Drug Prescribing for Patients with Chronic Kidney Disease in General Practice: a Cross-Sectional Study

Identification of akinetic but viable myocardium is important for the selection of patients for coronary revascularization. In order to assess predictive values of end-diastolic wall thickness and dobutamine induced wall thickening obtained by magnetic resonance imaging (MRI) and [18F]Fluorodeoxyglucose uptake assessed by positron emission tomography (F-18-FDG-PET), these parameters were compared to recovery of left ventricular function after successful revascularization. Forty patients with chronic myocardial infarction and regional a- or dyskinesia by ventriculography underwent rest- and dobutamine-MRI studies (10 μg dobutamine/kg body weight/min) and F-18-FDG-PET. Viability of the infarct region was considered to be present if; 1) end-diastolic wall thickness was ≥ 5.5 mm; 2) dobutamine induced wall thickening ≥ 2 mm could be measured; and 3) normalized F-18-FDG-uptake was ≥ 50% in ≥ 50% of akinetic segments. Preserved end-diastolic wall thickness was found in 32/40 patients, functional improvement during dobutamine infusion in 26/40 patients and preserved F-18-FDG-uptake in 29/40 patients. After revascularization regional left ventricular function improved in 25/40 patients. Positive and negative predictive values and diagnostic accuracy were 78%, 100%, and 83% for preserved end-diastolic wall thickness, 92%, 93%, and 93% for dobutamine inducible contraction reserve and 86%, 100%, and 90% for preserved F-18-FDG-uptake. Quantitative assessment of dobutamine induced systolic wall thickening by MRI and F-18-FDG-uptake by PET are highly accurate techniques for the identification of viable myocardium and prediction of functional recovery after successful revascularization. Preserved end-diastolic wall thickness results in an overestimation of viable myocardium compared to functional improvement, but wall thickness <5.5 mm excludes recovery of regional function.

Introduction: Spinal cord electrical stimulation may be a treatment option for patients having angina pectoris CCS III-IV although being on optimal medical treatment (nitrate, β-blocker, aspirin, Ca++-antagonist, ACE-inhibitor, statin) and not suitable for conventional treatment strategies, e.g. CABG or PTCA. Although it has been shown to produce symptomatic relief, doubts remain about its effect on myocardial blood flow and cardiac ischemia.

In agreement with the study group of the ESC, we would recommend SCS as first-line therapy for refractory angina pectoris. As a matter of course, conventional treatment strategies should not be replaced by SCS. Hence, a strict evaluation before implanting a SCS device is indispensable.

Zusammenfassung. Hintergrund: Es gibt einen zunehmenden Anteil von Patienten mit koronarer Herzerkrankung und Angina-pectoris-Beschwerden, bei denen trotz großer Fortschritte im operativen und katheterinterventionellen Bereich eine Revaskularisierung nicht möglich ist. Therapie: Eine kürzlich veröffentlichte Übersicht der Arbeitsgruppe zur Behandlung der refraktären Angina pectoris der Europäischen Gesellschaft für Kardiologie (ESC) führt die Neurostimulation an erster Stelle der alternativen Therapiemöglichkeiten für diese Patienten an. Dabei handelt es sich um ein bereits seit vielen Jahren bekanntes Verfahren, welches jedoch in der Bundesrepublik Deutschland, trotz großer Erfahrungen im europäischen Ausland, bisher nur vereinzelt angewendet wurde. Die vorliegenden Studien belegen, dass es sich dabei um eine effiziente Therapie handelt. Durch Reduktion der Angina-pectoris-Symptomatik und konsekutive Zunahme der körperlichen Leistungsfähigkeit wird eine entscheidende Verbesserung der Lebensqualität erzielt. Erste Daten aus einer eigenen Studie zeigen, dass sich auch die myokardiale Durchblutung unter Neurostimulation im Langzeitverlauf verbessert. Dies könnte an einer verbesserten Kollateralisierung durch die gesteigerte Belastbarkeit liegen oder aber ein direkter Effekt der Therapie sein. Schlussfolgerung: Wir sehen in Übereinstimmung mit den Empfehlungen der ESC die Neurostimulation als Therapiemöglichkeit der ersten Wahl für Patienten mit refraktärer Angina pectoris an. Konventionelle und kausal eingreifende Therapieverfahren sollen selbstverständlich nicht durch eine Neurostimulation ersetzt werden. Eine strenge Indikationsstellung ist daher unumgänglich.

