Tumor lysis syndrome in premature infant prompting early resection of a large sacrococcygeal teratoma: a case report.

BACKGROUND: Sacrococcygeal teratomas (SCTs) are the most common congenital neoplasm and often require resection soon after birth. There are rare reports of cardiac arrest during surgery due to manipulation of the tumor triggering secondary necrosis and hyperkalemia. CASE PRESENTATION: This case describes a very preterm infant with a SCT who develops spontaneous preoperative tumor lysis syndrome (TLS). The medical team utilized rasburicase and the patient underwent total gross resection at 40 h of life. CONCLUSIONS: We emphasize the importance of the early recognition and management of tumor lysis syndrome in SCT with rasburicase, aggressive management of hyperkalemia and consideration of early resection of SCTs even in the case of a very premature infant.

Retrospective evaluation of factors associated with emergency frequency and survival in equids presenting for emergency care (2019-2020): 3071 cases.

OBJECTIVE: To determine factors associated with frequency and outcome of equid emergencies in private practice. DESIGN: Retrospective study from February 2019 to January 2020. SETTING: Private practice large animal hospital. ANIMALS: A total of 3071 equids of various breeds and ages presenting for emergency care. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Variables included for analysis of daily emergency frequency included day of the week, month, and daily climate data. A Poisson regression model found the maximum temperature (P = 0.05), average barometric pressure (P = 0.005), and decreases in barometric pressure (P = 0.05) were associated with an increasing daily number of emergencies. Overall survival for all emergencies was 89% (2748/3071). Variables included for analysis of nonsurvival for emergencies included signalment, body system, clinical examination findings, laboratory data, and experience of the veterinarian. A logistic regression model for primary emergencies (nonreferral) found that increasing age, increasing heart rate, and decreased gastrointestinal sounds were associated with an increase in nonsurvival. Body system and experience of the veterinarian affected nonsurvival. A logistic regression model for all emergencies (primary and referral) found that absent gastrointestinal sounds and an increasing PCV were associated with increased nonsurvival. CONCLUSIONS: The number of daily emergencies in this practice was affected by the month of the year and day of the week. Additionally, hotter days, increased barometric pressure, or drops in barometric pressure are likely to be associated with a higher emergency caseload. Nonsurvival of primary equid emergencies in private practice increases with age, higher heart rates, and decreased gastrointestinal sounds.

Effects of calcium supplementation to resuscitation fluids in endurance horses: A randomized, blinded, clinical trial.

BACKGROUND: The addition of calcium to resuscitation fluids is a common practice in horses, but studies evaluating the effects of calcium supplementation are limited. In healthy horses, decreases in heart rate and changes in serum electrolyte concentrations have been reported. HYPOTHESIS: Calcium gluconate administration at a rate of 0.4 mg/kg/min to eliminated endurance horses with metabolic problems will affect heart rate, gastrointestinal sounds, and serum electrolyte concentrations. ANIMALS: Endurance horses eliminated from the Tevis Cup 100-mile (160 km) endurance ride for metabolic problems and requiring IV fluid therapy were eligible. METHODS: Sixteen horses were randomly assigned to receive 0.4 mg/kg/min of calcium (23% calcium gluconate solution) over 1 hour diluted in 10 L of a non-calcium containing isotonic crystalloid (CAL group) or 10 L of a non-calcium containing isotonic crystalloid (CON group). Staff members administering the fluids were blinded to treatment group. Blood samples were collected and physical examinations performed before and after treatment. Heart rates were recorded every 15 min during fluid administration. Data were compared using 2-way analysis of variance (ANOVA) with repeated measures for continuous variables and Fisher's exact test for categorical variables. RESULTS: Calcium was associated with lower heart rates 45 min after starting the infusion (P = .002). Gastrointestinal sounds were less likely to improve in the calcium group compared with the control group (P = .005). An increase in plasma phosphorus concentration (P = .03) was associated with calcium administration. CONCLUSIONS: Intravenous calcium supplementation to endurance horses eliminated from competition after development of metabolic problems may decrease heart rate but impairs improvement in gastrointestinal sounds.

How we approach hemangiomas in infants.

