://thyroid.org/professionals/public ... 2/toc.html
Галина Афанасьевна, для Володи статейка:
http://thyroid.org/professionals/public ... 12_3_5.pdf
Он, правда, все равно будет против.
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Melnichenko
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CLINICAL THYROIDOLOGY April 2009 Volume 21 Issue 4
http://thyroid.org/professionals/public ... 4/toc.html
http://thyroid.org/professionals/public ... 4/toc.html
Remnant ablation with 50 mCi
COMMENTARY
The amount of radioiodine required for postoperative remnant ablation has been a matter of controversy for decades. The amounts of 131I are generally selected empirically and arbitrarily. Two systematic reviews (1, 2) found that large amounts of 131I, of approximately 100 mCi, are more efficient for remnant ablation than are lower activities of approximately 30 to 50 mCi, particularly after less than total thyroidectomy. The authors of both systematic reviews concluded that patients with differentiated thyroid cancer should routinely be treated with higher amounts of 131I following total thyroidectomy. However, the authors opined that it is not possible to reliably determine whether 30 mCi achieves results similar to those with 100 mCi and that large randomized trials are needed to resolve the issue to guide clinical practice. Such studies are now available.
In a randomized clinical trial aimed at finding the smallest effective amount of 131I for remnant ablation, Bal et al. (3) stratified 565 patients by 5-mCi (185-MBq) increments of 131I into eight study groups treated with 15 to 50 mCi. Patients receiving at least 25 mCi of 131I had a threefold greater chance of achieving successful remnant ablation than did patients receiving smaller amounts of 131I (60% vs. 81%, P = 0.006). The authors concluded that the therapeutic efficacy of 25 mCi or more 131I was equal to 50 mCi.
Another randomized clinical trial by Mäenpää et al. (4) of 160 adults with papillary or follicular thyroid cancer found, after randomly assigning patients to receive either 30 or 100 mCi of 131I, that there was no conclusive evidence that 100 mCi is more effective for ablation of the thyroid remnant than 30 mCi, and that 100 mCi is associated with more adverse effects. In each of the above-mentioned studies patients were prepared with thyroid-hormone withdrawal.
A study by Barbaro et al. (5) of 16 patients prepared with recombinant human TSH (rhTSH) and treated with 30 mCi of 131I found that remnant ablation was achieved in 81% of patients pretreated with rhTSH and 75% treated with thyroid-hormone withdrawal.
A randomized study by Pacini et al. (6) using rhTSH or thyroid-hormone withdrawal in preparation for a 100-mCi treatment of remnant ablation used several criteria for successful ablation: no visible uptake in the thyroid bed, or if visible, radioiodine uptake less than 0.1% on neck scans performed 8 months after therapy. The criteria were satisfied in 100% of the patients in both groups. A secondary criterion for ablation—an rhTSH-stimulated serum thyroglobulin concentration of <2 ng/ml—was fulfilled in 96% of euthyroid (rhTSH) patients and 86% of hypothyroid (withdrawal) patients (P = 0.234). Moreover, euthyroid patients treated with rhTSH received a one-third lower radiation dose to the blood, as compared with the radiation received by patients in the hypothyroid group. This study demonstrates comparable remnant ablation rates in patients prepared for 131I remnant ablation with 100 mCi by either administering rhTSH or withholding thyroid hormone.
Recommendation 36 of the 2009 ATA guidelines (7) for the management of thyroid cancer suggests that the minimum activity (30 to 100 mCi) necessary to achieve successful remnant ablation should be used, particularly for low-risk patients.
The study by Kusacic Kuna et al. shows that 50 mCi provides an optimal result, although the end points for remnant ablation were not as stringent as the studies cited above. Nonetheless, the rate of successful remnant ablation was significantly higher with 50 mCi as compared with 120 mCi, which is especially remarkable considering the high level of 131I uptake on a diagnostic whole-body scan obtained immediately after surgery indicating the presence of large thyroid remnants. Given the major concern about whole-body radiation and second cancers as the result of 131I therapy, it is prudent to follow the ATA guideline suggesting the use of the smallest amount of 131I that is effective. Preparing the patient with rhTSH provides even less whole-body radiation.