Centrocytes in germinal centers on selection differentiate into plasma cells and/or memory B cells. Cells that have acquired autoreactivity by somatic mutation generally fail to undergo positive selection and die by apoptosis. Presence of isotype-switched high-affinity autoantibodies in serum of autoimmune patients suggests that autoreactive plasma cells eventually emerge from a germinal center reaction. Currently, it is still unclear to which extent the same is true for autoreactive memory B cells. To address this question, we have analyzed whether IgG-bearing memory B cells with specificity for thyroid peroxidase (FPO) can be found in blood of patients with autoimmune thyroid disease and in normal blood donors. Autoreactive TPO-specific IgG(+) memory B cells were identified using a previously described assay combining two-step immunomagnetic enrichment with flow cytometric detection. Autoreactive IgG(+) memory B cells were found in 65% of the patients with autoimmune thyroid disease and in 17% of normal blood donors; 40% of the latter had no detectable TPO-specific IgG in the serum. The specificity of enriched TPO-specific IgG(+) memory B cells was confirmed by in vitro proliferation and differentiation into anti body-secreting cells at limiting dilution and analysis of the supernatants for the presence of TPO-specific IgG. Detection of TPO-specific IgG(+) memory B cells in most patients with clinically manifested autoimmune thyroid disease and few normal blood donors may argue for a role of circulating memory B cells in onset of disease.

Aim: During the past decade stress-echocardiography has gained increasing popularity for detection of myocardial ischemia in patients with coronary artery disease. However, about 10% to 15% of the patients submitted for stress-echocardiography do not have an adequate acoustic window. The purpose of this study was to compare high-dose dobutamine-stress magnetic resonance imaging (dobutamine-MRI) with dipyridamole-TI-201-SPECT (dipyridamole-SPECT) as alternative strategies for detection of myocardial ischemia in patients with inadequate image quality by stress-echocardiography. Patients and Methods: Of 296 patients which were consecutively submitted to stress-echocardiography 45 patients (15%) had two or more segments that could not be evaluated according to the 16-segment-model of the American Society of Echocardiography. They underwent dobutamine-MRI and dipyridamole-SPELT studies, which were evaluated using a 28-segment modell. Myocardial segments were attributed to perfusion territories of the coronary arteries. The results of ischemia detection were compared to the results of coronary angiography (stenosis greater than or equal to 50%) Results: In comparison to coronary angiography dobutamine-MRI yielded a sensitivity of 87%, a specificity of 86%, a positive predictive value of 93%, a negative predictive value of 75% and a diagnostic accuracy of 86%. For dipyridamole-SPELT results were 90%, 86%, 93%, 80% and 89%, respectively. These values were not significantly different. Conclusions: In patients not suitable for stress-echocardiography, both dobutamine-MRI and dipyridamole-SPELT are reliable strategies for detection of myocardial ischemia. Selection is dependent on the patient criteria, technical considerations, local logistics and experience of the observer.

