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Amyotrophic lateral sclerosis (ALS) is associated with impaired energy metabolism, including weight loss and decreased appetite which are negatively correlated with survival. Neural mechanisms underlying metabolic impairment in ALS remain unknown. ALS patients and presymptomatic gene carriers have early hypothalamic atrophy. The lateral hypothalamic area (LHA) controls metabolic homeostasis through the secretion of neuropeptides such as orexin/hypocretin and melanin-concentrating hormone (MCH). Here, we show loss of MCH-positive neurons in three mouse models of ALS based on SOD1 or FUS mutations. Supplementation with MCH (1.2 µg/d) through continuous intracerebroventricular delivery led to weight gain in male mutant Sod1G86R mice. MCH supplementation increased food intake, rescued expression of the key appetite-related neuropeptide AgRP (agouti-related protein) and modified respiratory exchange ratio, suggesting increased carbohydrate usage during the inactive phase. Importantly, we document pTDP-43 pathology and neurodegeneration in the LHA of sporadic ALS patients. Neuronal cell loss was associated with pTDP-43-positive inclusions and signs of neurodegeneration in MCH-positive neurons. These results suggest that hypothalamic MCH is lost in ALS and contributes to the metabolic changes, including weight loss and decreased appetite.

The effect of specific activity of meta[I-123]iodobenzylguanidine ([I-123]MIBG) on neuroblastoma uptake was studied in a nude mouse model (NMRI nu/nu) xenografted subcutaneously with SK-N-SH cells. Groups of eight animals received [I-123]MIBG intravenously with a specific activity of greater than or equal to 260 GBq/mu mol (no-carrier-added), 3.7 GBq/mu mol, 37 MBq/mu mol, and 0.37 MBq/mu mol, respectively. All animals in the group injected with 0.37 MBq/mu mol died immediately after the injection. Al 4 and 24 h, there was no significant effect of specific activity on tumor uptake of [I-123]MIBG in the different groups. The uptake of non-tumor tissue was in general lower with 37 MBq/mu mol compared to higher specific activities. The differences in blood, heart, liver, spleen and lungs were statistically significant at 24 h, whereas at 4 h significant differences were only present in the heart, liver and lungs. The results suggest that for the treatment of children with neuroblastoma a lower specific activity of radioiodinated MIBG may minimize the radiation exposure to non-tumor tissue but not to the tumor. Higher mass of MIBG >0.5 mu mol/g, however, is considered as lethal dose in our nude mice model and corresponding doses may cause toxic side effects in human.

Due to disturbances or a lack of excitation during the measurements, conventional identification methods offer solutions with limited precision for the inertial parameters of industrial robots (IR). This paper introduces an approach to increase the rank of the identification matrix through additional equations from the frequency domain. In areas of lower frequencies, the total inertia that is affecting an axis is related to the amplitude of the frequency response of the rotational speed controlled system (RSCS). Another advantage of the presented method is the possible correction of friction effects via the phase information, which enables a higher identification accuracy. The frequency responses are measured during exciting trajectories, which stimulate low frequencies. Thereby, the approach generates additional equations, which enables the identification of more inertial parameters with a higher accuracy. In this paper, the measurement method and the identification algorithm are outlined.

SummaryAim: In a screening study on people of working age the prevalence of morphological thyroid disorders was 33.1 %. It is not known precisely whether this further increases after retirement. The present study aimed to establish whether the increase in the prevalence of morphological and functional thyroid disorders continues beyond working age in elderly citizens. Methods: 223 participants were recruited in an institute for geriatric rehabilitative medicine. All patients were screened by thyroid ultrasound, measurement of serum levels of thyroid hormones and thyroid related autoantibodies as well as measurement of urinary iodine excretion. Results: The median thyroid volume was 17 ml (range 4-41 ml) in men and 16 ml (range 0.4-73 ml) in women. 27/59 (46 %) of the men (median age [range]: 77 [58-87] years) and 85/139 (61 %) of the women (median age [range]: 77 [52-97] years), or a total of 112/198 (57 %) residents, showed morphological thyroid abnormalities. There was no clear increase with age. 85 % of the participants without a history of thyroid treatment were euthyroid. 12 % showed a subclinical hyperthyroidism whereas 1 % showed a biochemically manifest hyperthyroidism. 2 % were biochemically hypothyroid. Tg-antibodies was elevated in 10 (5 %) and TPO-antibodies in 18 (9 %) of the patients. Median iodine excretion was 129 pg/l. 41.5 % of the patients showed iodine excretion values below 100 pg/l whereas only 7 % of the patients showed a severe iodine deficiency with an excretion below 50 pg/l. Conclusion: Compared to a previously described population of working age, the prevalence of morphological thyroid disorders does not further increase above the age of 65; thyroid function abnormalities in this iodine sufficient screening population were relatively rare.

Nitrate content in the groundwater of Belarus has increased dramatically due to intensive use of nitrogen fertilizers in agriculture. Research performed during the post-Chernobyl period showed that the increased incidence of thyroid cancer is affected both by the level of nitrates in the groundwater and the radiation dose to which the thyroid was exposed.

Radioiodine scintigraphy influences staging and treatment in patients with differentiated thyroid carcinoma. The limit of detection for fractional uptake in an iodine avid focus in a scintigraphic image was determined from the number of lesion net counts and the count density of the tissue background. The count statistics were used to calculate the diagnostic activity required to elevate the signal from a lesion with a given uptake significantly above a homogeneous background with randomly distributed counts per area. The dependences of the minimal uptake and the minimal size of lesions visible in a scan on several parameters of influence were determined by linking the typical biokinetics observed in iodine avid tissue to the lesion mass and to the absorbed dose received in a radioiodine therapy. The detection limits for fractional uptake in a neck lesion of a typical patient are about 0.001% after therapy with 7000 MBq, 0.01% for activities typically administered in diagnostic assessments (74-185 MBq), and 0.1% after the administration of 10 MBq I-131. Lesions at the limit of detection in a diagnostic scan with biokinetics eligible for radioiodine therapy are small with diameters of a few millimeters. Increasing the diagnostic activity by a factor of 4 reduces the diameter of visible lesions by 25% or about 1 mm. Several other determinants have a comparable or higher influence on the limit of detection than the administered activity; most important are the biokinetics in both blood pool and target tissue and the time of measurement. A generally valid recommendation for the timing of the scan is impossible as the time of the highest probability to detect iodine avid tissue depends on the administered activity as well as on the biokinetics in the lesion and background in the individual patient.

