The aim of this study was to compare the treatment results between radiosynoviorthesis and reradiosynoviorthesis of knees. Before the radiosynoviorthesis, an ultrasonography, X-ray, and three-phase bone scintigraphy were done. The treatment effect can be expected if a synovitis is proved by these examinations. To knees, 200 MBq of the yttrium citrate was injected for the first radiosynoviorthesis or for reradiosynoviorthesis. After an application, it is possible to do the scintigraphic examination, when information about a tracer distribution in joints is obtained. The treatment effect was evaluated by the clinical examination, the ultrasonography, and the three-phase bone scintigraphy with some lapse of time. If the effect of the radiosynoviorthesis was not satisfying, it could be repeated no sooner than 6 months later. Among our patients we had a high percentage of the repeated radiosynoviorthesis. The authors applicated the yttrium citrate to 1243 knees. A rate between single radiosynoviorthesis and reradiosynoviorthesis was 11:8. Repeated radiosynoviorthesis were as effective as the initial ones, and their repeated use does not decrease the expected therapeutic effect.
Iodine-131 (I-131) is often used in thyroid diagnostics and therapy. External and internal exposure to radioiodine can lead to molecular and cellular damage in peripheral blood lymphocytes. The aim of this study was to explore the influence of low and high doses of I-131 on susceptibility to ionizing radiation. Study groups consisted of 30 individuals free of thyroid diseases, 41 patients exposed diagnostically to low doses of I-131, and 37 hyperthyroidism patients exposed therapeutically to high doses. The standardized DNA repair competence assay was used to test the efficacy of the fast DNA repair process in G0 cells. Cytogenetic preparations were made in fresh blood samples before and after challenging cells in vitro with X-ray dose. The frequency of sister chromatid exchanges (SCE) and percentage of cells with significantly elevated numbers of SCE were used as cytogenetic biomarkers associated to homologous recombination and compared to reported earlier cytogenetic biomarkers of cancer risk. Strong individual variation in the biomarkers is observed in all investigated groups before and after challenging. Nevertheless, the efficiency of post challenging fast repair is significantly high in the patients exposed to diagnostic I-131 doses than in unexposed control group and linked to decreased cytogenetic damage. However, 5 weeks after administration of therapeutic doses, significant increases of unrepaired post challenging DNA and cytogenetic damages were observed indicating a health risk. Results also suggest that the appearance of cancers in immediate families might influence DNA repair differently in patients exposed to low than to high doses.
In this paper, the authors present their experience with the radioiodine therapy of thyroid functional autonomies. The aims of this study were to establish the efficacy and determine the adverse effects of radioiodine therapy of patients with thyroid functional autonomies. Over a period of 31 years (from 1974 to 2005) 868 patients (766 women, 102 men with the age from 33 to 86 years; average age, 58.5) with unifocal functional autonomy, multifocal functional autonomy, and disseminated functional autonomy, received at least one treatment of radioiodine in our Department of Nuclear Medicine. For diagnostics and the evaluation of the radioiodine therapeutic effect of functional autonomies, a thyroid scintigraphy is the basic and necessary procedure. We have also performed a thyroid ultrasonography, an assessment of a serum level of a total and free thyroxine, total tri-iodothyronine, thyroid-stimulating hormone (TSH), the radioiodine accumulation test, the estimation of the radioiodine effective half-life, and in some patients, thyrotrophin-releasing hormone (TRH)-TSH test. The follow-up examinations were done in all patients after 4-6 months, another examination after 1 year in 585 patients, and after 2 years in 284 patients. One therapeutic dose received 798 patients (91.9%) and it was sufficient for an elimination of functional autonomies. Some patients were retreated if there was the evidence of small or no treatment effect and no elimination of functional autonomies. Sixty-six (66) patients (7.6%) received two radioiodine treatments and 4 patients (0.5%) three treatments. Before radioiodine therapy, an average serum level of total thyroxine was 165.8 nmol/L, of free thyroxine 21.2 pmol/L, and of total triiodothyronine 3.3 nmol/L, and in all patients, TSH was suppressed. Before therapy, patient complaints were cardiovascular in 87%, neurological in 72%, hypermetabolic in 70%, and local in 31% of patients. After therapy, the average serum levels of total thyroxine were 110.9 nmol/L, free thyroxine 12.7 pmol/L, and total triiodothyronine 2.1 nmol/L with an improvement of symptoms in 91.5% of patients, no improvement in 8.2% and a worsening in 0.3% of patients. The suppression of TSH disappeared in 668 of treated patients (77%). An average volume reduction of thyroid of 40% was achieved in any type of functional autonomy after radioiodine treatment. Side-effects were minimal, and in some patients, presented as a transient neck pressure or pain and neck swelling. Postradiation hypothyroidism was diagnosed in 38 patients (4.4%). The results of this study show that the radioiodine therapy of the thyroid functional autonomies is safe, with a low incidence of adverse effects. It is effective, and for patients, is a nondemanding procedure.
Formator to osoba, która jest zdolna służyć drugiemu tak, że razem postępują w procesie stawania się coraz bardziej ludzcy. Obydwoje bowiem są dziećmi dzisiejszego świata i dziedziczą z niego zarówno silne, jak i słabe cechy. Formator ma być wystarczająco dobry, co oznacza wrażliwość potrzebną do odpowiadania na potrzeby formowanego poprzez swoją obecność, ale również umiejętność dawania potrzebnej przestrzeni do doświadczania tych potrzeb, jednak w wymiarze, który nie będzie oznaczał straty. Widoczna jest w tym rola dynamiki obecności i nieobecności poprzez doświadczenie satysfakcji i frustracji. Te elementy są obecne w relacji formacyjnej po to, by kandydat mógł poczuć się bezpiecznie i mógł aktywnie szukać odpowiedzi na pytania drzemiące w nim. Ten który przyjmuje rolę towarzyszenia, powinien zdobyć umiejętność balansowania pomiędzy pełnią (obecność) i brakiem (nieobecność). Słabością formatora jest bycie niewystarczająco innym, co pozwala na przyjęcie roli granicy, która staje się wyzwaniem i zaproszeniem do transcendencji.
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