Hypothyroidism during treatment with tyrosine kinase inhibitors

Tyrosine kinase inhibitors are relatively new targeted therapy drugs used for the treatment of metastatic clear cell kidney carcinoma, gastrointestinal stromal tumours, thyroid carcinoma and pancreatic neuroendocrine tumours during the progression of the disease. Hypothyroidism or thyroid dysfunction is often a side effect of this treatment. Therefore, monitoring of thyroid hormone levels before the beginning and during the treatment of tyrosine kinase inhibitors is a necessity. Hypothyroidism correlates with objective response to the treatment. Sunitinib. This is the most described tyrosine kinase inhibitor which causes hypothyroidism. The mechanism of hypothyroidism is still unclear. Sorafenib. Symptoms of hypothyroidism occur in 18% of patients treated with sorafenib due to metastatic renal cell carcinoma. Imatinib. Hypothyroidism is one of the most frequent side effects of the treatment. Emergent tracheotomy was necessary due to larynx swelling during marked hypothyroidism. Motesanib. Hypothyroidism or increased TSH level is diagnosed in 22% to 69% of patients with metastatic differentiated or medullary thyroid carcinomas. The management of patients with thyroid dysfunction and related symptoms such as fatigue is undoubtedly a challenge to an oncologist.Inhibitory kinaz tyrozynowych są stosunkowo nowymi lekami z grupy przeznaczonej do terapii celowanych, stosowanymi w leczeniu nowotworów złośliwych, takich jak przerzutowy jasnokomórkowy rak nerki, stromalny nowotwór przewodu pokarmowego (GIST), raki tarczycy oporne na leczenie jodem radioaktywnym, przerzutowe guzy neuroendokrynne trzustki. Niedoczynność tarczycy lub dysfunkcja tarczycy są częstymi powikłaniami tego leczenia. Dlatego konieczne jest oznaczenie stężenia hormonów tarczycy przed rozpoczęciem i w trakcie leczenia inhibitorami kinaz tyrozynowych. Niedoczynność tarczycy pozostaje w ścisłym związku z obiektywną odpowiedzią na leczenie. Sunitynib. Jest najczęściej opisywanym inhibitorem kinaz tyrozynowych, który wywołuje niedoczynność tarczycy. Mechanizm niedoczynności pozostaje niejasny. Sorafenib. U 18% osób leczonych sorafenibem z powodu przerzutowego raka nerki występują objawy niedoczynności tarczycy. Imatynib. Niedoczynność tarczycy jest jednym z najczęstszych powikłań leczenia imatinibem. W przebiegu nasilonej niedoczynności występowała konieczność wykonania pilnej tracheotomii z powodu obrzęku krtani. Motesanib. Niedoczynność tarczycy lub podwyższone stężenie TSH jest rozpoznawane u 22–69% chorych na przerzutowego zróżnicowanego lub rdzeniastego raka tarczycy. Postępowanie z chorymi z dysfunkcją tarczycy i ze współistniejącymi objawami, takimi jak zmęczenie, jest niewątpliwie wyzwaniem dla onkologa

Use of Tc99m-nanocolloid for sentinel nodes identification in cervical cancer

BACKGROUND: The initial draining lymph node for a primary tumor is referred to as the “sentinel” node. Firstly adopted in the management of patients with cutaneous melanoma and breast cancer, it is now widely tested in cervical cancer. In patients with cervical cancer, lymph node status is the most important prognostic factor for survival. In patients with cervical cancer FIGO stage I and II pelvic lymph node metastases are expected in 0–16 and 24.5-31% and para-aortic lymph node metastases are expected in 0–22 and 11–19% of patients. The removal of pelvic and para-aortic lymph nodes is essential for assessing the biology of the disease. Lymphoscintigraphy enables the visualisation of lymphatic drainage patterns from a great variety of tumour sites prior to surgery. Therefore, the current procedure is to perform the pre-operative mapping of sentinel nodes by static and/or dynamic lymphoscintigraphy, followed by in vivo identification using a gamma detection probe and selective surgical resection. MATERIAL AND METHODS: Between 2001–2003, 37 patients with cervical cancer FIGO stage I-IIa were seemed to be qualified to undergo lymphoscintigraphy. The day before surgery 99mTc-nanocolloid (100 MBq; 0.5–1.0 ml in volume) was applied in each quadrant of the cervix or around the tumor. The static scintigraphic scans were performed after 2 hours p.i. using a dual-head large-field-of-view Siemens gamma-camera equipped with high resolution collimators. SNs were identified intra-operatively using a handheld gamma detection probe (Navigator GPS-Tyco) and intra-operative lymphatic mapping with blue dye. After a resection of the SNs, a standard radical hysterectomy with pelvic and low para-aortic lymph node dissection was performed. Tumor characteristics were compared with sentinel node detection and with the histopathological and immunohistochemical results. RESULTS: The scintigraphy showed a focal uptake in 35 of the 37 patients. In all women one or more sentinel lymph nodes were identified intra-operatively. Of them, 24 patients had those located bilaterally. Histologically positive SNs were found in 5 women (13.5%). CONCLUSIONS: A combination pre-operatively administered radioactively labelled albumin with blue dye allows the successful detection of SN in patient with cervical cancer. This technique will result in a real advance in the less aggressive management of patients with early stage cervical cancer. Sentinel lymph node status may be representative of the pelvic lymph nodes status in cervical cancer and thus could provide important information for further treatment

