Recombinant human thyrotropin in thyroid cancer and hypopituitarism due to sella metastasis

We present a patient with thyroid cancer and hypopituitarism who required recombinant human thyrotropin (rhTSH) for I-131 Scanning with respect to subsequent therapy. The thyroid cancer had been unknown until central neurological symptoms developed, leading to the diagnosis of a huge metastasis to the sella that was the only manifestation of metastatic spread. The failure to generate endogenous thyrotropin (TSH) was overcome by the use of rhTSH for performing a I-131 test. Unfortunately, the I-131 uptake was not sufficient for therapy. This subject is the first reported case who required the application of rhTSH due to a single thyroid cancer metastasis in the sella region with secondary failure to generate endogenous TSH

Pathological regional blood flow in opiate-dependent patients during withdrawal: A HMPAO-SPECT study

The aims of the present study were to investigate regional cerebral blood flow (rCBF) in heroin-dependent patients during withdrawal and to assess the relation between these changes and duration of heroin consumption and withdrawal data. The rCBF was measured using brain SPECT with Tc-99m-HMPAO in 16 heroin-dependent patients during heroin withdrawal. Thirteen patients received levomethadone at the time of the SPECT scans. The images were analyzed both visually and quantitatively, a total of 21 hypoperfused brain regions were observed in 11 of the 16 patients. The temporal lobes were the most affected area, hypoperfusions of the right and left temporal lobe were observed in 5 and 5 patients, respectively. Three of the patients had a hypoperfusion of the right frontal lobe, 2 patients showed perfusion defects in the left frontal lobe, right parietal lobe and left parietal lobe. The results of the quantitative assessments of the rCBF were consistent with the results of the qualitative findings. The stepwise regression analysis showed a significant positive correlation (r = 0.54) between the dose of levomethadone at the time of the SPECT scan and the rCBF of the right parietal lobe. Other significant correlations between clinical data and rCBF were not found. The present results suggest brain perfusion abnormalities during heroin withdrawal in heroin-dependent patients, which are not due to the conditions of withdrawal

Does PRRT with standard activities of 177Lu-octreotate really achieve relevant somatostatin receptor saturation in target tumor lesions?: insights from intra-therapeutic receptor imaging in patients with metastatic gastroenteropancreatic neuroendocrine tumors

Twenty plantain crop fields were sampled to identify Meloidogyne spp. in Tierralta and Valencia municipalities. Ten soil and root samples per field were taken to obtain the nematodes. Meloidogyne species classification was based on the perineal pattern of the female, shape of the stylet in females, males and juveniles (J2), and shape and number of rings on the cephalic region in J2 and males. Stylet length and dorsal oesophageal gland (DOG) on males, females and J2, body length, tail and hyaline tail region in J2 were measured to identify the specie of root-knot nematode. Meloidogyne spp. were found in 80% of the fields in Valencia, and 60% of the field in Tierralta. M. incognita and M. arenaria were detected. M. incognita was the most frequent species throughout the sampled area. Mixtures of both species were found in both municipalities. This is the first report of mixed M. incognita and M. arenaria associated to plantain crop in Colombia.Veinte cultivos de plátano fueron muestreados en los municipios de Tierralta y Valencia para identificar las especies de Meloidogyne asociadas a este cultivo. Diez muestras de suelos y raíces fueron colectadas en cada de los lotes, las cuales fueron usadas para la obtención de los nemátodos. La clasificación de las especies se basó en las características morfológicas (patrón perineal de las hembras, forma del estilete de hembras, machos y juveniles (J2); forma y número de anillos de la región cefálica de J2 y machos) y morfométricas (longitud del estilete y la distancia de la base del estilete a la desembocadura de la glándula dorsal (D.G.O) de hembras, machos y J2; longitud del cuerpo, la cola y la región hialina de los J2. En el 80% de las fincas en Valencia se detectó la presencia de estos nematodos, mientras que el 60% de los predios en Tierralta fueron positivos para los mismos. Las especies encontradas fueron Meloidogyne incognita y M. arenaria. De estas, M. incognita fue la más frecuente detectada en la zona productora de plátano en los dos municipios. Mezcla de especies fueron detectadas en ambos municipios. Se reporta por primera vez en Colombia las especies M. incognita y M. arenaria, así como la mezcla de las mismas asociadas al cultivo de plátano

Prophylactic Peripheral Blood Stem Cell Collection in Patients with Extensive Bone-Marrow Infiltration of Neuroendocrine Tumours Prior to Peptide Receptor Radionuclide Therapy with 177Lu-DOTATATE

Peptide receptor radionuclide therapy (PRRT) of metastatic neuroendocrine tumors (NET) can be successfully repeated but may eventually be dose-limited. Since 177Lu-DOTATATE dose limitation may come from hematological rather than renal function, hematological peripheral blood stem cell backup might be desirable. Here, we report our initial experience of peripheral blood stem-cell collection (PBSC) in patients with treatment-related cytopenia and therefore high risk of bone-marrow failure. Five patients with diffuse bone-marrow infiltration of NET and relevant myelosuppression (≥grade 2) received PBSC before one PRRT cycle with 177Lu-DOTATATE (7.6 ± 0.8 GBq/cycle). Standard stem-cell mobilization with Granulocyte-colony stimulating factor (G-CSF) was applied, and successful PBSC was defined as a collection of >2 × 106/kg CD34+ cells. In case of initial failure, Plerixafor was administered in addition to G-CSF prior to apheresis. PBSC was successfully performed in all patients with no adverse events. Median cumulative activity was 44.8 GBq (range, 21.3–62.4). Three patients had been previously treated with PRRT, two of which needed the addition of Plerixafor for stem-cell mobilization. Only one of five patients required autologous peripheral blood stem-cell transplantation during the median follow up time of 28 months. PBSC collection seems to be feasible in NET with bone-marrow involvement and might be worth considering as a backup strategy prior to PRRT, in order to overcome dose-limiting bone-marrow toxicity

Successful radiopeptide targeting of metastatic anaplastic meningioma: Case report

A patient with anaplastic meningioma and lung metastases resistant to conventional treatment underwent radiopeptide therapy with 177Lu- DOTA-octreotate in our institute. The treatment resulted in significant improvement in patient's quality of life and inhibition of tumor progression. This case may eventually help to establish the value of radiopeptide therapy in patients with this rare condition

Repeated Radionuclide therapy in metastatic paraganglioma leading to the highest reported cumulative activity of 131I-MIBG

131I-MIBG therapy for neuroendocrine tumours may be dose limited. The common range of applied cumulative activities is 10-40 GBq. We report the uneventful cumulative administration of 111 GBq (= 3 Ci) 131I-MIBG in a patient with metastatic paraganglioma. Ten courses of 131I-MIBG therapy were given within six years, accomplishing symptomatic, hormonal and tumour responses with no serious adverse effects. Chemotherapy with cisplatin/vinblastine/dacarbazine was the final treatment modality with temporary control of disease, but eventually the patient died of progression. The observed cumulative activity of 131I-MIBG represents the highest value reported to our knowledge, and even though 12.6 GBq of 90Y-DOTATOC were added intermediately, no associated relevant bone marrow, hepatic or other toxicity were observed. In an individual attempt to palliate metastatic disease high cumulative activity alone should not preclude the patient from repeat treatment