Aim: The influence of physiological and pharmacological amounts of iodine on the uptake of radioiodine in the thyroid was examined in a 4-compartment model. This model allows equations to be derived describing the distribution of tracer iodine as a function of time. The aim of the study was to compare the predictions of the model with experimental data. Methods: Five euthyroid persons received stable iodine (200 pg, 10 mg). 1-123-uptake into the thyroid was measured with the Nal(TI)-detector of a body counter under physiological conditions and after application of each dose of additional iodine. Actual measurements and predicted values were compared, taking into account the individual iodine supply as estimated from the thyroid uptake under physiological conditions and data from the literature. Results: Thyroid iodine uptake decreased from 80% under physiological conditions to 50% in individuals with very low iodine supply (15 pg/d) (n = 2). The uptake calculated from the model was 36%. Iodine uptake into the thyroid did not decrease in individuals with typical iodine supply, i.e. for Cologne 65-85 pg/d (n = 3). After application of 10 mg of stable iodine, uptake into the thyroid decreased in all individuals to about 5%, in accordance with the model calculations. Conclusion: Comparison of theoretical predictions with the measured values demonstrated that the model tested is well suited for describing the time course of iodine distribution and uptake within the body. It can now be used to study aspects of iodine metabolism relevant to the pharmacological administration of iodine which cannot be investigated experimentally in humans for ethical and technical reasons.

SCHMIDT, MATTHIAS M.D.; THEISSEN, PETER M.D.; MOKA, DETLEF M.D.; VOTH, EBERHARD M.D.; SCHMITTER, HEINZ-THEO M.D.; SCHICHA, HARALD M.D. Author Information

BACKGROUND:Beside thrombolysis, percutaneous transluminal coronary angioplasty (PTCA) has become a well-established treatment for acute myocardial infarction. However, restenosis occurs in approximately 15%-40% of patients. Despite a frequently occurring infarct-related regional systolic dysfunction at rest, the identification of hemodynamically relevant restenosis seems important in terms of risk stratification, adequate treatment, and possible improvement of prognosis in these patients. This study was designed to assess the role of transesophageal dobutamine stress echocardiography and myocardial scintigraphy for identification of hemodynamically significant restenosis after PTCA for acute myocardial infarction.METHODS:Multiplane transesophageal stress echocardiography (dobutamine 5, 10, 20, 30, and 40 micrograms/kg per min) studies and myocardial single photon emission computed tomography (SPECT) studies were performed in 40 patients, all of whom underwent PTCA in the setting of acute myocardial infarction > or = 4 months prior to the test. Repeated coronary angiography was performed in all study patients who showed stress-induced perfusion defects or wall-motion abnormalities, or both.RESULTS:Significant restenosis (> or = 50%) was angiographically found in 15 (37.5%) of 40 patients. Of these 15 patients, transesophageal dobutamine stress echocardiography identified restenosis in 12 (80%) and myocardial SPECT in 14 (93%), yielding diagnostic agreement in 70% of patients. Echocardiographic detection of restenosis was based mainly on a biphasic response to increasing doses of dobutamine. Sensitivity and specificity for identification of hemodynamically relevant restenosis in individual patients was 80% and 92%, respectively for dobutamine stress echocardiography versus 93% and 68% for myocardial SPECT.CONCLUSIONS:Both transesophageal dobutamine stress echocardiography and myocardial SPECT were highly sensitive in identifying significant restenosis after PTCA for acute myocardial infarction. Therefore, either test, as a single diagnostic tool or especially if performed together, are clinically valuable alternatives to coronary angiography for the detection of restenosis after PTCA for acute myocardial infarction.

