Radioiodine treatment of hyperthyroidism in a pregnant women.

UNLABELLED: We describe the effects of radioiodine treatment of a pregnant thyrotoxic woman. METHODS: The woman received 500 MBq of (131)I in her 20th gestational week. The pregnancy was discovered 10 days after radioiodine administration. A gamma camera examination of the abdomen at that time showed a distinct focus of activity, which was interpreted as the fetal thyroid. Gamma camera examinations of the mother and fetus were performed at 10, 11, 12, 13 and 18 days after administration of the therapeutic activity and were the basis of dose calculations. The child was examined by hormone tests and mental performance tests, up to 8 yr after birth. RESULTS: The uptake at 24 hr postadministration was calculated to be 10 MBq (2%) in the fetal thyroid gland. The effective half-life was 2.5 days, giving a calculated absorbed dose to the fetal thyroid gland of 600 Gy, which is considered to be an ablative dose. The calculated absorbed dose to the fetal body, including brain, was about 100 mGy, and 40 mGy to the fetal gonads. Doses were estimated taking contributions from radioiodine in the mother, the fetal body and the fetal thyroid into consideration. The woman was encouraged to continue her pregnancy and received levothyroxine in a dose to render her slightly thyrotoxic. At full term, an apparently healthy boy, having markedly raised cord blood serum thyroid-stimulating hormone concentration and subnormal thyroxine (T4) and low-normal triiodothyronine (T3) concentrations, was born. Treatment with thyroxine was initiated from the age of 14 days, when the somatosensoric evoked potential latency time increased to a pathological value and hormonal laboratory tests repeatedly confirmed the hypothyroid state. At 8 yr of age, the child attends regular school. A neuropsychological pediatric examination showed that the mental performance was within normal limits, but with an uneven profile. He has a low attention score and displays evidently subnormal capacity regarding figurative memory. CONCLUSION: Radioiodine treatment in pregnancy in the 20th gestational week does not give a total absorbed dose to the fetal body that justifies termination of pregnancy. A high absorbed dose to the fetal thyroid, however, should be the basis of the management of the pregnancy and offspring.

Effects of hormonal replacement therapy on the postural balance among postmenopausal women.

OBJECTIVE: To establish whether hormone replacement therapy affects postural balance in postmenopausal women. METHODS: Nineteen healthy postmenopausal women with vasomotor symptoms were included. Median age was 54 years, median time since menopause was 3 years. They underwent dynamic posturography before and after 4 and 12 weeks of transdermal estrogen treatment (17 beta-estradiol 50 micrograms/day) as well as after 2 additional weeks of combined estrogen-progestagen treatment. The dynamic posturography method quantifies the amplitude, frequency, and pattern of body sway and tests the visual, vestibular, and somatosensory systems, which together maintain balance. The two most difficult tests either cancel visual and distort somatosensory inputs or give distorted information from both the visual and somatosensory systems. RESULTS: Hormone replacement therapy increased static balance performance assessed by dynamic posturography. A highly significant improvement was seen in the two most difficult tests between the pretreatment test and the test performed after 4 weeks of estrogen therapy (P < .01, P < .001, respectively). This improvement was sustained after 12 weeks and also during the 14th week, with the women on combined estrogen-progestagen treatment. CONCLUSION: Estrogen treatment increased balance performance measured by dynamic posturography, indicating that the beneficial effects from estrogens on postmenopausal fracture risk may include central nervous system effects on balance. Two weeks' addition of gestagen to the treatment regimen did not counteract the estrogen effects.

Iodine-131 treatment of hyperthyroidism: significance of effective half-life measurements.

UNLABELLED: Our goals were to evaluate the effect of half-life determination and differences in the half-life of 131I between patients with Graves' disease and toxic nodular goiter, and the influence of antithyroid drugs on iodine uptake. METHODS: We reviewed the records of 555 patients who had received radioiodine treatment for Graves' disease and toxic nodular goiter to analyze iodine uptake, half-life values and pretreatment with antithyroid drugs. Two different methods of dose calculation were compared: one using repeated uptake measurements at 24 and 48 hr and 4 or 6 days to define the effective half-life. The other method assumed a half-life of 5 days and uptake at 24 hr only. All patients were treated according to the first method. A follow-up questionnaire was sent to 327 patients (238 responders) to assess the treatment outcome. RESULTS: After comparing the results of the two methods, we found that repeat uptake measurements and determination of effective half-life results in administered activities that differ considerably from those calculated when an assumed, fixed half-life and a single uptake measurement are used. The simpler method would lead to over- as well as undertreatment of the patient. There was a functional difference between patients with Graves' disease and toxic nodular goiter, as reflected by the shorter 131I half-life in Graves' disease (mean 5.0 days) than toxic nodular goiter (mean 6.0 days) and a skewed distribution in toxic nodular goiter. Patients pretreated with antithyroid drugs had shorter 131I half-lives in both categories. Ten percent of the patients required more than one treatment; 94% of the patients with Graves' disease and 45% with toxic nodular goiter had thyroxine substitution 1-5 yr after treatment. CONCLUSION: A dose calculation method that uses three uptake measurements provides sufficient data about the effective half-life of 131I in the thyroid. There is considerable difference in the half-life based on the disease being treated (Graves' disease or toxic nodular goiter). The 131I half-life also is shorter after pretreatment with anti-thyroid drugs. Thus, the simpler method leads to significant uncertainty, leading to over- as well undertreatment of the patient.