The aim of the work was to examine the relationship between thyroglobulin autoantibody (TgAb) levels and the Tg recovery rate (TgRR) using different concentrations of Tg (50, 10, 5, and 1 μg/l) in the recovery buffer. A total number of 225 serum samples from individual patients were analyzed. Samples were selected for their TgAb in 6 groups: TgAblimit of detection (LoD; n=50), LoDTgAb≤60 IU/ml (n=62), 60 IU/mlTgAb≤100 IU/ml (n=30), 100 IU/mlTgAb≤500 IU/ml (n=41), 500 IU/mlTgAb≤1 000 IU/ml (n=13) and TgAb1 000 IU/ml (n=28). TgAb were measured with 2 different assays (VARELISA and BRAHMS Anti-Tgn RIA). TgAb levels and the TgRR determined using the 50, 10, 5, and 1 µg/l buffers showed strong significant correlations with a Spearmans' rho of - 0.720, - 0.688, - 0.686, and - 0.356, respectively, for the VARELISA assay and - 0.670, -0.617, - 0.570, and - 0.274, respectively, for the Anti-Tgn assay (all p0.001). TgRRs were a median of 94.8% (30.5-113.0%), 90.8% (40.6-127.6%), 90.0% (8.2-119.3%), and 89.4% (range - 43.6-121.6%) for the TgRR determined using recovery buffers with concentrations of 50, 10, 5, and 1 μg/l respectively. With decreasing Tg concentration in the recovery buffer the percentage of abnormal results increased, although the extreme increase we found in the 1 μg/l group is largely caused by a lack of analytical precision in the 73 sera with Tg levels exceeding 5 μg/l. Our results give cause for further investigation into reviving the concept of Tg-recovery measurement using 5 μg/l Tg in the recovery buffer instead of the traditional 50 μg/l.

Context: Imaging with [123I]iodometomidate ([123I]IMTO) has been shown to diagnose adrenocortical lesions with high sensitivity and specificity. Objective: Our objective was to evaluate the clinical utility of [123I]IMTO imaging in adrenocortical carcinoma (ACC). Design: We conducted a prospective monocentric diagnostic study and a prospective case series at a single tertiary referral center. Patients and Interventions: Fifty-eight patients with histologically confirmed ACC, all European Network for the Study of Adrenal Tumors stage IV (with distant metastases), received 185 MBq [123I]IMTO. Sequential planar whole-body scans until 24 hours post injection and single photon emission computed tomography/computed tomography (SPECT/CT) hybrid imaging 4 to 6 hours post injection were performed. Main Outcome Measures: Outcome measures included uptake of [123I]IMTO in ACC lesions, sensitivity and specificity of [123I]IMTO imaging compared with conventional imaging, and number of patients eligible for [131I]IMTO t...

SummaryAim: The objective of this study was to assess the feasibility, dosimetry, tolerability and efficacy of systemically administrated p-[131I] - iodo-L-phenylalanine (131IPA) combined with hypo-fractionated external beam radiation therapy (EBRT) in patients with recurrent glioblastoma multiforme (GBM). Patients, methods: Five patients (2 women, 3 men, aged 27-69) with recurrent GBM and exhaustion of regular therapy options were included. All had a positive O-(2-[18F]Fluoroethyl)- L-tyrosine positron emission tomography (FET-PET) and pretherapeutic dosimetry was performed. Tumour targeting was verified by 131IPA-SPECT up to six days after radiotracer administration. After 131IPA therapy, patients were treated with hypo-fractionated EBRT in six fractions of 5 Gy (n = 4) or in eleven fractions of 2 Gy in one case. Results: Based on the individual dosimetry, the patients received a single intravenous administration of 2 to 7 GBq of 131IPA, resulting in radiation absorbed doses to the blood of 0.80–1.47 Gy. The treatment was well tolerated; only minor complaints of nausea and vomiting that responded to ondansetron and pantoprazol were noticed in the first two patients. After preventive medication, the last three patients had no complaints during therapy. In none of the patients a decrease of leukocyte or thrombocyte counts below the baseline level or the lower normal limit was observed. Tumour doses from 131IPA were low (≤ 1 Gy) and all patients died three to eight (median 5.5) months after therapy. Conclusion: In this initial experience, treatment of GBM with 131IPA in combination with EBRT was demonstrated to be safe and well tolerated, but less effective than suggested by the animal studies.

A semi-anthropomorphic 'distal radius like' phantom, developed by Kalender and Ruegsegger for use in peripheral bone densitometry using single photon (DPA) dual X-ray (DXA) and quantitative computed tomography (QCT) machines, has been studied with a view to cross-calibrating different types and brands of densitometers in current use. In the context of an EU 'Concerted Action' (second Framework Programme) the phantom was repeatedly measured on six SPA machines, three DXA machines and nine QCT machines (545 measurements). Linear regression equations were derived, individual to each machine, which allowed the derivation of 'standardized densities'. In this way we converted measurements made by machines of the same modality to a common scale of measurements. Two machines (one DXA, one SPA) showed statistically significant instability over time emphasising the need for rigorous quality control in the application of densitometry. In other respects these results provide an encouraging basis for the derivation of standardized normative ranges and the more effective use of peripheral densitometry in future clinical and epidemiological studies.