Pediatric oncologists are increasingly involved in the management of benign vascular tumors and their associated life-threatening complications. Hemangiomas are the most common referring diagnosis to multidisciplinary vascular anomalies clinics. However, as contemporary research has revealed, hemangiomas are not a single, easily defined entity but rather a diverse set of related vascular tumors, each having a unique natural history, growth pattern, and response to therapy. This manuscript seeks to illustrate how we evaluate and manage these complex tumors, their complications, and associated syndromes, while remaining ever vigilant for malignant hemangioma mimickers such as soft tissue sarcomas and congenital leukemia.

Primary Immunodeficiency in Children With Autoimmune Cytopenias: Retrospective 154-Patient Cohort.

Background: Primary immunodeficiency is common among patients with autoimmune cytopenia. Objective: The purpose of this study is to retrospectively identify key clinical features and biomarkers of primary immunodeficiency (PID) in pediatric patients with autoimmune cytopenias (AIC) so as to facilitate early diagnosis and targeted therapy. Methods: Electronic medical records at a pediatric tertiary care center were reviewed. We selected 154 patients with both AIC and PID (n=17), or AIC alone (n=137) for inclusion in two cohorts. Immunoglobulin levels, vaccine titers, lymphocyte subsets (T, B and NK cells), autoantibodies, clinical characteristics, and response to treatment were recorded. Results: Clinical features associated with AIC-PID included splenomegaly, short stature, and recurrent or chronic infections. PID patients were more likely to have autoimmune hemolytic anemia (AIHA) or Evans syndrome than AIC-only patients. The AIC-PID group was also distinguished by low T cells (CD3 and CD8), low immunoglobulins (IgG and IgA), and higher prevalence of autoantibodies to red blood cells, platelets or neutrophils. AIC diagnosis preceded PID diagnosis by 3 years on average, except among those with partial DiGeorge syndrome. AIC-PID patients were more likely to fail first-line treatment. Conclusions: AIC patients, especially those with Evans syndrome or AIHA, should be evaluated for PID. Lymphocyte subsets and immune globulins serve as a rapid screen for underlying PID. Early detection of patients with comorbid PID and AIC may improve treatment outcomes. Prospective studies are needed to confirm the diagnostic clues identified and to guide targeted therapy.

COVID-19 Trends in the Phoenix Metropolitan Area from a Mobile Testing Program: Last Quarter of 2020.

The coronavirus (COVID-19) pandemic continues to be a public health concern, and Arizona has once again been a COVID-19 hotspot, peaking at 118.3 cases per 100,000. Understanding the trends in COVID-19 positivity rates over time is crucial in planning and mitigation of the virus. This current study analyzes the trends in COVID-19 testing, and COVID-19 antigen and antibody positivity rates over a 3-month time-span from October to December 2020. A retrospective study was conducted collecting data from a mobile testing program during October to December 2020 in the Phoenix metropolitan area. COVID-19 antigen and antibody positivity rates were analyzed. A total of 6710 patients were included in the study. As the months progressed, more patients were tested (October: 1635; November: 2037; December: 3038). The COVID-19 antigen positivity rate was significantly higher in December, compared to October and November (13.43% vs. 11.43 and 10.86%, p = 0.021). COVID-19 IgG rates were also significantly higher in November and December, compared to October (16.65 and 16.50% vs. 8.74%, p < 0.001). There was a progressive increase in COVID-19 positivity cases towards the end of 2020, likely attributed to factors including social gatherings during the holidays and the relaxing of the closure restrictions. Continued public health measures is crucial in preventing the spread of COVID-19.

Attentional shifting differences in autism: Domain general, domain specific or both?

LAY ABSTRACT: Previous research has shown that autistic individuals look at other people less and orient to them more slowly than others. Yet, it is still unclear if this represents general visual differences (e.g. slower looking at any new information, social or not) or a uniquely social difference (e.g. only slower looking to humans but not objects). Here, we aimed to examine how quickly autistic and non-autistic adults look to and away from social (i.e. faces) and non-social information (i.e. squares and houses). We used an attentional shifting task with two images where sometimes the first image disappears before the new image appears (makes it easier to notice the new image) and other times it stays on the screen when the new image appears. In Experiment 1, we showed schematic faces and squares to 27 autistic and 26 non-autistic adults, and in Experiment 2, we showed photographs of faces and houses to 18 autistic and 17 non-autistic adults. In general, autistic adults looked at the new non-social or social images similarly to non-autistic adults. Yet, only autistic adults looked at new social information faster when the first image disappeared before the new image appeared. This shows that autistic individuals may find it easier to notice new social information if their attention is not already occupied.