Medical and Pediatric OncologyVolume 36, Issue 4 p. 489-490 Misleading Lead Asymmetric salivary gland 123I-meta-iodobenzylguanidine uptake in a patient with cervical neuroblastoma and horner syndrome Thorsten Simon MD, Corresponding Author Thorsten Simon MD [email protected] Children's Hospital, University of Cologne, Cologne, GermanyChildren's Hospital, Depart-ment of Pediatric Hematology and Oncology, University of Cologne, Joseph-Stelzmann-Straße 9, 50924 Cologne, Germany.Search for more papers by this authorEberhard Voth MD, Eberhard Voth MD Children's Hospital, University of Cologne, Cologne, GermanySearch for more papers by this authorFrank Berthold MD, Frank Berthold MD Children's Hospital, University of Cologne, Cologne, GermanySearch for more papers by this author Thorsten Simon MD, Corresponding Author Thorsten Simon MD [email protected] Children's Hospital, University of Cologne, Cologne, GermanyChildren's Hospital, Depart-ment of Pediatric Hematology and Oncology, University of Cologne, Joseph-Stelzmann-Straße 9, 50924 Cologne, Germany.Search for more papers by this authorEberhard Voth MD, Eberhard Voth MD Children's Hospital, University of Cologne, Cologne, GermanySearch for more papers by this authorFrank Berthold MD, Frank Berthold MD Children's Hospital, University of Cologne, Cologne, GermanySearch for more papers by this author First published: 15 March 2001 https://doi.org/10.1002/mpo.1114Citations: 2AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. REFERENCES Brodeur GM, Prichard J, Berthold F, et al. Revisions of the international criteria for neuroblastoma diagnosis, staging, and response to treatment. J Clin Oncol 1993; 11: 1466–1477. 10.1200/JCO.1993.11.8.1466 CASPubMedWeb of Science®Google Scholar Nakajo M, Shapiro B, Sisson JC, et al. Salivary gland accumulation of meta-131Iiodobenzlguanidine. J Nucl Med 1984; 25: 2–6. CASPubMedWeb of Science®Google Scholar Sandler ED, Hattner RS, Parisi MT. Asymmetry of salivary gland I123 metaiodobenzylguanidine (MIBG) uptake in a patient with cervical neuroblastoma and Horner's syndrome—possible etiologic mechanisms. Ped Radiol 1992; 22: 225–226. 10.1007/BF02012504 CASPubMedWeb of Science®Google Scholar Sisson JC, Wieland DM, Jaques S Jr, et al. Radiolabeled meta-iodobenzylguanidine and the adrenergic neurons of salivary glands. Am J Physiol Imag 1987; 2: 1–9. CASPubMedGoogle Scholar Pacholczky T, Blakely RD, Amara SG. Expression cloning of a cocaine- and antidepressant-sensitive human noradrenaline transporter. Nature 1991; 350: 350–354. 10.1038/350350a0 PubMedGoogle Scholar Jaques S Jr, Tobes MC, Sisson JC, et al. Comparision of the sodium dependency of uptake of meta-iodobenzylguanidine and norepinephrine in cultured bovine adrenomedullary cells. Mol Pharmacol 1984; 26: 539–546. CASPubMedWeb of Science®Google Scholar Wafelman AR, Hoefnagel CA, Meas RAA, Beijnen JH. Radioiodinated metaiodobenzylguanidine: a review of its biodistribution and pharmacokinetics, drug interactions, cytotoxicity and dosimetry. Eur J Nucl Med 1994; 21: 545–559. 10.1007/BF00173043 CASPubMedWeb of Science®Google Scholar Elgazzar AH, Gelfand MJ, Washburn LC, et al. I-123 MIBG scintigraphy in adults. A report of clinical experience. Clin Nucl Med 1995; 20: 147–152. 10.1097/00003072-199502000-00011 CASPubMedWeb of Science®Google Scholar Dwamena BA, Zempel S, Klopper JF, et al. Brain uptake of iodine-131 metaiodobenzylguanidine following therapy of malignant pheochromocytoma. Clin Nucl Med 1998; 23: 441–445. 10.1097/00003072-199807000-00009 CASPubMedWeb of Science®Google Scholar Babin-Ebell J, Gliese M. Extraneuronal uptake of noradrenaline in human tissue (uptake2). Heart Vessels 1995; 10: 151–153. 10.1007/BF01744482 CASPubMedWeb of Science®Google Scholar Martel F, Azevedo I, Osswald W. Uptake of 3H-catecholamines by rat liver cells occurs mainly through a system which is distinct from uptake1 or uptake 2. Naunyn-Schmiedebergs Arch Pharmacol 1994; 350: 130–142. 10.1007/BF00241086 CASPubMedWeb of Science®Google Scholar Citing Literature Volume36, Issue41 April 2001Pages 489-490 ReferencesRelatedInformation