Die Neufassung bzw. Uberarbeitung bestehender Leitlinien zur Nachsorge des Schilddrusenkarzinoms ist aufgrund zahlreicher Publikationen in jungerer Vergangenheit und neu gewonnener Erkenntnisse unverzichtbar und tragt zu einer erwunschten Standardisierung des Patientenmanagements bei. Neuerungen auf diagnostischem Gebiet betreffen in erster Linie die Etablierung der Hybridbildgebung (z. B. 131 I-SPECT/CT), eine kontinuierliche Verbesserung der sonografischen Techniken und die Weiterentwicklung der Thyreoglobulin-Assays. Zunehmend gewinnt eine risikoorientiertes, individualisiertes Follow-up, z. B. mit einer „liberalisierten“ Einstellung des TSH, d. h. dem Verzicht auf eine lebenslange Suppression, an Bedeutung. Nachsorgeintervalle und insbesondere die Frequenz der Untersuchungen werden neu definiert und an das veranderte Patientenspektrum angepasst. Fragen der Lebensqualitat und psychosoziale Aspekte rucken mehr und mehr ins Blickfeld und sind Teil einer umfassenden Patientenbetreuung.

summary of some of the cited publications introduces eachrecommendation; comprehensive tabular overviews ofsupporting data are not given. The reader therefore cannoteasily assess the thoroughness with which the literatureregarding controversial topics was considered. In particular,the ATA guidelines’ summaries often fail to mentionevidence against the recommendation.Further, whether greater weight is accorded to publishedmeta-analyses such as those by Sawka et al. [12, 13] than tosingle-centre observational studies is not specified in theguidelines’ methodology description. Meta-analyses ofcourse may show effects that individual studies are toosmall to detect; for example, the meta-analysis by Sawka etal. [13] regarding the effect of RRA on recurrence anddisease-specific mortality considered six studies addressingrecurrence at distant sites. None of the studies individuallyincluded enough distant recurrences for a 95% confidenceinterval (CI) for risk reduction that excluded the zero value.However, pooling the results from all six studies, the riskreduction was 2% and the 95% CI 4–1%. A significantlylower number of new metastases over the course of thedisease after

SummaryDue to its excellent tolerability and low incidence of side effects, 131I therapy has been the treatment of choice for benign thyroid diseases for over 60 years. A potentially increased risk of malignancies due to this therapy is however still subject of debate. Aim: To review the literature pertaining to 131I therapy of benign thyroid diseases in order to establish whether there is an increased incidence of, or increased mortality due to malignancies of the thyroid or other organs. Methods: In order to allow for sufficient long-term follow-up time after 131I therapy, only literature after 1990 was reviewed. Two criteria were applied to consider an increased incidence of malignancies linked to 131I therapy: a) there should be a latency period of at least 5 years between 131I therapy and the observation of an increased risk b) an elevated risk should increase with increasing radiation exposure. Results: A total of 7 studies reporting cancer incidence and / or mortality in 4 different patient collectives spanning a total of 54 510 patients over an observation period varying from 2-49 years were found. Although some studies detected a slightly increased risk for malignancies of the thyroid or the digestive system, others did not find these effects - while other studies even reported a slightly lower risk of malignant (thyroid) disease after 131I therapy for benign thyroid diseases. Conclusion: As over 60 years of experience has thus far failed to produce conclusive evidence to the contrary, it can be concluded that there is no increased risk of malignancies after 131I therapy for benign thyroid disease.

Differentiated thyroid cancer in childhood and adolescence contributes to ca. 10% of the total incidence of malignant thyroid tumors. In childhood, the thyroid gland is vulnerable to radiation; therefore the risk for radiation induced thyroid cancer is considerably increased especially in infants. Contrary to adults, the aggressiveness of the disease correlates negatively with age, i. e. local invasiveness and metastases are more common in small children. In childhood and adolescence, the papillary type of thyroid cancer is much more frequent than other histological types. Lymph node metastases in the neck occur in approximately 50% of the patients; distant metastases (mainly to the lungs) develop in approximately 25% of patients. Usually, the diagnosis of thyroid cancer in childhood and adolescence is made sonographically; a typical sign is a hypoechogenic nodule. However, a diffuse tumor manifestation with infiltration of the whole thyroid gland may occur in childhood for staging. The risk groups proposed by UICC for adults cannot be applied to children. The standard therapy for thyroid cancer patients consists of total thyroidectomy and lymph node dissection of the medial neck compartment followed by radioiodine therapy and consecutive TSH-suppressive Levothyroxine substitution. Children usually need higher doses of Levothyroxine per kg/body weight as adults. The treatment results of differentiated thyroid cancer in childhood and adolescence can be considered as excellent; 10-years-survival-rates amount to nearly 100%. A multivariate analysis shows, that radical thyroidectomy and postoperative a radioiodine therapy are independent, significant predictors of success with respect to the prevention of loco-regional recurrences. After radioiodine treatment of lung metastases in children and adolescents, the risk for radiation induced pulmonary fibrosis may be increased. However, in a considerable percentage of the cases, a continuous decrease of serum-Thyroglobuline as predictor of long lasting partial remission may be observed in spite of whole body scans still showing some uptake in lung metastases.

Klinisch relevante Schilddrusenkarzinome sind in 5–6% der operierten Knotenstrumen zu finden. Multinodose Strumen weisen zudem haufig autonome Areale auf. Daher bedarf es effektiver rationaler differentialdiagnostischer Methoden und Entscheidungsalgorithmen, um unter der grosen Zahl der Schilddrusenknoten diejenigen Knoten mit einem erhohten Karzinomrisiko oder einer Schilddrusenautonomie zu identifizieren. Darstellung einer aktuell uberarbeiteten Leitlinie und weiterer Leitlinien und Konsensusstellungnahmen sowie selektive Literaturubersicht. Bereits mittels Anamnese, Sonographie und TSH-Bestimmung (thyreoideastimulierendes Hormon) sind eine erste Risikobeurteilung und Selektion fur die weitere Schilddrusendiagnostik moglich. Die Feinnadelbiopsie (FNB) ist die Methode mit der besten Sensitivitat und Spezifitat fur die Dignitatsabklarung sonographisch darstellbarer, szintigraphisch normal speichernder oder kalter Schilddrusenknoten > 1 cm. Voraussetzungen fur einen effektiven Einsatz der FNB in der klinischen Routine sind allerdings eine adaquate Ausbildung und umfangreiche Erfahrungen von Punkteur und Zytopathologe. Wahrend malignitatsverdachtige solitare Schilddrusenknoten unverzuglich dem Chirurgen zugefuhrt werden mussen, kann bei fehlenden klinischen, sonographischen und zytologischen Malignitatshinweisen, normalem Calcitonin sowie Euthyreose der Verlauf – ggf. unter Medikation – beobachtet werden, wenn nicht eine chirurgische Therapie aufgrund lokaler Beschwerdesymptomatik, trachealer Beteiligung oder mediastinaler Ausdehnung begrundet ist.