TISSUE CHANGES OBSERVED IN EASTERN BOX TURTLES (TERRAPENE CAROLINA CAROLINA) FOLLOWING A PRESCRIBED FIRE.

Necropsies were performed on five eastern box turtles (Terrapene carolina carolina), found in an area recently subjected to an early-season prescribed fire, to determine whether mortality was burn related. External injuries primarily consisted of burns to exposed extremities and carapacial scutes which ranged from two burned scales to >80% of the shell. Internally, there was no evidence of smoke inhalation, but multiorgan and multifocal inflammation may have contributed to mortality.

Clinical and biochemical factors associated with survival in equids attacked by dogs: 28 cases (2008-2016).

BACKGROUND: Trauma from dog attacks has been associated with mortality rates as high as 23% in some species. However, the prognosis and clinical features of this type of injury have not been described in equids. HYPOTHESES/OBJECTIVES: To describe survival rate, signalment, clinical features, and biochemical results in equids presented for emergency care after presumed dog attacks. We hypothesized there would be differences between survivors and nonsurvivors. ANIMALS: A total of 28 equids presented for presumed dog attacks from 3 referral centers. METHODS: A retrospective study was performed using data from 3 hospitals between 2008 and 2016. Survival was defined as survival at 14 days postdischarge. Variables were compared between survivors and nonsurvivors using a t test, Mann-Whitney U test, or Fisher's exact test as appropriate. RESULTS: Overall mortality rate was 21%. Ponies and miniature horses represented 16/28 (57%) of the animals in the study. Full-sized equids had a lower risk of nonsurvival as compared to smaller patients (odds ratio = 0.02; 95% confidence intervals = 0.00-0.27; P < .005). Animals with lower body temperatures had increased risk for nonsurvival (P = .0004). Increased admission blood lactate concentrations (P = .003) and decreased serum total protein concentrations (P = .006) were associated with nonsurvival. CONCLUSIONS: The mortality rate in equids attacked by dogs was similar to what is reported for other veterinary species. Smaller equids and those with increased admission blood lactate concentration, lower body temperature, and lower total serum protein concentrations were less likely to survive.

COVID-19 Exposure Among First Responders in Arizona.

OBJECTIVE: The number of COVID-19 cases in Arizona is rapidly increasing, leading the country in the rate of new daily cases. Exposure among first responders remains unknown. METHODS: Rates of SARS-CoV-2 IgG among first responders in Arizona were determined, and attitudes/views about the impact of COVID-19 on their work life was analyzed. RESULTS: Of 3326 first responders, 50 (1.50%) tested positive for SARS-CoV-2 IgG. Most first responders thought antibody testing would help ease their anxieties (62.5%) and be beneficial to their work-life (60.6%). CONCLUSION: The rate of COVID-19 exposure among first responders in Arizona is low-1.50%. COVID-19 is a concern among many of the first responders, and antibody testing was beneficial in easing their anxieties about going to work and performing work-related duties.

Resolution of neurologic signs presumed to be associated with hyperammonemia in 2 endurance horses.

This case report describes 2 endurance horses with non-hepatic hyperammonemia. The animals were competing in a 160-km endurance competition in extreme heat conditions and were presented for obtundation. One of the horses also had evidence of blindness. The blood ammonia concentration was elevated (196 µmol/L and 249 µmol/L) and both horses improved following treatment with intravenous fluids and supportive care. These are the first documented cases of clinical signs presumed to be associated with hyperammonemia in endurance horses. Despite the severity of the clinical presentation, both horses made a full recovery. Key clinical message: Non-hepatic hyperammonemia should be considered as a potential cause of blindness and obtundation in competing endurance horses. Horses appear to respond well to treatment with intravenous fluids.