SummaryAim: During the past decade stress-echocardiography has gained increasing popularity for detection of myocardial ischemia in patients with coronary artery disease. However, about 10% to 15% of the patients submitted for stress-echocardiography do not have an adequate acoustic window. The purpose of this study was to compare high-dose dobutamine-stress magnetic resonance imaging (dobutami-ne-MRI) with dipyridamole-Tl-201-SPECT (dipyridamole-SPECT) as alternative strategies for detection of myocardial ischemia in patients with inadequate image quality by stress-echocardiography. Patients and Methods: Of 296 patients which were consecutively submitted to stress-echocardiography 45 patients (15%) had two or more segments that could not be evaluated according to the 16-seg-ment-model of the American Society of Echocardiography. They underwent dobutamine-MRI and dipyridamole-SPECT studies, which were evaluated using a 28-segment modeli. Myocardial segments were attributed to perfusion territories of the coronary arteries. The results of ischemia detection were compared to the results of coronary angiography (stenosis >50%.) Results: In comparison to coronary angiography dobutamine-MRI yielded a sensitivity of 87%, a specificity of 86%, a positive predictive value of 93%, a negative predictive value of 75% and a diagnostic accuracy of 86%. Eor dipyridamole-SPECT results were 90%, 86%, 93%, 80% and 89%, respectively. These values were not significantly different. Conclusions: In patients not suitable for stress-echocardiography, both dobutamine-MRI and dipyridamole-SPECT are reliable strategies for detection of myocardial ischemia. Selection is dependent on the patient criteria, technical considerations, local logistics and experience of the observer.

AIM:Premedication with antithyroid drugs (ATD) compared to patients not pretreated with ATD causes a higher failure rate of radioiodine therapy (RITh) or demands higher therapeutical dosage of radioiodine (RI). For clinical reasons and because of accelerated iodine metabolism in hyperthyreosis a compensated thyroid metabolism is desirable. Aim of this study was to investigate the influence of ATD on the biokinetics of RI in case of Graves' disease in order to improve RITh of patients pre-treated with ATD.METHODS:385 consecutive patients who underwent RITh because of Graves' disease for the first time were included: Group A (n = 74): RITh under continuous medication with ATD; Group B (n = 111): Application of RI under continuous medication with ATD, in case of insufficient RI-uptake or shortened effective RI-half-life ATD were stopped 1-5 days after RITh; Group C (n = 200): ATD were stopped 2 days prior to RITh in all patients. We examined the influence of ATD on RI-uptake and effective RI-half-life as well as the absorbed dose achieved on the thyroid in dependence of thyroid volume and applied RI-dosage [TEQ--therapy efficiency quotient, (2)].RESULTS:In the RI-pretest (all patients under ATD) the RI-uptake was comparable in all three groups. During RITh RI-uptake, effective RI-half-life and therefore the TEQ were significantly higher in Group C as compared to Groups A and B (p < 0.001, respectively). In Group B the medication with ATD was stopped in 61 of 111 cases 1-5 days after RITh. In this subgroup the effective RI-half-life increased from 4.4 +/- 1.7 d to 5.1 +/- 1.6 d after stopping of ATD (p = 0.001).CONCLUSION:Stopping of ATD 2 days prior to RITh leads to an increased efficiency of about 50% compared to RITh carried out under ATD and therefore to a clear reduction of radiation exposure to the rest of the body with equal absorbed doses of the thyroid. Stopping of ATD shortly after RITh increases efficiency in case of short effective RI-half-life, but it is inferior to stopping ATD 2 days prior to RITh.

