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UNLABELLED: Radiosynoviorthesis (RSO) with the nuclides rhenium-186 sulphide (186Re) and erbium-169 citrate (169Er) is an established concept for the treatment of persistent synovitis of medium and small sized joints. THE AIM of the present studies was to investigate the biological radiation effect based on analysing chromosome aberrations. PATIENTS, METHODS: Immediately before and 17 to 19 days (186Re) or 45 to 50 (169Er) days after RSO with 186Re or 169Er colloid and subsequent immobilisation of the treated joint, blood samples of a total of 23 patients were collected. The yield of dicentric chromosomes in lymphocytes was determined exclusively in metaphases of the first cell cycle in vitro. In addition, for 186Re the activity leakage was measured three days after RSO by whole-body scintigraphy. RESULTS: No statistically significant increase in the number of dicentric chromosomes (40 and 88 before and 59 and 105 after treatment with 186Re and 169Er, respectively) in a total of 47017 cells analysed from 46 blood samples could be found as a result of RSO. For 186Re an activity leakage of 3.9%±7% with a maximum of 23.4% corresponding to an effective dose of 2.8±4.5 mSv , respectively 13.8 mSv, was determined. Also in the case of the maximum leakage no significant increase of dicentric chromosomes were detected. CONCLUSIONS: No significant biological radiation effect can be detected after RSO with 186Re and 169Er, also in cases of high leakage. Therefore, RSO can be classified as a save therapeutic procedure without a relevant radiation risk.

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OBJECTIVE: The aim of this international multicentric randomized phase 3 clinical trial was to compare prospectively radiosynoviorthesis (RSO) with rhenium-186-sulfide (186Re) to intra-articular corticotherapy in patients with clinically controlled rheumatoid arthritis (RA), but in whom one or a few medium-sized joints remained painful or swollen. METHODS: One hundred and twenty-nine joints in 81 RA patients [stratified into 2 groups: wrists (group 1, n = 78) and all the other joints (group 2, n = 51, including 18 elbows, 21 shoulders and 12 ankles)] were randomized to receive intra-articular injections of either 186Re-sulfide (64 +/- 4 MBq), or cortivazol (Altim) 3.75 mg. Clinical assessment was performed before and then at 3, 6, 12, 18 and 24 months after local therapy, using a 4-step verbal rating scale (VRS) and a 100 mm visual analog scale for pain, a 4-step VRS for joint swelling and mobility and a 2-step VRS for the radiological stage. The Mantel-Haenszel test was used for qualitative variables, analysis of variance (ANOVA) for quantitative pain analysis and Kaplan-Meyer survival test for relapse analysis. RESULTS: 186Re was observed to be statistically superior to cortivazol at 18 and 24 months while no statistical difference was seen for any criterion at 3, 6 and 12 months post injection. At 24 months, the difference in favor of 186Re was significant for pain (p = 0.024), joint swelling (p = 0.01), mobility (p = 0.05, non-wrists only), pain and swelling (p = 0.03) and pain or swelling (p = 0.02). "Survival" studies (Kaplan-Meyer) demonstrated a greater relative risk of relapse in corticoid treated joints, but only from the second year of follow-up. No serious side effect was observed in any patient, with only light and transient local pain and/or swelling occurring in 24% of cases, regardless of the treatment used. CONCLUSION: 186Re-sulfide and cortivazol had similar efficacy up to 12 months post-injection, but 186Re became clearly more effective at 18 and 24 months, for all criteria monitored and for RA outcome. Therefore, 186Re RSO can be recommended for routine clinical use.