Fin des signes neurologiques présumés être associés avec de l'hyperammoniémie chez deux chevaux d'endurance. Le présent rapport de cas décrit la situation de deux chevaux d'endurance avec une hyperammoniémie non-hépatique. Les animaux compétitionnaient dans une course d'endurance de 160 km dans des conditions de chaleur extrême et furent présentés pour confusion. Un des chevaux avait également des évidences de cécité. Les concentrations d'ammoniaque sanguin étaient élevées (196 µmol/L et 249 µmol/L) et les deux chevaux s'améliorèrent à la suite du traitement avec des fluides intraveineux et des soins de support. Ces cas représentent les premiers cas documentés de signes cliniques présumés être associés avec de l'hyperammoniémie chez des chevaux d'endurance. Malgré la sévérité de la présentation clinique, les deux chevaux ont récupéré complètement.Message clinique clé :L'hyperammoniémie non-hépatique devrait être considérée comme une cause potentielle de cécité et de confusion chez des chevaux d'endurance en compétition. Les chevaux semblent bien répondre à un traitement avec des fluides intraveineux.(Traduit par Dr Serge Messier).

Alveolar soft-part sarcoma: Case demonstrating principles for uncommon vascular lesions.

BACKGROUND: Alveolar soft-part sarcoma (ASPS) is an uncommon malignancy that may present in a manner similar to benign vascular tumors. METHODS: A 6-year-old boy with autism spectrum disorder was referred to the Johns Hopkins All Children's Hospital vascular anomalies clinic for the evaluation of a tongue mass. RESULTS: Prior to the presentation, at 5 years of age, neck computed tomography (CT) was performed. This showed a well circumscribed, enhancing mass at the anterior aspect of the tongue. The radiologic impression was that this lesion was most likely a hemangioma. Two years later, the patient was evaluated in the vascular anomalies clinic. At that examination a 2-3 cm swelling was noted on the dorsal aspect of the tongue. The mass was fleshy and firm with discrete borders. Handheld Doppler examination indicated a high-flow lesion. The patient underwent an excisional biopsy. The lesion was identified as an alveolar soft-part sarcoma based on pathologic characteristics. CONCLUSION: Familiarity with common vascular tumors and malformations allows providers to diagnose the majority of these lesions on a combination of clinical history and physical examination. Atypical and combined lesions do benefit from imaging to help characterize and aid in the differential diagnosis. Biopsy enables definitive diagnosis but is necessary in the minority of cases. When in doubt, referral to a specialized, multidisciplinary vascular anomalies clinic will ensure that these patients receive management for this challenging collection of conditions.

Laser ablation of embryonic veins in children.

BACKGROUND: Klippel-Trenaunay syndrome (KTS) and related overgrowth syndromes are rare conditions that often present to academic pediatric units and multidisciplinary vascular anomaly clinics. These conditions are commonly associated with abnormalities of the superficial and deep venous structures and carry an increased risk of venous thromboembolism. METHODS: A retrospective chart review was completed of all patients treated at Johns Hopkins All Children's Hospital with endovenous laser ablation therapy (EVLT) for management of dilated embryonic veins in the setting of limb overgrowth. RESULTS: Three patients with limb overgrowth underwent EVLT between 2015 and 2017. All patients had successful occlusion of the targeted veins on post-procedure imaging. One patient developed a cellulitis successfully treated with oral antibiotics. CONCLUSIONS: Endovenous laser ablation therapy is a well-tolerated and safe procedure for prophylactic closure of abnormal superficial embryonic veins. This study supports the use of this technique in managing increased thromboembolic risk in this unique patient population and recognizes the need for a long-term study to determine its efficacy.

Evaluation of potential predictor variables for PCR assay diagnosis of Anaplasma phagocytophilum infection in equids in Northern California.

OBJECTIVE To identify clinical or clinicopathologic variables that can be used to predict a positive PCR assay result for Anaplasma phagocytophilum infection in equids. ANIMALS 162 equids. PROCEDURES Medical records were reviewed to identify equids that underwent testing for evidence of A phagocytophilum infection by PCR assay between June 1, 2007, and December 31, 2015. For each equid that tested positive (case equid), 2 time-matched equids that tested negative for the organism (control equids) were identified. Data collected included age, sex, breed, geographic location (residence at the time of testing), physical examination findings, and CBC and plasma biochemical analysis results. Potential predictor variables were analyzed by stepwise logistic regression followed by classification and regression tree analysis. Generalized additive models were used to evaluate identified predictors of a positive test result for A phagocytophilum. RESULTS Total lymphocyte count, plasma total bilirubin concentration, plasma sodium concentration, and geographic latitude were linear predictors of a positive PCR assay result for A phagocytophilum. Plasma creatine kinase activity was a nonlinear predictor of a positive result. CONCLUSIONS AND CLINICAL RELEVANCE Assessment of predictors identified in this study may help veterinarians identify equids that could benefit from early treatment for anaplasmosis while definitive test results are pending. This information may also help to prevent unnecessary administration of oxytetracycline to equids that are unlikely to test positive for the disease.