Ernest L. Mazzaferri, MD MACP
COMMENTARY
The amount of radioiodine required for postoperative remnant ablation has been a matter of controversy for decades. The amounts of 131I are generally selected empirically and arbitrarily. Two systematic reviews (1, 2) found that large amounts of 131I, of approximately 100 mCi, are more efficient for remnant ablation than are lower activities of approximately 30 to 50 mCi, particularly after less than total thyroidectomy. The authors of both systematic reviews concluded that patients with differentiated thyroid cancer should routinely be treated with higher amounts of 131I following total thyroidectomy. However, the authors opined that it is not possible to reliably determine whether 30 mCi achieves results similar to those with 100 mCi and that large randomized trials are needed to resolve the issue to guide clinical practice. Such studies are now available.
In a randomized clinical trial aimed at finding the smallest effective amount of 131I for remnant ablation, Bal et al. (3) stratified 565 patients by 5-mCi (185-MBq) increments of 131I into eight study groups treated with 15 to 50 mCi. Patients receiving at least 25 mCi of 131I had a threefold greater chance of achieving successful remnant ablation than did patients receiving smaller amounts of 131I (60% vs. 81%, P = 0.006). The authors concluded that the therapeutic efficacy of 25 mCi or more 131I was equal to 50 mCi.
Another randomized clinical trial by Mäenpää et al. (4) of 160 adults with papillary or follicular thyroid cancer found, after randomly assigning patients to receive either 30 or 100 mCi of 131I, that there was no conclusive evidence that 100 mCi is more effective for ablation of the thyroid remnant than 30 mCi, and that 100 mCi is associated with more adverse effects. In each of the above-mentioned studies patients were prepared with thyroid-hormone withdrawal.
A study by Barbaro et al. (5) of 16 patients prepared with recombinant human TSH (rhTSH) and treated with 30 mCi of 131I found that remnant ablation was achieved in 81% of patients pretreated with rhTSH and 75% treated with thyroid-hormone withdrawal.
A randomized study by Pacini et al. (6) using rhTSH or thyroid-hormone withdrawal in preparation for a 100-mCi treatment of remnant ablation used several criteria for successful ablation: no visible uptake in the thyroid bed, or if visible, radioiodine uptake less than 0.1% on neck scans performed 8 months after therapy. The criteria were satisfied in 100% of the patients in both groups. A secondary criterion for ablation—an rhTSH-stimulated serum thyroglobulin concentration of <2 ng/ml—was fulfilled in 96% of euthyroid (rhTSH) patients and 86% of hypothyroid (withdrawal) patients (P = 0.234). Moreover, euthyroid patients treated with rhTSH received a one-third lower radiation dose to the blood, as compared with the radiation received by patients in the hypothyroid group. This study demonstrates comparable remnant ablation rates in patients prepared for 131I remnant ablation with 100 mCi by either administering rhTSH or withholding thyroid hormone.
Recommendation 36 of the 2009 ATA guidelines (7) for the management of thyroid cancer suggests that the minimum activity (30 to 100 mCi) necessary to achieve successful remnant ablation should be used, particularly for low-risk patients.
The study by Kusacic Kuna et al. shows that 50 mCi provides an optimal result, although the end points for remnant ablation were not as stringent as the studies cited above. Nonetheless, the rate of successful remnant ablation was significantly higher with 50 mCi as compared with 120 mCi, which is especially remarkable considering the high level of 131I uptake on a diagnostic whole-body scan obtained immediately after surgery indicating the presence of large thyroid remnants. Given the major concern about whole-body radiation and second cancers as the result of 131I therapy, it is prudent to follow the ATA guideline suggesting the use of the smallest amount of 131I that is effective. Preparing the patient with rhTSH provides even less whole-body radiation.