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OBJECTIVES: Intra-articular injection of 169Erbium-citrate (169Er-citrate; radiosynoviorthesis or radiosynovectomy) is an effective local treatment of rheumatic joint diseases. However, its efficacy in corticosteroid-resistant rheumatoid arthritis-affected joints has not been clearly demonstrated. METHODS: A double-blind, randomised, placebo-controlled, international multicentre study was conducted in patients with rheumatoid arthritis with recent (< or = 24 months) ineffective corticosteroid injection(s) into their finger joint(s). Eighty-five finger joints of 44 patients were randomised to receive a single injection of placebo (NaCl 0.9%) or 169Er-citrate. Results of evaluation 6 months later were available for 82 joints (46 metacarpophalangeal and 36 proximal interphalangeal joints) of 42 patients: 39 169Er-citrate-injected joints and 43 placebo-injected joints. Efficacy was assessed using a rating scale for joint pain, swelling and mobility. RESULTS: Intent-to-treat analysis of the results of the 82 joints showed a significant effect of 169Er-citrate compared to placebo for the principal criteria decreased pain or swelling (95 vs 79%; p = 0.038) and decreased pain and swelling (79 vs 47%; p = 0.0024) and for the secondary criteria decreased pain (92 vs 72%; p = 0.017), decreased swelling (82 vs 53%; p = 0.0065) and increased mobility (64 vs 42%; p = 0.036). Per-protocol analysis, excluding 18 joints of patients who markedly changed their usual systemic treatment for arthritis, gave similar percentages of improvement but statistical significance was lower owing the reduced power of the statistical tests. CONCLUSION: These results confirm the clinical efficacy of 169Er-citrate synoviorthesis of rheumatoid arthritis-diseased finger joints after recent failure of intra-articular corticotherapy.

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Inflammatory joint diseases as well as arthropathy are common joint diseases. Many of them may be treated by synovectomy to stop disease progression and to improve joint function. Radiosynoviorthesis as one therapeutic procedure of rheumatoid arthritis, other inflammatory joint diseases, persistent synovial perfusion, and other joint diseases is widely used in many countries in Europe. Using Y-90 for the knee joint, Re-186 for middle sized joints and Er-169 for small joints an improvement of symptoms and function may be observed in about 60-80% of patients.

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In 14 patients with various kinds of cardiomyopathy (DCM, HCM with and without obstruction, latent cardiomyopathy (= LCM], after confirmation of diagnosis, myocardial imaging with the recently developed substance 123I-metaiodobenzylguanidine (MIBG), an analog to guanethidine, was performed. In comparison, four patients in whom cardiac disease had been excluded, were evaluated. Myocardial uptake and washout were evaluated quantitatively. As a result, each kind of cardiomyopathy showed a significantly higher activity uptake versus normals, especially in patients with DCM. In all patients, the washout rate was increased compared to normals. The higher uptake is caused by depletion of catecholamine stores, as already known in DCM. On the other hand, the increased washout rate is considered to be a sign of a high sympathetic tone found in patients with HCM and LCM. The results seem to demonstrate a primary or secondary involvement of the sympathetic nervous system in these entities of hitherto unknown etiology.

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In a macroautoradiographic study in pregnant and nonpregnant mice the distribution pattern of 14C-Endralazine (6-Benzoyl-3-hydrazino-5,6,7,8-tetrahydropyrido(4,3-c)-pyridazine- mesilate), a new direct vasodilator drug, was investigated, since earlier studies with minoxidil and hydralazine had shown apparent discrepancies between the relatively short elimination-half-life and the long pharmacological effect of the drugs. After a single oral administration of 5 mg/kg 14C-endralazine the initial high amounts of radioactivity in the gastro-intestinal tract, the kidneys and the liver continuously decreased in the course of the 2nd to the 8th hour after application. 24 h after administration the drug was nearly completely eliminated from these organs except the liver. A remarkably high and persistent affinity of 14C-radioactivity to the blood vessel walls was found even 48 h after application which could explain the long acting pharmacological response to the drug. Only low levels of radioactivity were registrated in the fetus of pregnant mice.

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The 131-hippuran clearance was determined preoperatively in 24 female Alsatian dogs. At three times (days 1, 7 and 28) after antireflux grafting operation, PAH, inulin, and 131I-hippuran clearances of the two kidneys were determined separately on both sides with a radioisotope nephrogram. There was a postoperative functional restriction of the operated or contralateral kidney at no time and for none of the clearance substances. However, there was a significant increase of the tubulosecretory partial function of both kidneys on the 1st postoperative day. The single findings of the radioisotope nephrograms of interest are discussed.

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Using functional scintigraphy of the salivary glands, the function of the nervus intermedius can be assessed by estimating excretory quotients for both submandibular glands. This method is preferred to the standard salivation test method of Magielski and Blatt, despite a minimal exposure of the patient to radiation from the injected Natriumpertechnetat. The technical course of this investigation, along with the indications for its use, will be presented.