Expanding the clinical and molecular findings in RASA1 capillary malformation-arteriovenous malformation.

RASA1-related disorders are vascular malformation syndromes characterized by hereditary capillary malformations (CM) with or without arteriovenous malformations (AVM), arteriovenous fistulas (AVF), or Parkes Weber syndrome. The number of cases reported is relatively small; and while the main clinical features are CMs and AVMs/AVFs, the broader phenotypic spectrum caused by variants in the RASA1 gene is still being defined. Here, we report the clinical and molecular findings in 69 unrelated cases with a RASA1 variant identified at ARUP Laboratories. Sanger sequencing and multiplex ligation-dependent probe amplification were primarily used to evaluate RASA1. Several atypical cases were evaluated using next-generation sequencing (NGS) and array-comparative genomic hybridization (aCGH). Sixty individuals had a deleterious RASA1 variant of which 29 were novel. Nine individuals had a variant of uncertain significance. Five large RASA1 deletions were detected, giving an overall deletion/duplication rate of 8.3% (5/60) among positive cases. Most (75.4%) individuals with a RASA1 variant had CMs, and 44.9% had an AVM/AVF. Clinical findings in several cases expand the RASA1 phenotype. Our data suggest that screening for large RASA1 deletions and duplications in this disorder is important and suggest that NGS multi-gene panel testing is beneficial for the molecular diagnosis of cases with complex vascular phenotypes.

The Relationship Between Autistic Traits and Atypical Sensory Functioning in Neurotypical and ASD Adults: A Spectrum Approach.

Sensory processing atypicalities are a common feature in Autism Spectrum Disorders (ASD) and have previously been linked to a range of behaviours in individuals with ASD and atypical neurological development. More recently research has demonstrated a relationship between autistic traits in the neurotypical (NT) population and increased levels of atypical sensory behaviours. The aim of the present study is to extend previous research by examining specific patterns across aspects of autistic traits and sensory behaviours within both ASD and NT populations. The present study recruited 580 NT adults and 42 high-functioning ASD adults with a confirmed diagnosis to investigate the relationship between specific aspects of autistic traits and sensory processing using the subscales of the autism spectrum quotient (AQ) and adult/adolescent sensory profile (AASP). Results showed a significant relationship between all subscales except for attention to detail and imagination on the AQ and provided the first evidence that the strength and pattern of this relationship is identical between NT and ASD adults. These data also provided support for the broader autism phenotype, uncovering a clear progression of sensory atypicalities in line with an increase in autistic traits, regardless of diagnostic status, which has potential implications for the spectrum approach to ASD and how sensory behaviours across the whole of the neurotypical population are conceptualised.

MOBILE SCREENING TO IDENTIFY AND FOLLOW-UP WITH HIGH RISK, HIV NEGATIVE YOUTH.

BACKGROUND: HIV prevalence remains disproportionately high among youth, especially among young men who have sex with men, young people with substance use disorders, and recently incarcerated youth. However, youth may not report behavioral risks because they fear stigma or legal consequences. While routine HIV screening programs have increased testing, current programs are not designed to identify, or provide prevention services to, high-risk patients who test HIV negative. AIMS: To examine the feasibility and preliminary efficacy of: a tablet-based screening designed to facilitate HIV risk reporting and testing among a sample of young urban emergency department (ED) patients; and a text message-based follow up protocol for patients who test HIV-negative and report increased behavioral risk. METHODS: 100 ED patients aged 18 - 24, who declined HIV tests offered at triage, completed a tablet-based intervention that included a risk screening, an educational video, and offered participants HIV tests. If patients accepted testing and reported increased risk, the tablets offered follow-up text messages. RESULTS: 30 participants accepted HIV tests following the intervention and 21 participants, identified by custom software as high-risk, agreed to receive text messages. Two thirds (66.7%) of text recipients responded to questions at week 6, more than half (57.1%) responded at week 8, one (4.76%) re-tested after week 12. CONCLUSION: Results indicate our intervention provides a feasible way to facilitate risk reporting, increase HIV testing, and maintain ongoing contact with hard-to-reach youth via tablet computers and text messages.