Use of Tc99m-nanocolloid for sentinel node identification in cervical cancer

BACKGROUND: The initial draining lymph node for a primary tumor is referred to as the “sentinel” node. Firstly adopted in the management of patients with cutaneous melanoma and breast cancer, it is now widely tested in cervical cancer. In patients with cervical cancer, lymph node status is the most important prognostic factor for survival. In patients with cervical cancer FIGO stage I and II pelvic lymph node metastases are expected in 0–16 and 24.5-31% and para-aortic lymph node metastases are expected in 0–22 and 11–19% of patients. The removal of pelvic and para-aortic lymph nodes is essential for assessing the biology of the disease. Lymphoscintigraphy enables the visualisation of lymphatic drainage patterns from a great variety of tumour sites prior to surgery. Therefore, the current procedure is to perform the pre-operative mapping of sentinel nodes by static and/or dynamic lymphoscintigraphy, followed by in vivo identification using a gamma detection probe and selective surgical resection. MATERIAL AND METHODS: Between 2001–2003, 37 patients with cervical cancer FIGO stage I-IIa were seemed to be qualified to undergo lymphoscintigraphy. The day before surgery 99mTc-nanocolloid (100 MBq; 0.5–1.0 ml in volume) was applied in each quadrant of the cervix or around the tumor. The static scintigraphic scans were performed after 2 hours p.i. using a dual-head large-field-of-view Siemens gamma-camera equipped with high resolution collimators. SNs were identified intra-operatively using a handheld gamma detection probe (Navigator GPS-Tyco) and intra-operative lymphatic mapping with blue dye. After a resection of the SNs, a standard radical hysterectomy with pelvic and low para-aortic lymph node dissection was performed. Tumor characteristics were compared with sentinel node detection and with the histopathological and immunohistochemical results. RESULTS: The scintigraphy showed a focal uptake in 35 of the 37 patients. In all women one or more sentinel lymph nodes were identified intra-operatively. Of them, 24 patients had those located bilaterally. Histologically positive SNs were found in 5 women (13.5%). CONCLUSIONS: A combination pre-operatively administered radioactively labelled albumin with blue dye allows the successful detection of SN in patient with cervical cancer. This technique will result in a real advance in the less aggressive management of patients with early stage cervical cancer. Sentinel lymph node status may be representative of the pelvic lymph nodes status in cervical cancer and thus could provide important information for further treatment

Yttrium-90 distribution following radiosynoviorthesis of the knee joint in rheumatoid arthritis patients : a SPECT/CT study

Objective To examine yttrium-90 distribution 1 and 72 h following its injection into a knee joint in patients with rheumatoid arthritis (RA). Methods In 14 RA patients we injected yttrium-90 into the affected knee joint using lateral approach. To assess the radioisotope distribution in the joint, the superimposed sequential SPECT and CT imaging was performed 1 and 72 h after the injection. We analyzed the percentage of radioisotope distribution in three predefined compartments of the knee joint (lower, upper medial, upper lateral). Results After 1 and 72 h, the mean percentage distributions were, respectively, 7.14 and 23.07 % in lower; 21.42 and 15.38 % in upper medial, and 71.42 and 61.53 % in upper lateral compartment. The percentage of isotope deposition did not change significantly with time in any of the compartments (all p > 0.26). The deposition of isotope, both at 1 and 72 h, was significantly greater in upper lateral compartment, where the injection was performed, than in all other compartments (all p < 0.05). Conclusions Using the SPECT/CT hybrid method, we proved that the majority of isotope is located at the compartment adjacent to the injection. Two injections targeting different compartments might improve the clinical efficacy of the procedure