Die Autoren veroffentlichen eine Verfahrensanweisung zur szintigraphischen Lokalisation von Wachterlymphknoten beim malignen Melanom und anderen Hauttumoren, beim Mammakarzinom, bei Kopf-Hals-Tumoren, beim Prostatakarzinom und beim Peniskarzinom. Wesentliche Ziele der szintigraphischen Wachterlymphknotendiagnostik bestehen in der Minimierung des Operationsausmases und der postoperativen Morbiditat sowie der Optimierung der histopathologischen Aufarbeitung durch Fokussierung auf die relevanten Lymphknoten. Die Wachterlymphknotenszintigrahie trifft selber keine Aussage zu einem evtl. tumorosen Befall und ist nicht indiziert, wenn bereits eine lymphogene Metastasierung diagnostiziert ist. Es werden Vorgehensweisen zur Durchfuhrung zusammengestellt, die zum Ziel haben, den oder die Wachterlymphknoten zuverlassig und mit hoher Nachweisrate typischerweise in einem fruhen Stadium einer Tumorerkrankung zu detektieren. Die Strahlenexposition des Patienten ist so niedrig, dass Schwangerschaft keine Kontraindikation darstellt. Aufgrund der sehr geringen Strahlenexposition von

AIM: Withdrawal of levothyroxine with resultant hypothyroidism is still used in preparation for I-131 diagnostic whole-body scan (DWBS) and thyroglobulin (TG)-measurement in patients afflicted with differentiated thyroid cancer (DTC). Recombinant human thyroid-stimulating hormone (rhTSH) enhances TSH stimulation obviating the clinical and economical consequences of hypothyroidism. Primary aim of this study was an intraindividual comparison of diagnostic follow-up measurements under these two sets of conditions by taking clinical and socio-economic parameters into account. Second aim was to determine a clear patient preference for the one method or the other. METHODS: This non-interventional observational study included patients (n=192 signed informed consent, n=128 protocol compliant patients without need for therapeutic intervention) with DTC first treated by thyroidectomy and radioiodine ablation. Control visits including I-131 DWBS were planned at 3-6 months post-thyroidectomy after a phase (KU 1) of thyroid hormone withdrawal (THW) and again after 6-12 months later in a euthyroid state under exogenous stimulation with rhTSH (KU 2). Study design was open, prospective and multicentric. Data collected consisted of patient information (SF-12 ® Health Survey), thyroid-specific results of clinical examinations and several aspects of daily life, e. g., employment, days of absence from work and other economic aspects. RESULTS: In contrast to KU 1, in KU 2 there is a highly significant improvement (p

The most important information in the determination of the status of iodine nutrition of a population comes from the measurement of the urinary excretion of iodine. Several methods are available for measuring urinary iodine. The choice among methods depends on the intended application, the number of samples, the cost and the technical capability. Epidemiological field studies demand simple, rapid and cost-effective methods. Suitable for these applications are the rapid urinary iodide test and the ammonium persulfate oxidation method which gives comparable results to the chloric acid method without having the drawbacks of being hazardous and explosive. In research studies however, sophisticated automated technology like the Technicon Autoanalyzer or Paired-Ion Reversed Phase HPLC are used in which the high cost of instrumentation are outweighed by the benefits of processing a large number of samples with high accuracy and minimal technician time. For determining serum inorganic iodide (SII) the HPLC assay is the method of choice, because contaminations from the protein bound iodine fraction do not interfere with the detection process. The clinical relevance of the measurement of SII is limited, but allows the calculation of the absolute iodine uptake which has great value in pathophysiologic studies.

This work describes an optimization of a simple photometric determination of iodine concentrations in urine using a modified ceric arsenite method with ammonium persulfate as oxidant. By means of this sensitive method iodine concentrations can be determined in very small specimens (50 microL). Urine samples (105) collected from a mixed population, were analyzed for urine iodine content by the optimized ammonium persulfate method, a Technicon Autoanalyzer II and a paired-ion-RP HPLC. We found that the precision of this optimized ammonium persulfate method yields inter assay CVs of10% for urinary iodine concentrations10 microg/dL. Recovery of [123I]iodide added to urine in vitro was 100.9 +/- 2.4%. The detection limit was 0.0029 microg iodine. There was a high correlation between all three methods (r0.94 in any case) and the interpretation of the results was consistent. We conclude that this simple, manual ammonium persulfate method is suitable for urinary iodine analysis and can be performed in any routine clinical laboratory.

Im Unterschied zu Erwachsenen sind Schilddrusenknoten im Kindes- und Jugendalter selten; nur in 0,5% der Kinder konnen sonographisch Knoten nachgewiesen werden. In den meisten Fallen der in Routineultraschalluntersuchungen diagnostizierten Knoten handelt es sich um gutartige Proliferationen von Schilddrusenzellen, die keiner weiteren Therapie bedurfen, und nur in einem geringen Prozentsatz lasst sich ein maligner Tumor detektieren. Die vorliegende Ubersichtsarbeit erlautert die wichtigsten differenzialdiagnostischen Schritte, die mittels Sonographie und Feinnadelbiopsie eine hohe Sensitivitat in der Diagnose der malignen Knoten gewahrleisten sollen, bei gleichzeitig moglichst geringer Rate an unnotigen Schilddrusenoperationen. Eine Zusammenarbeit mit Untersuchern, die uber grose Erfahrung in der Knotensonographie und der Durchfuhrung der Feinnadelbiopsie verfugen, ist fur eine erfolgreiche Diagnostik zwingend erforderlich.