Aim: Premedication with antithyroid drugs (ATD) compared to patients not pretreated with ATD causes a higher failure rate of radioiodine therapy (RITh) or demands higher therapeutical dosage of radioiodine (RI). For clinical reasons and because of accelerated iodine metabolism in hyperthyreosis a compensated thyroid metabolism is desirable. Aim of this study was to investigate the influence of ATD on the biokinetics of RI in case of Graves' disease in order to improve RITh of patients pre-treated with ATD. Methods: 385 consecutive patients who underwent RITh because of Graves' disease for the first time were included: Group A (n = 74): RITh under continuous medication with ATD; Group B (n = 111): Application of RI under continuous medication with ATD, in case of insufficient RI-uptake or shortened effective RI-half-life ATD were stopped 1-5 days after RITh; Group C (n = 200): ATD were stopped 2 days prior to RITh in all patients. We examined the influence of ATD on RI-uptake and effective RI-half-life as well as the absorbed dose achieved on the thyroid in dependence of thyroid volume and applied RI-dosage [TEQ-therapy efficiency quotient, (2)]. Results: In the RI-pretest (all patients under ATD) the RI-uptake was comparable in all three groups. During RITh RI-uptake, effective RI-half-life and therefore the TEQ were significantly higher in Group C as compared to Groups A and B (p <0,001, respectively). In Group B the medication with ATD was stopped in 61 of 111 cases 1-5 days after RITh. In this subgroup the effective RI-half-life increased from 4,4 +/- 1,7 d to 5,1 +/- 1,6 d after stopping of ATD (p = 0,001). Conclusion: Stopping of ATD 2 days prior to RITh leads to an increased efficiency of about 50% compared to RITh carried out under ATD and therefore to a clear reduction of radiation exposure to the rest of the body with equal absorbed doses of the thyroid. Stopping of ATD shortly after RITh increases efficiency in case of short effective RI-half-life, but it is inferior to stopping ATD 2 days prior to RITh.

Summary Aim: The influence of physiological and pharmacological amounts of iodine on the uptake of radioiodine in the thyroid was examined in a 4-compartment model. This model allows equations to be derived describing the distribution of tracer iodine as a function of time. The aim of the study was to compare the predictions of the model with experimental data. Methods: Five euthyroid persons received stable iodine (200 μg, 10 mg). 1-123-uptake into the thyroid was measured with the Nal (Tl)-detector of a body counter under physiological conditions and after application of each dose of additional iodine. Actual measurements and predicted values were compared, taking into account the individual iodine supply as estimated from the thyroid uptake under physiological conditions and data from the literature. Results: Thyroid iodine uptake decreased from 80% under physiological conditions to 50% in individuals with very low iodine supply (15 μg/d) (n = 2). The uptake calculated from the model was 36%. Iodine uptake into the thyroid did not decrease in individuals with typical iodine supply, i.e. for Cologne 65-85 μg/d (n = 3). After application of 10 mg of stable iodine, uptake into the thyroid decreased in all individuals to about 5%, in accordance with the model calculations. Conclusion: Comparison of theoretical predictions with the measured values demonstrated that the model tested is well suited for describing the time course of iodine distribution and uptake within the body. It can now be used to study aspects of iodine metabolism relevant to the pharmacological administration of iodine which cannot be investigated experimentally in humans for ethical and technical reasons.