Ernest L. Mazzaferri, MD MACP
Case #
78 летний джетельмен. 20 лет назад со слов пациента ему был удален узел щитовидной железы. Злокачественных клеток в удаленном узле не нашли.
Недавно был прооперирован по поводу опухоли легкого. Удалены нижняя и средняя доли правого легкого. На гистологии - метастазы фолликулярного рака щитовидной железы.
Из сопутствующих заболеваний - аутоиммунная тромбоцитопения, мерцательная аритмия, гипертония. Принимает Кумадин, Дигоксин, Дилтиазем, Липитор.
Что дальше делать?
Недавно был прооперирован по поводу опухоли легкого. Удалены нижняя и средняя доли правого легкого. На гистологии - метастазы фолликулярного рака щитовидной железы.
Из сопутствующих заболеваний - аутоиммунная тромбоцитопения, мерцательная аритмия, гипертония. Принимает Кумадин, Дигоксин, Дилтиазем, Липитор.
Что дальше делать?
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Melnichenko
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Несомнено , в ткани железы опухоль фолликулярная ( мб новая или изначально был мультифокальный рак ). Зову Ванушко ( кстати, позвала и в реале на форум ) , прошу гематолога на консультацию и принимаем решение об операции ( мне почему -то 79 лет не кажутся безумной старостью ) Потом боюсь - а Ванушко уверен в себе ..
С уважением ГА Мельниченко
Пациент действительно ни в коем случае не выглядит безумным стариком. Стройный, даже такой спортивный мужчина. Очень интеллигентный. Жена милая с перманентом. Ирвин Клайн считает, что операция прогноз не изменит. Это его пациент изначально. Почему, не обьясняет. Но они тем не менее, кажется собрались к хирургу за вторым мнением.
Еще один случай, который бы мне хотелось обсудить.
Пациентка 57 лет. В далеком прошлом туберкулез. По непонятной причине ее терапевт ежегодно назначал рентген легких. Много лет. На последнем рентгене было обнаружено затемнение в верхушке правого легкого, которое после КТ и биопсии оказалось метастазом в ребро с вовлечением окружающих мягких тканей. Метастаз состоит из клеток щитовидной железы. Причем совершенно нормальных.
Щитовидная железа удалена. Исследована вдоль и поперек в нескольких больницах. Опухоли нет. После операции без тироксина пациентка остается в эутиреозе в течение месяца. Сцинтиграфия с иодом после операции после одной дозы Тирогена - захвата в ложе железы нет, множественные очаги захвата в костях скелета. Накопление в очагах через 48 часов - 62%.
Пациентка абсолютно бессимптомна. Болей нет. Правда, небольшая боль в области метастаза в одном из ребер появилась после иньекции Тирогена. Прошла через несколько дней.
Пациентка 57 лет. В далеком прошлом туберкулез. По непонятной причине ее терапевт ежегодно назначал рентген легких. Много лет. На последнем рентгене было обнаружено затемнение в верхушке правого легкого, которое после КТ и биопсии оказалось метастазом в ребро с вовлечением окружающих мягких тканей. Метастаз состоит из клеток щитовидной железы. Причем совершенно нормальных.
Щитовидная железа удалена. Исследована вдоль и поперек в нескольких больницах. Опухоли нет. После операции без тироксина пациентка остается в эутиреозе в течение месяца. Сцинтиграфия с иодом после операции после одной дозы Тирогена - захвата в ложе железы нет, множественные очаги захвата в костях скелета. Накопление в очагах через 48 часов - 62%.
Пациентка абсолютно бессимптомна. Болей нет. Правда, небольшая боль в области метастаза в одном из ребер появилась после иньекции Тирогена. Прошла через несколько дней.
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Melnichenko
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