From 1980 to 1989, 226 patients (199 females, 27 males, median age 41 [18-76] years) underwent surgery because of clinical hyperthyroidism. 152 patients had autoimmune thyrotoxicosis, and 74 functional autonomy. Histological examination of resected thyroid tissue revealed carcinoma in 6 cases (2.6%): 3 (2%) in autoimmune hyperthyroidism, and 3 (4%) in functional autonomy. Five tumours fulfilled the criteria for occult papillary thyroid carcinoma (highly differentiated, less than 1.5 cm diameter). One woman had both a multilocular papillary carcinoma and a medullary carcinoma without proven metastases. In none of the cases was a malignant tumour suspected preoperatively from sonography or scintigraphy studies. In the patients with occult carcinomas, extended bilateral subtotal resection was regarded as curative. In the patient with papillary and medullary carcinoma, remaining thyroid therapy was given. One patient with Basedow's (Graves') disease and a papillary carcinoma of diameter 1.3 cm received radioiodine at her own request. She and the four remaining patients received suppression therapy (150-200 micrograms L-thyroxine daily), with frequent follow-up. During follow-up for a mean period of 24 months (range 6-51 months) there were no metastases or tumour recurrences.

Initial symptoms of thyroid cancer were collected and analysed for 1116 patients with thyroid cancer in an iodine-deficient region, retrospectively for the period 1960-80 (604 patients), prospectively for 1981-87 (512). Using the WHO classification, 56.1% of patients had papillary, 32.7% follicular, 4.8% C-cell, 3.7% anaplastic and 2.7% various other malignant tumours. In 40% of all patients the initial sign had been a solitary intrathyroid nodule. Cervical lymph node swelling as initial sign had been significantly more frequent in men (21.1%) than in women (10.3%; P less than 0.003). In patients aged under 40 years the cervical lymph node signs were three times as common as among those over 50 years. Distant metastases as initial sign of papillary carcinoma were seen only in those over 60 years. Tumour stages T3 and T4 were seen significantly more frequently in over 60-year-old (42.2%) than under 40-year-old (25.1%; P less than 0.001), independent of histological type. Composition and initial signs of this patient cohort in an iodine-deficient region differed only slightly from those in an iodine-rich region.

Side effects of antithyroid treatment were retrospectively analysed in 1256 patients with hyperthyroidism. Overall rate of side effects was 14.3%. Skin reactions were the most frequent ones (5.6%), followed by arthropathies (1.6%). The incidence of agranulocytosis was 0.14%. Median duration of all side effects was 1.5 months. In half the cases the side effects were controllable so that treatment was continued, although at a changed dosage. The rate of cross-reaction between carbimazole and thiamazole, on the one hand, and propylthiouracil, on the other, was 13.8% and 15.2%, respectively. The side effects became apparent after a mean of one month's treatment, almost always (in 97.1%) within the first year of treatment. There was a significant dose dependence for an initial thiamazole dose of over 20 mg (relative side effect risk of 2.3), and for an initial dose of over 30 mg for carbimazole (relative side effect risk of 1.6). Although most side effects were not dangerous, in normal instances the lowest possible dosage should be administered to control hyperthyroid metabolism. Long-term treatment with low doses seem to be without problems.

Die Verfahrensanweisung zur Radioiodtherapie (RIT) und zur 131I-Ganzkorperszintigraphie beim differenzierten Schilddrusenkarzinom im Kindes- und Jugendalter reiht sich thematisch neben die entsprechenden Verfahrensanweisungen (Version 3), die fur erwachsene Patienten verfasst sind, und konkretisiert die interdisziplinare Leitlinie der Deutschen Krebsgesellschaft um die nuklearmedizinischen Aspekte. Besonderheiten im Kindes- und Jugendalter sind die hohere Aggressivitat des papillaren Schilddrusenkarzinoms, die Haufigkeit eines organuberschreitenden Tumorwachstums und einer disseminierten pulmonalen Metastasierung sowie die hohe lokale Rezidivrate. Die TNM-Klassifikation wird aufgrund der geringen Ausdehnung der normalen kindlichen Schilddruse der Risikostratifikation nicht gerecht. Grundsatzlich besteht auch bei Kindern die Empfehlung zur Radioiodtherapie, wobei die 131I-Aktivitat gewichtsabhangig appliziert wird. Bei kleinen papillaren Schilddrusenkarzinomen (≤1 cm) ist die Indikation zu einer ablativen Radioiodtherapie eher groszugig zu stellen. Nach Hormonentzug wird die TSH-Stimulation bereits nach zwei Wochen (Kinder) bzw. drei Wochen (Jugendliche) erreicht. Antiemetika werden groszugig verordnet. Die Indikation zur CT des Thorax und zur Lungenfunktionsuntersuchung ist bei Metastasenverdacht groszugig zu stellen. Auf die diagnostische 131I-Ganzkorperszintigraphie drei bis sechs Monate nach ablativer Radioiodtherapie sollte wegen der Haufigkeit einer lymphogenen Metastasierung nicht verzichtet werden. Nachsorgeintervalle sind eher kurzer zu wahlen, um eine unzureichende Compliance bei Kindern fruhzeitig zu erfassen und um die Hormondosis gewichtsbezogen anzupassen. Der hohere Normbereich von fT3 fur Kinder ist zu beachten. Es liegt keine ausreichende Evidenz vor, ob und wann eine nicht-suppressive Einstellung der Schilddrusenfunktion sinnvoll ist. Daher ist die TSHSuppression grundsatzlich anzustreben.

