Technegas (TcG) was produced using a commercially available TcG generator. The structure and size distribution of TcG particles were examined by means of the following methods: (a) transmission electron microscopy (TEM), range: 1 nm-100 microns; (b) time-of-flight mass spectroscopy (MS), range: < 3 nm; (c) photon correlation spectroscopy (PCS), range: 3 nm-3 microns. The TEM images showed graphite particles (size 7-23 nm) agglomerated into larger secondary aggregates. The size of these aggregates, determined from PCS and TEM measurements, showed a log-normal distribution and typically ranged from 60 to 160 nm. No isolated particles smaller than 3 nm could be detected by MS. We conclude that TcG particles consist of technetium-99m labelled agglomerated graphite particles and have an average size of 97 nm (geometrice standard deviation (GSD): 1.55).
Radionuclide synoviorthesis (RSO) is a local radiotherapy that can be used in cases of synovialitis. RSO is performed by intraarticular injection of beta emitters (Er-169, Re-186, Y-90). Before RSO is planned, a precise indication is necessary, which must be verified by the acting nuclear physician, preferably using soft-tissue scintigraphy. If RSO is handled in an interdisciplinary fashion, it will be a valuable tool in the treatment of synovialitis.
Summary Aim: Evaluation of the effectiveness of radiosynoviorthesis (RSO) in osteoarthritis and other disorders with concomitant synovitis versus rheumatoid arthritis by means of a standardized questionnaire. Patients, methods: 803 RSO treatments were monitored in 691 patients by standardized questionnaires of 7 centers in 3 countries. Patients were assigned to 3 groups according to their age (20-40, 41-60, 61-80 years). Additionally, the data were analyzed separately for patients with rheumatoid arthritis (group A) and those with osteoarthritis, psoriasis arthritis, pigmental villonodular synovitis or persistent effusions after joint replacement (group B). Results: Ameliorations of joint pain, swelling/effusion or flexibility were found in 80% of group A and 56% of group B (p <0.01). Quality of life improved in 78% of group A and 59% of group B (p <0.01). The response rate was similar for small- and large-sized joints in group A, but significantly higher for large-sized joints in group B (p <0.01). The positive effects on joint pain, swell-ing/effusion or flexibility lasted longer in group A (p <0.01). Repeated RSOs were as effective as initial ones. The clinical outcome was neither influenced by age, nor gender, nor transient immobilisation for 48 hours after RSO. Conclusion: Although slightly more efficient in rheumatoid arthritis, RSO represents an effective treatment option also in osteoarthritis and other disorders with concomitant synovitis.
Zusammenfassung Ziel: Effektivitätsvergleich der Radiosynoviorthese (RSO) bei aktivierter Arthrose und anderen Gelenkerkrankungen mit chronischer Synovialitis versus rheumatoider Arthritis. Überprüfung der Eignung eines standardisierten Fragebo-gens für Multizenterstudien. Patienten, Methoden: Bei 691 Patienten wurden 803 RSO-Behandlungsverläufe von 7 Zentren in 3 Ländern mit Hilfe eines standardisierten Fragebogens erfasst. Die Patienten wurden 3 Alterskategorien (20–40, 41–60 und 61–80 Jahre) zugeordnet. Außerdem wurden sie eingeteilt in Gruppe A (primär chronische Polyarthritis) und Gruppe B (aktivierte Arthrose, Psoriasisarthritis, reaktive Arthritis, postoperative Arthritis, villonoduläre Synovialitis, Synovialitis nach TEP-Implantation). Ergebnisse: Die Ansprechraten betrugen 80% bei Gruppe A und 56% bei Gruppe B (p <0,01), Besserungen der Lebensqualität gaben 78% (Gruppe A) bzw. 59% (Gruppe B) an (p <0,01). Im Gegensatz zu Gruppe A zeigte sich in Gruppe B bei kleinen Gelenken eine schlechtere Ansprech-rate als bei großen (p <0,01). Außerdem hielten die Bes-serungen von Schmerz, Schwellung/Erguss und Beweglichkeit in Gruppe A länger an (p <0,01). Wiederholte RSOs waren ähnlich effektiv wie erstmalige. Hinsichtlich des The-rapieerfolgs konnte kein Einfluss von Patientenalter, Geschlecht oder postinterventioneller Immobilisation über 48 Stunden nachgewiesen werden. Schlussfolgerung: Wenngleich mit etwas geringerer Wirksamkeit als bei der rheumatoiden Arthritis, so ist die RSO auch bei aktivierter Arthrose und anderen Gelenkerkrankungen mit chronischer Synovialitis eine effektive Therapie.
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