No abstract

Summary Cancer risks were studied in 834 thyroid cancer patients given 'l'I (4,551 MBq, average) Iodine-131 was first described in medical practice more than 40 years ago and is still frequently used in the diagnosis and treatment of thyroid disorders (Hamilton & Lawrence, 1942;Hertz & Roberts, 1942).In cases of nuclear explosions or reactor accidents large amounts of 131I could be spread over vast areas causing a potential hazard to human beings (Becker, 1987). Data on risks associated with radioactive iodines are still relatively scarce despite studies of populations exposed to fallout from nuclear weapons testing (Conard, 1984;Hamilton et al., 1987) and patients receiving diagnostic (Holm et al., 1989) and therapeutic doses of '"'I (Brincker et al., 1973;Edmonds & Smith, 1986;Hoffman, 1984;Holm, 1984;Saenger et al., 1968).Studies of thyroid cancer patients treated with '3'I are also rare, probably because of the low incidence of the disease and the associated small number of patients admitted to each centre. High-dose '"'I has been linked to leukaemia following treatment for thyroid cancer (Brincker et al., 1973;Edmonds & Smith, 1986) and also to cancers of the bladder (Edmonds & Smith, 1986). Record-linkage studies of patients with thyroid cancer have reported increased risks of leukaemia (Teppo et al., 1985), cancer of the breast, kidney and connective tissue (Tucker et al., 1985), and cancer of the nervous tissue and non-Hodgkin's lymphoma (0sterlind et al., 1985).The present study was designed to evaluate the risk of second primary cancer in a cohort of thyroid cancer patients treated with 13'I, and to contrast the risk with that of nonexposed thyroid cancer patients. Subjects and methodsPatient data were obtained from the oncologic centres of six university hospitals in Sweden: (1) Lund; (2) Malm6; (3) Gothenburg; (4) Stockholm; (5) Uppsala, and (6)

The effects of peroperative electrical calf muscle stimulation with groups of impulses giving a short lasting tetanus of the calf muscles on postoperative deep venous thrombosis (DVT) and pulmonary embolism (PE) were compared with that of dextran 40 given per and postoperatively. The incidence of DVT and PE during the first 4-6 postoperative days was recorded. The diagnosis of DVT was based on the 125I-fibrinogen uptake test and phlebography and of PE on pre- and postoperative perfusion pulmonary scintigram and chest X-ray examination. Both methods reduced the incidence of PE. Calf muscle stimulation reduced the DVT incidence in patients with malignant disease while the reduction in DVT incidence for the whole group only was significant in the stimulation as well as the dextran 40 group. Mean values for preoperatively determined levels of antithrombin III, beta-thromboglobulin, fibrinopeptide A, plasminogen and ability to release fibrinolytic activity during venous stasis did not differ between those patients who developed or those who did not develop postoperative DVT or PE. However, antithrombin III levels below 80 per cent appeared to predispose to postoperative thromboembolism. The two prophylactic methods have similar effects on the incidence of postoperative thromboembolism. The stimulation method has certain advantages due to its safety and simplicity.

Follow-up examinations of one hundred persons treated with x-rays for tuberculous adenitis between 1930 and 1946 have been carried out to determine if there is an increased incidence of hyperparathyroidism (HPT) after radiation exposure. Neck explorations were done in patients with hypercalcemia and signs and symptoms compatible with HPT. Individuals with thyroid masses were also operated upon when examination of fine needle specimens gave suspicions of malignancy. Eleven subjects were found to have developed parathyroid adenoma or hyperplasia. Four other individuals have hypercalcaemia but are asymptomatic. The mean absorbed dose in the parthyroid glands varied between 75 and 2,200 rads. Six individuals received more than 1,200 rads; four of them later developed HPT, while no HPT occurred below a dose of 300 rads. The high incidence of HPT among patients who had been heavily exposed to radiation suggests a cause and effect relationship between radiation treatment and development of HPT.

During a 3-year period a consecutive series of 102 patients were treated for renal cell carcinoma at one urological unit. Thirty-three patients (32.4%) had metastatic spread, but bone metastases were found in six patients only, i.e. 5.9% of the whole series and 18.2% of the patients with metastases preoperatively. The bone metastases had in all six patients given local symptoms first indicating radiography, and thereafter radionuclide scintigraphy of the entire skeleton. Bone scintigraphy performed merely by routine in 70 patients did not reveal one single case of bone metastasis. Only one patient had a solitary bone metastasis, and this metastasis was considered inoperable because of its location and size and the patient's age. The decision about nephrectomy was not in any case altered by the finding of bone metastases. Solitary bone metastasis must be diagnosed early since they may be radically removed. Routine scintigraphy of the skeleton in symptomless patients, however, has a low yield. Screening for skeletal metastases may therefore be best performed by careful physical examination and history-taking.