SummaryThe version 3 of the procedure guideline for radioiodine test is an update of the guideline previously published in 2003. The procedure guideline discusses the pros and cons of a single measurement or of repeated measurements of the iodine-131 uptake and their optimal timing. Different formulas are described when one, two or three values of the radioiodine kinetic are available. The probe with a sodiumiodine crystal, alternatively or additionally the gammacamera using the ROI-technique are instrumentations for the measurement of iodine-131 uptake. A possible source of error is an inappropriate measurement (sonography) of the target volume. The patients' preparation includes the withdrawal of antithyroid drugs 2–3 days before radioiodine administration. The patient has to avoid iodine-containing medication and the possibility of additives of iodine in vitamin- and electrolyte-supplementation has to be considered.

The aim of this analysis was to collect and analyse Germany-wide data on the status and development of in-patient Nuclear Medicine therapy. The official hospital quality reports were to be used as the data source.The reference reports from all hospitals in Germany with Nuclear Medicine therapy units, compiled by Gemeinsamer Bundesausschuss (G-BA) from the machine-usable XML data of the quality reports, were analysed for the years 2010 and 2012. Results from our own preceding investigations of structured quality reports for the years 2004, 2006 and 2008 were used to assess the longer-term development. To determine the Germany-wide incidence of thyroid surgery and radio-iodine therapy, public databases of Institut für das Entgeltsystem im Krankenhaus (InEK) were assessed for the years from 2004 to 2012.The total number of in-patient Nuclear Medicine treatment cases decreased from 50 363 to 47 314 patients in the period from 2010 to 2012. There was a marked decline of 17.5% in case incidence over the longer period from 2004 to 2012. The decrease is primarily due to a decrease in cases with hyperthyroidism (ICD code E05). The number of thyroid surgeries has been declining since 2009. There was a moderate 23.7% increase in the number of cases with the diagnosis of thyroid carcinoma (ICD code C73) from 2004 to 2012.Presumably, the improved iodine supply in Germany has led to a decline in inpatients with hyperthyroidism in nuclear medicine and consequently to a decrease in both the number of radio-iodine therapies and thyroid operations in surgery. In contrast, the number of patients in nuclear medicine therapy units diagnosed with thyroid cancer has increased moderately which correlates with the worldwide increasing incidence of this disease.

Hashimoto’s thyroiditis (HT) represents a wide-spread autoimmune disease. In euthyroid patients with HT, an impaired assimilation of common carbohydrates has been observed. Our objectives were to compare the frequency of (1) fructose (FM), lactose (LM) and sorbitol malassimilation (SM), (2) gastrointestinal symptoms (GS) following carbohydrate ingestion and (3) recurrent GS relevant to the participants’ daily lives. We conducted a prospective case–control study of 45 ambulatory patients with HT and 38 healthy volunteers, matched with regard to age, gender and area of origin. Hydrogen breath tests with fructose, lactose, sorbitol and glucose were performed, the lactose testing additionally comprising measurements of capillary blood glucose (cBG). GS during the tests and recurrent GS concerning the participants’ daily lives were assessed. A food-frequency questionnaire was administered. FM was diagnosed in 48.9% of patients compared with 26.3% of the control group (P=0.035). In all, 42.2% of patients with HT and 21.1% of healthy controls showed LM (P=0.04). FM and/or LM was present in 73.3% of the patients and in 42.1% of healthy controls (P=0.004). GS after the ingestion of fructose (P=0.003) or lactose (P=0.025) and recurrent GS were significantly more prevalent in the case group. The consumption of free fructose, lactose or sorbitol did not differ. Carbohydrate malassimilation and gastrointestinal complaints are frequent in euthyroid patients with HT, leading to novel clinical and pathophysiological considerations and concepts.

Tyrosine kinase inhibitors (TKIs) such as vandetanib have shown clinical effectiveness in advanced medullary thyroid cancer (MTC). During TKI treatment, fluctuations in the tumor markers carcinoembryonic antigen (CEA) and calcitonin (CTN) are frequently observed. Their role for treatment monitoring and the decision-making process has not been fully elucidated yet. Twenty-one patients (male, 16, female, 5; mean age, 49 ± 13 years) with progressive MTC receiving vandetanib (300 mg orally per day) were considered. Tumor restaging was performed every 3 months including contrast-enhanced computed tomography (CT). Response was assessed according to recent criteria (Response Evaluation Criteria in Solid Tumors, RECIST 1.1). Additionally, CEA and CTN were measured at the day of CT imaging and alterations observed in tumor markers were compared to respective imaging findings (partial response, PR; stable disease, SD; progressive disease, PD). During long-term follow-up (510 ± 350 days [range, 97–1140 days]), CTN and CEA levels initially dropped in 71.4% and 61.9% of the patients followed by fluctuations in serum marker levels. A rise in CTN ≥39.5% between 2 subsequent measurements (defined by ROC analysis) had a sensitivity of 70.6% and a specificity of 83.2% in predicting PD with an accuracy of 82.0% (area under the curve (AUC), 0.76). Oscillations in CEA levels were not predictive for PD. Whereas tumor marker fluctuations in MTC patients undergoing TKI treatment are a frequent phenomenon, a significant rise in CTN ≥40% turns out to as an early indicator of tumor progression.