Mapping the Developmental Trajectory and Correlates of Enhanced Pitch Perception on Speech Processing in Adults with ASD.

Whilst enhanced perception has been widely reported in individuals with Autism Spectrum Disorders (ASDs), relatively little is known about the developmental trajectory and impact of atypical auditory processing on speech perception in intellectually high-functioning adults with ASD. This paper presents data on perception of complex tones and speech pitch in adult participants with high-functioning ASD and typical development, and compares these with pre-existing data using the same paradigm with groups of children and adolescents with and without ASD. As perceptual processing abnormalities are likely to influence behavioural performance, regression analyses were carried out on the adult data set. The findings revealed markedly different pitch discrimination trajectories and language correlates across diagnostic groups. While pitch discrimination increased with age and correlated with receptive vocabulary in groups without ASD, it was enhanced in childhood and stable across development in ASD. Pitch discrimination scores did not correlate with receptive vocabulary scores in the ASD group and for adults with ASD superior pitch perception was associated with sensory atypicalities and diagnostic measures of symptom severity. We conclude that the development of pitch discrimination, and its associated mechanisms markedly distinguish those with and without ASD.

Oxytocin increases the likeability of physically formidable men.

Physical size and strength are associated with dominance and threat. The current study tested (i) whether men's evaluations of male strangers would be negatively influenced by cues indicating physical formidability, and (ii) whether these evaluations would be influenced by oxytocin, a neuropeptide that mediates social behavior and reduces social anxiety. In a placebo-controlled double-blind design, we administered either oxytocin (24 I.U.) or placebo intranasally to 100 healthy males and assessed their responses to an image of either a physically formidable (strong) or physically non-formidable (weak) male peer. Whereas participants receiving placebo expressed dislike and avoidance of the strong male relative to the weak male, oxytocin selectively improved social evaluation of the strong male. These results provide first evidence that oxytocin regulates social evaluation of peers based on body features indicating strength and formidability. We discuss the possibility that oxytocin may promote the expansion of social networks by increasing openness toward potentially threatening individuals.

Response to sorafenib in a pediatric patient with papillary thyroid carcinoma with diffuse nodular pulmonary disease requiring mechanical ventilation.

BACKGROUND: Papillary thyroid cancer (PTC) presents with local and distant metastases more frequently in children than in adults. However, hypoxemia secondary to pulmonary metastases has not been reported in the literature. Sorafenib is a small-molecule multikinase inhibitor used in radioactive iodine ((131)I)-refractive papillary thyroid carcinoma. PATIENT FINDINGS: An eight-year-old boy presented with fever and hypoxemia and was found to have H1N1 viral pneumonia requiring mechanical ventilation and antiviral and glucocorticoid treatment. After initial improvement, he was readmitted one month later because of persistent hypoxemia. A high-resolution computed tomography of the chest and neck revealed multiple 1-4 mm nodules and necrotic lymph nodes on the right side of the neck. Left lung wedge resection and right deep cervical node biopsies were consistent with PTC. He underwent a total thyroidectomy with a central neck node dissection and postoperatively required prolonged mechanical ventilation. Due to the inability to be weaned from mechanical ventilation, treatment with sorafenib 200 mg daily (10 mg/kg/day, 250 mg/m(2)) was initiated. Eight days thereafter, ventilation support was discontinued and the child was extubated. However, he failed extubation secondary to supraglottic edema, and seven days later tracheostomy was performed. The dosage of sorafenib was increased to 200 mg twice daily (20 mg/kg/day, 500 mg/m(2)). After 52 days of therapy, a repeat computed tomography scan showed reduction in the lung nodule size to 1-2 mm. He underwent (131)I therapy 87 days after sorafenib was started. A post-treatment scan showed extensive uptake throughout the lungs and thyroid bed, supraclavicular nodes, and cervical nodes. CONCLUSIONS: This is the first reported case of a pediatric patient with respiratory failure possibly secondary to diffuse micronodular PTC requiring mechanical ventilation and subsequent delay in definitive therapy. Sorafenib could be considered for gap therapy when (131)I therapy cannot be administered in a timely manner. Treatment with this multikinase inhibitor does not seem to adversely affect the uptake of (131)I in radiation-naïve patients.