Symptoms of menopause and health of women during perimenopause

Introduction. Perimenopausal age is the time in a woman’s life, when her reproductive capacity declines. Characteristic symptoms in the majority of systems accompany this process. Aim. The aim of the study was to determine the symptoms of menopause and investigate the most common health problems in perimenopausal women. Materials and methods. The study involved 180 women in perimenopausal age (45-55 years). The subjects were mainly residents of rural areas (65%) and married (84%). Most of them declared secondary education (57%). A questionnaire developed by the authors was used in the study. Results. Most women observed typical menopausal symptoms mostly between 45 and 49 years of age. Most often, these were hot flushes, the second place was night sweats, and the third place was insomnia. Almost 40% of women are treated for chronic diseases, most of them for hypertension, thyroid disease and diabetes. Conclusions. The changes associated with perimenopausal age in the majority of respondents include genitourinary system, respiratory system, skeletal system and metabolic changes. Level of education influences the level of knowledge among women on the menopause. Women from rural areas used non-pharmacological methods to mitigate the symptoms of menopause to a greater extent

Characteristics of resistance to puccinia coronata f. sp. avenae in Avena fatua

Crown rust, caused by Puccinia coronata f. sp. avenae, is the most widespread and harmful fungal disease of oat. The best defense against the pathogen is use of cultivars with genetic resistance, which is effective, economic, and an environmentally friendly alternative to chemical control. However, the continuous evolution of the pathogen can rapidly overcome major gene resistance, creating an urgent need to identify new sources. Wild oat accessions have already proven to be valuable donors of many resistance genes, but the weed species Avena fatua remains underexploited. Its abundance across multiple environments and the frequent occurrence of herbicide-resistant populations demonstrate its ready ability to adapt to biotic and abiotic stresses; yet, surprisingly, there are no extensive studies which describe crown rust resistance occurrence in gene bank stocks of A. fatua. In this study, 204 accessions of A. fatua maintained in the collections of the United States Department of Agriculture (USDA) and Polish National Centre for Plant Genetic Resources were evaluated at the seedling stage for crown rust reaction using host–pathogen tests with five highly diverse and virulent races of P. coronata. Of tested genotypes, 85% showed a heterogeneous infection pattern, while 61% were susceptible or moderately susceptible to all races. Of the 79 resistant A. fatua accessions, seedling resistance to at least two P. coronata isolates was recognized within 19 accessions, with 13 displaying a homogeneously resistant phenotype to one or two races. Accessions showing multiple single seedling resistance to three or four isolates were observed. Based on the seedling reaction to isolates used in the study, 18 infection profiles (IP) were determined. Using UPGMA clustering, resistant accessions were divided into six main clusters encompassing samples with similar IPs. Twelve of 18 patterns allowed us to postulate the likely presence of novel crown rust resistance genes, whose origin was predominantly from Kenya or Egypt. Future work will clarify the genetic basis of the resistances observed here, as well as confirm their potential utility in breeding resistant oat cultivars. </jats:p

Symptoms of menopause and health of women during perimenopause

Introduction. Perimenopausal age is the time in a woman’s life, when her reproductive capacity declines. Characteristic symptoms in the majority of systems accompany this process. Aim. The aim of the study was to determine the symptoms of menopause and investigate the most common health problems in perimenopausal women. Materials and methods. The study involved 180 women in perimenopausal age (45-55 years). The subjects were mainly residents of rural areas (65%) and married (84%). Most of them declared secondary education (57%). A questionnaire developed by the authors was used in the study. Results. Most women observed typical menopausal symptoms mostly between 45 and 49 years of age. Most often, these were hot flushes, the second place was night sweats, and the third place was insomnia. Almost 40% of women are treated for chronic diseases, most of them for hypertension, thyroid disease and diabetes. Conclusions. The changes associated with perimenopausal age in the majority of respondents include genitourinary system, respiratory system, skeletal system and metabolic changes. Level of education influences the level of knowledge among women on the menopause. Women from rural areas used non-pharmacological methods to mitigate the symptoms of menopause to a greater extent