A case report of patient with cerebellar variant of stiff person syndrome.

Stiff person syndrome (SPS) is a rare autoimmune neurological disorder with antibodies against antigens involved in neurotransmission of gamma-aminobutyric acid (GABA). About 10% of patients with SPS may develop ataxia. This cerebellar variant is a distinct subset of SPS with more severe and complex clinical phenotype. We report the clinical, neuropsychological and neuroradiological findings in a 39-year-old female with cerebellar variant of SPS.

Dynamic heart phantom for the quality control of SPECT equipment.

A nuclear imaging of heart is a noninvasive procedure that reveals the cardiac structure and physiology enabling evaluation of cardiac function. According to the regulations published by the Polish Government and the Polish Ministry of Health, the nuclear medicine departments must follow the new legislation which has imposed quality assurance (QA) and quality control (QC) of equipment and medical testing procedures as compulsory. The foremost reason to perform QC tests of medical imaging equipment, using ionizing radiation, is to assure the provision of the best possible diagnostic service to the patient with the least radiological hazard. One of the most common ways of testing in nuclear medicine is using phantoms. The aim of this study was to design and perform a dynamic heart phantom. The heart phantom was designed according to directive of the ICRU Report 48. It consists of a pump, tubes, cardiac volume and a membrane simulating left ventricle. The pump compresses and decompresses membrane. The pumping frequency can be changed from 60 to 200 bpm. The phantom cardiac volume should be filled with radiopharmaceutical. The elaborated dynamic heart phantom is used for QC of imaging system in nuclear medicine department. The QC measurements were performed with the phantom filled with 45-50 MBq of (99m)Tc-MIBI solution and placed in water filled anthropomorphic torso phantom. The dynamic heart phantom can also be used to simulate all types of the myocardial infarctions and help to choose the best geometry of the measurement.

Functional autonomies of thyroid and efficacy of radioiodine therapy.

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.

Retrospective Biological Dosimetry at Low and High Doses of Radiation and Radioiodine Impact on Individual Susceptibility to Ionizing Radiation.

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.

Reradiosynoviorthesis of the knee.

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.

[Influence of somatovisceral reflexes activation (TENS) on gallblader emptying in chole-lithiasis patients]. / Wplyw aktywacji odruchów somatyczno-trzewnych (TENS) na opróznianie pecherzyka zólciowego u pacjentów z kamica pecherzyka zolciowego.

There have been several reports describing impact of transcutaneous electrical nerve stimulation (TENS) on bile emptying. The aim of this study was to determine the effect of somatovisceral reflex excitation by TENS on gallbladder emptying in patients with cholelithiasis using hepatocholescintigraphy TENS induced somatovisceral reflexes that decrease the gallbladder ejection rate. Relaxation of the gallbladder and bile ducts emptying seem to be related to the reciprocal reflexes dampened by inflammation associated cholelithiasis.

[Esophageal scintigraphy in patients with systemic sclerosis: clinical symptoms correlated with the esophagus noted by the patients]. / Badanie scyntygraficzne przelyku u chorych z twardzina ukladowa; korelacje z objawami klinicznymi ze strony przelyku zglaszanymi przez chorych.

Systemic sclerosis (SSc) is a multisystem connective tissue disorder characterized by excessive accumulation of the extracellular matrix. About 90% of the patients with SSc have detectable gastrointestinal tract involvement, 50% of these patients have clinically important manifestations. The aim of the study was estimation of the connection between subjective symptoms from the esophagus and results of the esophageal scintigraphy. 30 patients with systemic sclerosis were comprised to the study. Esophageal scintigraphy was performed in each patients, as well as questionnaire about type, intensity and frequency of esophageal dysmotility. Also it estimated was stiffness of the skin according to modified Rodnan score. Independent of esophageal dysmotility symptoms which were noted by patients, esophageal scintigraphy registered changes in 97% of the patients. The most often esophageal dysmotility was observed in lower part of the esophagus. Statistically Dysmolity of the central portion of the esophagus was observed more often in patients with diagnosed ISSc.