7 research outputs found
Neuroendocrine Tumors: A Focus on Liver Metastatic Lesions
Transhepatic radionuclide infusion has been introduced as a new treatment approach for unresectable liver neuroendocrine metastatic lesions with the prerequisite of a positive In-111 Pentetreotide (Octreoscan). Patients with multiple liver neuroendocrine metastases can be locally treated after selective hepatic artery catheterization and infusion of radiolabeled somatostatin analogs, and in case of extra-hepatic secondary spread, after simple i.v. application. According to the world wide references, the average dose per session to each patient is 6.3 ± 0.3 GBq (∼160–180 mCi) of In-111-DTPA-Phe1-Pentetreotide, 10- to 12-fold in total, administered monthly or of 4.1 ± 0.2 GBq (∼105–116 mCi) of Y-90 DOTA TOC, threefold in total, or of 7.0 ± 0.4 GBq (∼178–200 mCi) of Lu-177 DOTA TATE, fourfold to sixfold in total (the choice of which being based on the tumor size, assessed by CT or MRI). Follow-up at monthly intervals has to be performed by means of ultrasonography (US). Treatment response has to be assessed according to the WHO criteria (RECIST or SWOG)
Severe dopaminergic pathways damage in a case of chronic toluene abuse
Introduction: Toluene toxicity primarily affects central nervous system
white matter, causing a characteristic brain MRI pattern.
Case report: A toluene addicted man, after an abstinence period and a
treatment with neuroleptics, presented with severe worsening of
preexisting generalized tremor, opsoclonus, dysarthria, gait inability,
jerky tendon reflexes and behaviour disorders. Magnetic resonance
imaging showed mild leukoencephalopathy and hypointensities in deep gray
matter nuclei. The DaT-scan revealed a decrease in presynaptic dopamine
reuptake.
Conclusion: Clinical and neuroradiological findings and the possible
sensitivity to neuroleptics indicate dopaminergic impairment. Our case
suggests that chronic toluene abuse causes presynaptic dopaminergic
depletion. (C) 2009 Elsevier B.V. All rights reserved
Selective hepatic arterial infusion of In-111-DTPA-Phe(1)-octreotide in neuroendocrine liver metastases
Purpose The aim of this study is to evaluate the effectiveness of
In-111-DTPA-Phe(1)-octreotide infusions after selective catheterization
of the hepatic artery in inoperable metastasised liver, sst(2)
receptor-positive neuroendocrine tumours due to the effect of In-111
Auger electron emission, minimising in parallel the toxicity of
non-target tissue.
Methods The average dose per session administered monthly to each
patient (17 cases in total) was 6.3 +/- 2.3 GBq. Repetitions did not
exceed 12-fold, except in one case (15 sessions). Response assessment
was classified according to the Response Evaluating Criteria in Solid
Tumours. CT/MRI scans were performed as baseline before, during and
after the end of treatment, and monthly ultrasound images for follow-up
measurements. Toxicity (World Health Organization criteria) was measured
using blood and urine tests of renal, hepatic and bone marrow function.
Results Complete response was achieved in one (5.9%) patient and
partial in eight (47.0%), and disease stabilization in 3 (17.7%)
patients; five (29.4%) did not respond. A 32-month median survival time
was estimated in 12 (70.5%). Nine of these 12 surviving had a mean
target diameter shrinkage from 144 +/- 81 to 60 +/- 59 mm. Grade 1
erythro-, leuko- and thrombo-cytopenia occurred in three (17.6%) cases.
Conclusion In unresectable metastatic liver lesions positive for
somatostatin receptors repeated, transhepatic high doses of
In-111-DTPA-Phe(1)-octreotide show an effective therapeutic outcome.
Given the locoregional modality character of the administration
technique plus the extremely short range of In-111 Auger and internal
conversion electrons emission, no nephro-, liver- or myelo-toxicity has
so far been observed
Differences in cause and 12-month follow-up outcome of parkinsonian symptoms in depressed older adults treated with antipsychotics: a case series
BackgroundParkinsonian symptoms are common adverse effects of
antipsychotics. Older adults are particularly vulnerable to drug-induced
parkinsonism. Nonetheless, parkinsonian symptoms in seniors treated with
antipsychotics cannot be straightforwardly attributed to antipsychotic
medication. A comprehensive diagnostic workup is necessary in many cases
in order to shed light on the cause of such symptoms in this patient
population.Case seriesEight cases of hospitalized depressed older adults
with parkinsonian symptoms, who were treated for at least one year with
antipsychotics, are reported. Based on neurological consultation,
structural brain imaging and Ioflupane (I-123) dopamine transporter
(DAT) single photon emission computerized tomography (SPECT),
Parkinson's disease was diagnosed in one case, idiopathic tremor in
another, vascular parkinsonism in another one, while in another
individual parkinsonian symptoms persisted at 12-month post-discharge
follow-up even though his/her symptoms were classified as drug-induced
on discharge. In four patients, parkinsonian symptoms were definitely
drug-induced and no movement disturbances were reported at
follow-up.ConclusionsDifferences in the cause and outcome of
parkinsonian symptoms in seniors treated with antipsychotics merit
systematic and in-depth study considering the therapeutic and prognostic
implications of an accurate detection of the cause of such symptoms.
Familiarizing clinical psychiatrists with these differences could pave
the way towards approaching seniors with severe, atypical and/or
persistent parkinsonian symptoms in a more individualized diagnostic and
therapeutic manner, and towards more cautious prescribing of
antipsychotics in this age group
Predictive value of the clinically and scintigraphically important bone lesions in hormone-refractory prostate cancer (HRPC)
Multimodal management of neuroendocrine liver metastases
AbstractBackgroundThe incidence of neuroendocrine tumours (NET) has increased over the past three decades. Hepatic metastases which occur in up to 75% of NET patients significantly worsen their prognosis. New imaging techniques with increasing sensitivity enabling tumour detection at an early stage have been developed. The treatment encompasses a panel of surgical and non-surgical modalities.MethodsThis article reviews the published literature related to management of hepatic neuroendocrine metastases.ResultsAbdominal computer tomography, magnetic resonance tomography and somatostatin receptor scintigraphy are widely accepted imaging modalities. Hepatic resection is the only potentially curative treatment. Liver transplantation is justified in highly selected patients. Liver-directed interventional techniques and locally ablative measures offer effective palliation. Promising novel therapeutic options offering targeted approaches are under evaluation.ConclusionsThe treatment of neuroendocrine liver metastases still needs to be standardized. Management in centres of expertise should be strongly encouraged in order to enable a multidisciplinary approach and personalized treatment. Development of molecular prognostic factors to select treatment according to patient risk should be attempted