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A ureteroneocystostomy (UNC) was carried out on 32 dogs. A standardised measurement of flow across the ureterovesical anastomosis revealed a significant obstruction on the day of the operation itself and on the first 5 days after the operation. On the 1st, 7th and 28th day after the operation there was no significant reduction in either tubulo-secretory or glomerular function on the operated and non-operated kidneys.

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This paper presents first experiences with a new method of bilateral retroperitoneal lymph node dissection in cases of nonseminomatous testis tumors: lymph node-bearing tissue - labeled by conventional lymphoscintigraphy - is intraoperatively directly detected by means of a semiconductor and then removed. In our experience this nuclide detector-directed lymph node dissection seems to be a remarkable improvement of retroperitoneal lymph node dissection because of higher effectiveness, more careful surgical technique and shortened time of operation.

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Doses of ca. 2--3 mg/kg of nitroprusside, cyanide and thiocyanate, tracer-marked with 14C, were applied i.v. to pregnant mice and rats. Autoradiograms of the whole animal were taken 1 min, 10 min and 60 min after administration. After administering nitroprusside two phases of the tracer pattern could be distinguished: the phase of removal of the cyanide poisoning with tracer-markings predominant in the liver and the lungs, followed by the phase of thiocyanate excretion, with tracer-markings predominantly in the stomach and urinary system. Tracer-markings in the foetuses were observed during the thiocyanate phase, but not during the cyanide phase. The therapeutic consequences are discussed.

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We examined 56 patients with latent or clinical hypothyroidism and a control group of 18 patients with acute hypothyroidism. We were especially interested in the localization and extent of hearing abnormalities. 45% of the patients with chronic hypothyroidism showed a hearing loss. 2 of these patients had a pure conductive loss, 7 a combined hearing loss and 16 a sensorineural hearing loss. We demonstrated hair cell damage in 13 of the patients with chronic hypothyroidism. This loss was mild to moderate in over 90% of the cases. Although several patients had basilar-cochlear hearing losses, no characteristic audiograms could be found. 50% of the patients showed a small improvement in hearing after thyroid substitution therapy. The results of our examinations are discussed in detail.

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We examined 56 patients with latent or clinically manifest hypothyroidism and 18 patients with acute athyreosis as a control group. We were especially interested in the localization and extent of hearing abnormalities. 45% of the patients with chronic hypothyroidism showed a hearing loss. Of these, two patients had a pure conductive loss, seven a combined hearing loss and 16 a sensori-neural hearing loss. We demonstrated hair cell damage in 13 of the patients with chronic hypothyroidism. The hearing loss was mild to moderate in over 90% of the cases. Although several patients had a basocochlear hearing loss, no characteristic audiogram was found. There was a correlation between the conductive loss and the severity of the hypothyroidism. 50% of the patients showed a significant improvement in hearing after substitution therapy. The results of our examinations are discussed in detail.

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Isolated Triiodothyronine (T3) hyperthyroidism in childhood is rate. The incidence among hyperthyroid children is about 10%. The authors present a case history of a 12 2/12 year old girl with T3-thyrotoxicosis. Cause, diagnosis and therapy are thoroughly discussed. The importance to estimating serum T3 concentration for establishing the diagnosis of T3 hyperthyroidism is emphasized.

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Thyroid carcinomas rarely metastasize to the skin. In three patients skin metastases following follicular, papillo-follicular and medullary carcinomas were seen. In two cases the metastatic spread was haematogenous, in a third patient with a retrosternal thyroid carcinoma there was massive spread through the anterior thoracic wall. The diagnosis was made on histological invesitgation of the skin lesions and after total body scintigraphy with 131I. In one seemingly-healthy patient the histological investigation of skin nodule first led to the diagnosis of thyroid carcinoma. If skin metastases occur several years after the discovery of a visceral tumour the possibility of a second primary tumour should be considered. The results of combined treatment with with surgery, radio-therapy, (radioiodine and tele-cobalt) and hormone treatment show that skin metastases in thyroid carcinoma do not necessarily have a hopeless prognosis.

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