Early detection of local and regional recurrence is the main goal during follow-up of patients with larynx and pharynx cancer. Hypothyroidism occurring in those patients stays frequently undiagnosed as screening for hypothyroidism is not part of the routine follow-up. This study was performed to assess the prevalence of hypothyroidism in these patients. We included 120 patients (106 male, 14 female) with larynx or pharynx cancer treated more than 2 months earlier (mean = 41 months) in the study. Cancer treatment consisted of either surgery (n = 44), radiotherapy (n = 15), or surgery combined with postoperative radiotherapy (n = 61). In all patients, thyroid function studies (thyrotropin [TSH], free triiodothyronine [FT3], and free thyroxine [FT4]) were performed. Twenty-six of all patients (22%) were hypothyroid; in two patients hypothyroidism was diagnosed postoperatively and these two patients were on replacement therapy with thyroid hormones. The highest rate of hypothyroidism (34%) was present in patients treated with surgery combined with radiotherapy, whereas among patients treated with surgery only 7% were hypothyroid (p < 0.001). There was no difference in the duration of follow-up between therapy and inclusion in the study between those two groups. Two of 15 patients treated only with radiotherapy were diagnosed hypothyroid, but in this group the latency was shorter (p < 0.05). The results indicate that thyroid function studies should be routinely performed in the follow-up of head and neck cancer patients, especially if radiotherapy was part of the treatment.

Background: The aim of this study was to assess the value of technetium 99m-MIBI scintigraphy using the single photon emission computed tomography (SPECT) technique for preoperative localization of smaller (≤ 1 g) parathyroid adenomas. Methods: A total of 92 patients (34 men, 58 women; mean age, 60 ± 13 years) with an established diagnosis of primary hyperparathyroidism and nondiagnostic ultrasonography (inclusion criteria) were scanned preoperatively. After a thyroid examination to check for other possible radionuclide-accumulating thyroid diseases, a planar technetium 99m-pertechnetate/technetium 99m-MIBI subtraction scintigraphy (15 minutes post injection) and tomographic images (120 minutes post injection) were acquired after intravenous injection of 740 MBq of technetium 99m-MIBI and using a 3-head gamma camera (Picker Prism 3000). Sensitivity was defined by the ability to predict the correct site of a parathyroid adenoma. Results: All patients had parathyroid adenomas ≤ 1 g (53 patients, 0.5 -1.0 g; 39 patients, < 0.5 g). Correct localization of parathyroid adenomas to one side or the other was achieved in 87% of the patients using planar technetium 99m-pertechnetate/technetium 99m-MIBI subtraction scintigraphy. Sensitivity was increased to 95% by supplementary use of the SPECT technique and a 3-D display (volume-rendered reprojection for visualization). There was technetium 99m-MIBI accumulation in 11 benign thyroid nodes, but none of the healthy parathyroid glands were shown on the scan. Conclusions: This study indicates that technetium 99m-MIBI parathyroid scintigraphy is a sensitive and specific tool for topographic localization even of small parathyroid adenomas, especially with the use of SPECT. This method could help to improve the efficiency of parathyroidectomy (eg, by making unilateral exploration sufficient). (Surgery 2000;128:29-35.)

AIM:We investigated whether additional application of "cold" iodine after therapy with radioiodine could result in a prolongation of the effective half life of iodine-131 and would thus lead to an increase of the effective thyroid radiation dose.METHODS:Time-activity-curves after therapy with radioiodine were analysed in 25 patients (16 women, 9 men). Nine patients suffered from autonomously functioning thyroid nodules, 5 from autonomous multinodular goiter and 11 from Graves' disease. These patients had an effective half life shorter than 4 days resulting in an undertreatment of > 20% with respect to the desired effective thyroid radiation dose. 2-4 days after therapy with radioiodine all patients received "cold" iodine for three days in a dose of 3 x 200 micrograms per day.RESULTS:In 14 of the 25 patients an increase of the effective half life was observed. Patients with an autonomously functioning thyroid nodule showed a mean increase of the effective thyroid radiation dose of 40 +/- 44 Gy, patients with toxic multinodular goiter of 29 +/- 30 Gy and patients with Graves' disease of 37 +/- 37 Gy.CONCLUSION:Additional application of "cold" iodine after therapy with radioiodine can prolong the effective half life in selected patients. We suspect a correlation with the thyroid iodine pool. This will be the basis for further investigations hopefully resulting in a better patient preselection to determine who might respond to this therapy.