Bulky centroblastic non-Hodgkin's lymphoma of the cranium vault mimicking brain involvement managed with chemotherapy: a case report.

BACKGROUND: Patients with central nervous system (CNS) involvement by high grade non-Hodgkin's lymphoma (NHL) have a poor prognosis. The roles of computed tomography, radiotherapy, and intrathecal and systemic chemotherapy still need to be defined. METHODS: A patient with bulky cranial lymphoma mimicking brain involvement is reported. A 62-year-old man was admitted with a huge scalp lump, headache, fatigue, and focal and generalized neurologic symptoms. Computed tomography showed an abnormal mass in the frontoparietal region involving the subcutaneous scalp, osteolytic destruction of the cranial vault, and a bulky mass that was interpreted to be intracranial. A systemic survey also revealed bulky retroperitoneal involvement and focal involvement of the spleen. Biopsy revealed a B-cell NHL of centroblastic type according to the Kiel classification. RESULTS: The patient was treated with a modified combination of cyclophosphamide plus mitoxantrone plus vincristine plus prednisone (CNOP) and intrathecal methotrexate. The patient responded with complete remission, including partial bone restoration of the cranium. At the time of this writing, his relapse free survival lasted 5 years. CONCLUSIONS: The initial interpretation of this case indicated that systemic chemotherapy with modified CNOP plus intrathecal methotrexate would be useful in the management of NHL with CNS involvement. The clinical outcome with rapid neurologic repair and also bone restoration of the cranial vault within 5 years suggests that the lymphoma probably never penetrated the dura and a successful treatment was achieved with combination chemotherapy only.

The impact of religious faith and practice on patients suffering from a major affective disorder: a cost analysis.

Presents empirical data showing the relationship between religious beliefs and practices and lengths of stay in the hospital for patients suffering from one form of mental illness. Includes a spiritual injury scale which measures guilt, anger or resentment, sadness/grief, lack of meaning, feeling God/life has treated one unfairly, religious doubt, and fear of death. Shows in statistical form the relationship between these spiritual injuries and length of stay in the hospital. Indicates that spiritual injury issues are positively associated with longer lengths of hospital stay and that an inverse relationship exists between religious faith as measured by church attendance and cost for health care.

A comparison of combat's effects on PTSD scores in veterans with high and low moral development.

This study was designed to explore the effects of moral development on the relationship between combat intensity and severity of posttraumatic stress disorder. The effect of combat intensity on PTSD Interview total scores and several individual stress disorder symptom ratings was substantial in a Low Moral Development sample, but negligible in a High Moral Development group. These data suggest that moral development may blunt the effect of combat severity on PTSD. These effects were strongest on items that describe reexperiencing of the trauma and exaggerated arousal. Possible interpretations of the results and several caveats were discussed.

The use of the computer as a tool for assessment and research in pastoral care.

Numerous articles have been written that are critical of the pastoral care and chaplaincy profession for its failure to utilize quantitative instruments for clinical care and research. This paper presents an instrument and methodology for collecting data using the computer as an assessment tool. It also presents initial research data indicating the constructive relationship between religious faith and healing.

Endocrine changes and urinary citrate excretion.

Urinary citrate affects the ion-activity products of calcium oxalate and calcium phosphate and inhibits the growth of these crystals. Women are less prone to develop calcium stones and because they also excrete more citrate than men, an effect of sex steroids on citrate excretion might be important. We therefore analysed urinary citrate and creatinine before and during treatment with estrogen alone or together with medroxyprogesterone acetate in 29 postmenopausal women and at different gestational ages in 19 pregnant women. Urinary citrate and creatinine was also determined before and after orchidectomy in ten men with carcinoma of the prostate. The excretion of citrate and the ratios between citrate and creatinine were not significantly altered by pregnancy or orchidectomy. Neither did treatment with estrogen or estrogen/medroxyprogesterone acetate affect these variables. We were unable to explain the difference in citrate excretion between men and women by effects of sex steroids.