This observational study analyzes Ca-P metabolism and its impact on bone mass accrual and density and the muscle-bone mass/mass relationships in male and female children and adolescents who were parathyroidectomized because of thyroid carcinoma. Two hundred and eight children and adolescents (119 girls and 89 boys) from Gomel city (Belarus) and its rural surroundings were referred to our institution after having undergone total thyroidectomy for the treatment of advanced papillary thyroid cancer. A subgroup of children with demonstrated primary hypoparathyroidism received dihydrotachysterol (AT-10) and/or Ca supplementation. Among routine procedures over a maximum follow-up period of 5 years (average 3.7 years, maximum 8 visits), whole-body scans were taken using dual energy X-ray absorptiometry (DXA) at each visit in order to determine whole-body bone mineral content (TBMC), projected "areal" bone mineral density (TBMD), total lean mass (TLM) and total fat mass (TFM). The average serum Ca, P and AP concentrations over the whole observation period were significantly different between the groups; however, TBMC z-scores for all studied children were statistically similar in all visits. In girls, no between-group differences in height- and weight-controlled TBMC and TBMD or the TBMC/TLM ratio were observed (ANCOVA) and supplementation exerted no effect on these data, suggesting that the total bone mass accrual was not impaired by PTH deficiency in the studied conditions. However, non-supplemented boys showed lower values of the TBMC/TLM ratio than girls, and supplementation normalized these values in direct correlation with the induced improvement in serum P availability to bone. Results indicate that the primary impairment in parathyroid function and bone metabolism indicators in the thyroidectomized children was unrelated to any measurable change in crude bone mass values. However, in boys this condition impaired the TBMC/TLM ratio in such a way that the administered supplementation could normalize it as a function of improved P availability. Girls' skeleton seemed to have been naturally protected against the negative metabolic effect of the studied condition. An estrogen-induced enhancement of the biomechanical impact of muscle contractions on bone mass and structure could not be excluded in this group.

Background Currently debate still exists about the effects of thyroid hormone therapy on skeletal integrity, that is the safety of levothyroxine use with respect to bone mineral density. Objective A systematic review of the effects of TSH-suppressive and replacement levothyroxine therapy on bone mineral density evaluated main causes of conflicting results and its implications for clinical practice, and suggested directions of future research. Data source and study selection A MEDLINE search identified English-language studies assessing bone mineral density under levothyroxine therapy published from 1990 to 2001. Data extraction The studies were grouped by design and type of intervention. Outcomes were qualitatively analysed. Subgroup analysis assessed heterogeneity between studies. Data synthesis Of 63 identified studies, 31 studies reported no effects of levothyroxine on bone mineral density, 23 studies showed partial beneficial or adverse, and 9 studies overall adverse effects. A significant dose-response was not found. There was a tendency towards peripheral cortical bone loss, suggesting a site-specific effect. In adolescents, men, and premenopausal women evidence for levothyroxine influence was weaker than in postmenopausal women. However, also findings in postmenopausal women remained unclear. The extent and etiology of underlying thyroid diseases also contributed to inconsistent results. Further, controversial results were due to substantial heterogeneity of studies. Above all, studies were limited by moderate quality, small size, and inadequate control for confounders. Conclusions Based on current studies there is insufficient evidence about effectiveness of levothyroxine on bone mineral density. All conclusions, however, must take into account the important methodical drawbacks. Present data may only be proved by longitudinal, high quality studies in homogeneous patients with sufficient sample size, clinical implication of future research remains questionable, though.

SummaryThe version 2 of the procedure guideline for radioiodine test is an update of the guideline published in 1999. The following statements were added or modified: The procedure guideline discusses the pros and cons of a single measurement or of repeated measurements of the iodine-131 uptake and their optimal timing. Different formulas are described when one, two or three values of the radioiodine kinetic are available. The probe with a sodium iodide crystal, alternative or additionally the gamma-camera using the ROI-technique are instrumentations for the measurement of iodine-131 uptake. A possible source of error is an inappropriate measurement (sonography) of the target volume. The patients’ preparation includes the withdrawal of antithyroid drugs 2-3 days before radioiodine administration. The patient has to avoid iodine-containing medication and the possibility of additives of iodide in vitamin- or electrolyte-supplementation has to be considered.

SummaryThe version 2 of the guideline for diagnostic standards of thyroid disorders is an update of the guideline published in 1999 and describes standards of in vitro and in vivo procedures. The following statements are modified: In vitro procedures: When measurement of the TSH-receptor antibodies is indicated, the guideline recommends the use of a second generation assay (recombinant human TSH-receptor as antigen). The functional assay sensitivity for the measurement of thyroglobulin should reach a value ≤1 ng/ml. Moleculargenetic tests (RET proto-oncogen) are indicated in patients with a newly diagnosed medullary thyroid cancer and in the relatives of patients with hereditary medullary thyroid cancer. In vivo procedures: The sonographic examination should use a probe with a frequency of at least 7.5 MHz. Indications for the thyroid scintigraphy: nodule size ≥1 cm in diameter, autonomous goitre/nodule with clinical or subclinical hyperthyroidism, necessity of a differentiation between Graves’ disease and chronic lymphocytic thyroiditis, therapy control after a definitive treatment and – in individual cases – the follow-up of untreated autonomous nodules.

The aim of the work was to compare the automated thyroglobulin (Tg) assay on the automated BRAHMS KRYPTOR platform (hTG KRYPTOR) to the established BRAHMS Tg Plus immunoradiometric assay for the measurement of Tg levels and regular Tg recovery rates and to assess a recovery test using a low Tg concentration of 10 μg/l ("mini-recovery") in samples with a native Tg level of

Background Because of the increasing number of long-term survivors of metastatic testicular germ-cell cancer, a general concern has been secondary morbidities, especially cardiovascular risk factors. Patients and methods Thirty-two patients treated with cisplatin- and doxorubicin-containing chemotherapy ≥13 years before the time of analyses were evaluated for neuro-, oto-, pulmonary-, vascular- and gonadal toxicity including evaluation of myocardial damage and cardiovascular risk factors and analysis of microcirculation. Results Thirty percent of the patients showed abnormal left ventricle function. Elevated follicle stimulating hormone (FSH) and luteinising hormone (LH) levels in 75% of patients were often associated with low testosterone levels. Elevated total cholesterol levels were found in 82% and higher triglyceride levels in 44% of patients, most of them were overweight. About 25% of the patients developed diastolic arterial hypertension after chemotherapy. Reduced hearing was confirmed in 23% of patients, especially at frequencies higher than 3000 Hz. Moreover, 53% of patients presented transient evoked otoacoustic emissions. In 38% of patients non-symptomatic neuropathy was detected, in 28% symptomatic neuropathy, and in 6% disabling polyneuropathy. In 80% of patients with neuropathic symptoms additional morphological and functional abnormalities were found by nailfold capillary videomicroscopy, compared to only 57% of the patients without neuropathic symptoms. Conclusions Patients cured by cisplatin-based chemotherapy for metastatic testicular cancer have to be cognizant of their unfavorable cardiovascular risk profile, that might be a greater risk than developing a relapse or second malignancy.

