Background. Uterine myoma is the most common benign tumor of the pelvic organs in women. One of the effective therapies for myomas is uterine artery embolization (UAE), which can be associated with unintended ovarian embolization. However, there is no certainty about the effect of unintended ovarian embolization on fertility and ovarian function since no precise evidence-based ways of identifying unintended embolization have been described. Aim. To develop a highly accurate method for identifying unintended ovarian embolization during UAE. Materials and methods. A series of clinical cases of the utilization of combined embolization material based on the paramagnetic contrast agent gadoteridol and saturable HepaSphere microspheres are presented. Results. On admission, patients underwent magnetic resonance imaging (MRI) of the pelvic organs with contrast enhancement. After UAE with this combined embolization material, another pelvic MRI without contrast enhancement was performed on the in-hospital day 2. In the first clinical case, no hyperintensive zones were detected in the ovarian stroma. However, in the second case, a previously undetected hyperintensive signal up to 6 mm in diameter was seen in the stroma of the left ovary by repeat MRI. Conclusion. Using this combined material during UAE significantly increases the accuracy of possible unintended ovarian embolization detection as soon as in the early postoperative period.
BACKGROUND: The widespread use of radiation sources in medical practice (cardioendovascular surgery, endoscopy, traumatology, urology, neurosurgery, dentistry, radioisotope diagnostics departments) leads to irradiation of the lens of the eye and the skin of the hands with low-intensity scattered radiation. The introduction of new recommendations by the IAEA to reduce the limit of the annual equivalent dose to the lens (20 mSv), has led to incorrectness of the dose assessment for the lens, based on the effective dose. AIMS: Analysis of approaches and assessment of equivalent doses of irradiation of the lens of the eye and skin of the hands of medical personnel during various diagnostic studies under the influence of X-rays and gamma studies of radiopharmaceuticals, as well as comparison of the results obtained with previously published data. MATERIALS AND METHODS: The method of thermo-luminescent dosimetry was used. Dose assessment was carried out in the personnel of cardioendovascular surgery, endoscopy, isotope diagnostics, dentistry, and urology. RESULTS: The estimated annual equivalent doses to the lens of the eye for doctors of cardioendovascular surgery departments, in most cases, ranged from 35 to 90 mSv, the average medical staff - from 6 to 19 mSv (in some cases, the doctor - up to 225 mSv and the nurse - up to 180 mSv); the staff of the department of radioisotope diagnostics - from 4.5 to 9 mSv. The annual calculated equivalent doses to the skin of the hands were: cardioendovascular surgery personnel - from 17 to 100 mSv, and for the staff working with radiopharmaceuticals ‒ from 24 to 220 mSv. It is shown that the use of an estimate of the average dose per operation by cardioendovascular surgery doctors, as a rule, inevitably leads to an excess of the equivalent dose to the lens of the eye after a certain number of operations. CONCLUSION: Equivalent doses to the lens of the eye in cardioendovascular surgery doctors above 20 mSv per year can be formed when a certain number of operations is exceeded (from 100 to 200). A lesion of the lens of the eye in a cardio-endovascular surgery doctor was found at existing radiation levels. The results obtained indicate the need for further dosimetric measurements and epidemiological studies, on the basis of which recommendations can be developed for radiation protection of the lens of the eye and the skin of the hands of medical personnel working in the field of scattered, gamma, X-ray radiation of low intensity.
Objectives Radioactive iodine therapy is considered for patients with certain clinicopathological factors that predict a significant risk of recurrence, distant metastases of thyroid cancer or disease-specific mortality. The aim of the study was to investigate the association between polymorphisms of genes, products of which are involved in the processes of DNA damage response and autophagy, and the adverse reactions of radioiodine therapy in thyroid cancer patients. Methods The study included 181 patients (37 men, 144 women; median age 56 [41; 66.3] years) with histologically confirmed thyroid cancer and a history of thyroidectomy who received radioiodine therapy. NFKB1, ATM, ATG16L2, ATG10, TGFB1, and TNF polymorphisms were determined by allele-specific realtime-PCR. Results The frequency of adverse reactions was the following: gastrointestinal symptoms – 57.9 %, local symptoms – 65.8 %, cerebral symptoms – 46.8 %, fatigue – 54.4 %; signs of sialoadenitis six months after radioiodine therapy – 25.2 %. TT genotype carriers of ATG10 rs1864183 had higher frequency of gastrointestinal symptoms (vs. CC+CT), the CC genotype carriers of ATG10 rs10514231 had significantly more frequent cerebral symptoms (vs. CT+TT), as well as AA genotype carriers of TGFB1 rs1800469 (vs. AG+GG). CC genotype of ATG10 rs10514231 increased the incidence of radioiodine-induced fatigue, whereas GA genotype of the ATM rs11212570 had a protective role against fatigue. TGFB1 rs1800469 was associated with signs of sialoadenitis six months after radioiodine therapy. Conclusions Genetic factors may contribute to the occurrence of adverse reactions of radioiodine therapy in thyroid cancer patients.
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