Synovectomy with 153Samarium Hydroxyapatite in Haemophilic Arthropathy

There are two main types of haemophilia, classified according to deficiency: type A, caused by factor VIII deficiency; and type B, which is rarer and the result of a deficiency in factor IX. Haemarthroses account for 80% of bleeding in haemophilic patients, with half of these exhibiting deformities. Repeated joint effusion leads to a local inflammatory response, with the formation of hyperplasic and hypertrophic cells and subsequent buildup of haemosiderin. Fibroblasts proliferate and produce collagenases and proteinases that act on the synovium, cartilage and bone, with a decrease in the joint space. Another mechanism involved is the damage caused by direct action of red blood cells on the cartilaginous surface of the joint lining. 153-samarium was obtained in research reactor by neutron irradiation of 152Sm2O3 (99.4%) in the nitrate form, 152Sm(n,p)153Sm, for 30–36 h. The labelling process was performed with 40 mg of hydroxyapatite, according to Barboza et al. Radiochemical purity, particle size, microbiological tests for sterility and pyrogen were the tests applied to obtain an useful material. The introduction of 153Sm-HA for the treatment of haemophilic arthropathy in large and medium joints was a safe, cost-effective, minimally invasive and effective procedure in controlling bleeding and pain

Efeito clínico da sinovectomia em joelhos de pacientes hemofílicos com hidroxiapatita marcada com ytrio-90 e samário-153

Tese (doutorado)—Universidade de Brasília, Faculdade de Ciências da Saúde, Programa de Pós-Graduação em Cièncias da Saúde, 2014.Objetivo- Comparar o uso de 740 Mbq (20 mCi) de 153Sm e 185 Mbq (5mCi) de 90Y, ambos marcando hidroxiapatita (HA), na sinovectomia de pacientes hemofílicos. Material e Métodos- Foram estudados 33 homens, alocados em dois grupos: a- tratamento com 740 Mbq de 153Sm-HA : 20 joelhos de 18 pacientes, com a média de idade de 21,4±13,3 anos (variando de 7 a 56 anos) e escore médio de Pettersson de 5,3; b- tratamento com 185 Mbq de 90Y-HA: 16 joelhos de 15 pacientes, com a média etária de 26,3±10,3 anos (variando de 7 a 51 anos) e escore médio de Pettersson de 6,3. Neste protocolo, foram usadas partículas de 2-12μm, com estudos cintilográficos realizados após o procedimento. Não foi injetado corticosteróide simultaneamente e não foi recomendado a imobilidade articular após o procedimento. Os parâmetros avaliados após um ano foram frequência, de enartrose, dor por escala visual analógica e mobilidade articular. A ocorrência de efeitos adversos do tratamento também foi considerada. Foram utilizados os testes do qui ao quadrado, Wilcoxon e Mann-Whitney com p ≤ 0,05 como significativo. Resultados- A redução na ocorrência de hemartroses foi de 65,7% com o uso do 153Sm-HA e 82,6% para o 90Y-HA, sem diferença estatística entre os grupos (p = 0,632); a diminuição na dor foi 42,5% no grupo 1 e 30,7% no grupo 2 também sem diferença estatística entre esses grupos. Não houve alteração da mobilidade articular em ambos os grupos. Foram observados dois casos de discreta sinovite reacional no grupo a e um caso no grupo b, resolvidos sem intervenção médica. Os controles cintilográficos mostraram distribuição homogênea do material injetado, sem evidência de escape articular. Conclusões- Embora a energia beta de 2,2 Mev do 90Y seja considerada mais adequada para sinovectomia de joelhos, o uso de maiores atividades do 153Sm (beta-0,8 Mev) mostrou efeito terapêutico equivalente nesta amostra de pacientes hemofílicos. Isto é particularmente vantajoso e tem impacto econômico nos locais onde haja somente produção local do samário-153. __________________________________________________________________________ ABSTRACTAim- To compare the use of 740 Mbq (20 mCi) of 153Sm and 185 Mbq (5mCi) of 90Y, both labelling hydroxyapatite (HA), in the synovectomy of hemophilic patients. Material and Methods- Thirty three patients were studied, all males, allocated in two groups: a- treatment with intra-articular dose of 740 Mbq of 153Sm-HA: 20 knees of 18 patients, average age=21,4±13,3 years (range from 7 to 56 years old) and median score of Pettersson=5,3; b- treatment with 185 Mbq of 90Y-HA: 16 knees of 15 patients, average age=26,3±10,3 years (range from 7 to 51 years old) with median score of Pettersson=6,3. Protocol used particle size from 2 to 12μm and scintigraphic studies were performed after the synoviorthesis. No corticosteroid was co-injected and further immobilization was not recommended. The following criteria on the evolution one year after the synovectomy was used: reduction of the number of haemarthrosis and of the pain by visual analogic scale and improvement in articular mobility. The occurrence of adverse effects was also considered. The tests of qui-square and Wilcoxon and Mann-Whitney with p ≤0,05 as statistical significance were used. Results-The reduction in the frequency of haemarthrosis was 65,7% for 153Sm-HA and 82,6%% for 90Y-HA, without statistical differences among the groups(p = 0,632); the reduction of pain intensity was 42,5 % in group 1 and 30,7% in group 2.The improvement in articular motility was not significant in both groups. Two and one cases of mild synovitis were observed in the groups 1 and 2 respectively what were solved without medical intervention. The scintigraphic control after the procedure has not shown articular escape and the homogenous distribution of the injected material was confirmed. Conclusions- Although the 2,2Mev beta energy of 90Y is considered more adequate for knee synovectomy, the use of higher activities of 153Sm (beta=0,80 Mev) have similar therapeutic effect in this cohort of hemophilic patients. This may be particularly helpful and have economical impact in places which only have production of 153Sm and would be constrained to import 90Y

Carcinoma medular da tireóide associado a bócio nodular autônomo: relato de caso

Os autores relatam caso de paciente feminina com 55 anos, que mostrou carcinoma medular da tireóide associado a bócio nodular autônomo compensado. Na evolução evidenciou metástase pulmonar iodocaptante, que se beneficiou do tratamento com 176mCi de 131-1. A despeito da raridade desta associação, sugerem que os nódulos quentes tenham conduta cirúrgica e que o tratamento com radioiodo seja considerado como alternativa nas metástases captantes