The use of 131I for radioablative therapy in patients with differentiated thyroid cancer (DTC) requires a sufficient serum concentration of TSH for efficient thyroid tissue uptake of iodine. We describe the use of recombinant human TSH (rhTSH) in conjunction with ablative radioiodine therapy (RIT) in 11 patients (16 total treatments) with advanced and/or recurrent DTC (5 papillary, 6 follicular) for whom withdrawal of thyroid hormone suppression therapy (THST), the standard method to increase serum TSH, was not an option. Indications for rhTSH use in these patients included inability to tolerate withdrawal of thyroid hormones due to very poor physical condition or inability to achieve sufficient serum TSH levels after THST withdrawal. Ten patients had undergone thyroidectomy, and most (9 of 11) had received prior ablative RIT after THST withdrawal. Baseline thyroglobulin levels ranged from 25 to nearly 30,000 ng/mL, reflecting the heterogeneity of the patient population. In 7 cases (5 patients), posttherapy thyroglobulin levels assessed at a mean of 4.3 months (range, 2-10 months) after 131I therapy were decreased by at least 30% compared to pretherapy levels. In follow-up visits, an additional 3 patients showed marked clinical improvement or decreased or stabilized tumor burden in whole body scans compared to pretherapy scans. Three patients died of progressive disease within 2 months of therapy before follow-up assessments occurred. No adverse events were reported among the 8 surviving patients. The results suggest that rhTSH offers a promising alternative to THST withdrawal to allow ablative RIT after effective TSH stimulation in patients with advanced recurrent DTC who would not otherwise be able to receive this treatment. This therapeutic indication extends the clinical potential of this new agent, already demonstrated to be effective for use with 131I for diagnostic purposes.

BACKGROUND To determine current patterns of care and disease characteristics for patients with thyroid carcinoma, a Patient Care Evaluation Study was initiated in 1996 in the U.S. and Germany. This project addresses ongoing concerns with respect to the diagnostic evaluation and treatment of patients diagnosed with thyroid carcinoma and raises questions concerning how physicians are interpreting current standards and acting on the basis of these recommendations. METHODS Patients with primary thyroid carcinoma were entered into a prospective multicenter observational study with free choice of treatment (no control group) between January 1, 1996 and December 31, 1996 in Germany. This resulted in a total of 2537 cases under observation and analysis; 1685 patients had papillary carcinoma (66.4%), 691 had follicular carcinoma (27.2%), 70 had medullary carcinoma (2.8%), and 91 had anaplastic carcinoma (3.6%). The 2376 patients with carcinoma of either papillary or follicular histology were included in the current analysis. RESULTS The major symptoms reported for patients with papillary and follicular thyroid carcinoma was neck mass (reported in 76% and 79%, respectively) followed by dysphagia (reported in 25% and 27%, respectively), stridor (reported in 9% and 14%, respectively), and neck pain (reported in 7% and 8%, respectively). Greater than 50% of the patients with papillary thyroid carcinoma were reported to have American Joint Committee on Cancer/International Union Against Cancer Stage I disease. Between 37–39% of the follicular carcinoma patients had Stage I and Stage II disease. Only slight differences in the diagnostic approach to patients with papillary or follicular carcinoma were noted. The majority of patients underwent an ultrasound of the thyroid region (78.1%), which was suggestive of carcinoma in only 39% of the cases. A thyroid scan was performed on 76.6% of patients, and the results were suggestive of carcinoma in 44.8% of the individuals. In contrast, fine-needle aspiration biopsy of the thyroid is highly recommended in the current Clinical Practice Guidelines (CPG) but results were obtained in only 27.4% of the patients. Total thyroidectomy without lymph node dissection was the most commonly used surgical procedure in the treatment of patients with papillary and follicular thyroid carcinoma. Only approximately 2% of patients at low risk in the group with Stage I disease were treated with a lobectomy. In 80% of the patients with Stage I papillary thyroid carcinoma and approximately 90% of those patients diagnosed with Stage II, III, and IV disease treating physicians chose to utilize radioiodine as adjuvant treatment after disease-directed surgery. External beam radiation was added to the treatment regimen for many patients diagnosed with Stage III and IV disease (30% in patients with papillary thyroid carcinoma and 33% in patients with follicular thyroid carcinoma). CONCLUSIONS To the authors' knowledge no single effective diagnostic test for thyroid carcinoma currently is available and in the majority of cases a combination of ultrasound, thyroid scan, or fine-needle aspiration biopsy together with the clinical findings (e.g., thyroid mass) led to a diagnosis of carcinoma. The authors suspect that the high prevalence of concomitant pathologic findings such as goiter, even in the healthy population in Germany, reduces the accuracy of all diagnostic test methods and may account for the frequent use of imaging techniques. The majority of patients underwent a total or near-total thyroidectomy. Total thyroidectomy with radical lymph node dissection was used very frequently in those patients with papillary thyroid carcinoma (22%). German physicians tend to surgically treat early stage thyroid carcinoma somewhat more radically than recommended in the CPG. With respect to other treatment options employed as part of the first course of treatment, radioiodine appears to play the most important role. [See commentary on pages 1–4, this issue and communication on pages 202–17, this issue.] Cancer 2000;89:192–201. © 2000 American Cancer Society.

Summary Aim: Tumor scintigraphy with 201-TICI is an established diagnostic method in the follow-up of differentiated thyroid cancer. We investigated the relationship between thyroglobulin (Tg) level and tumor detectability. Subject and methods: We analyzed the scans of 122 patients (66 patients with proven tumor). The patient population was divided into groups with Tg above (N = 33) and below (N = 33) 5 ng/ml under TSH suppression or above (N = 33) and below (N = 33) 50 ng/ml under TSH stimulation. Tumor detectability was compared by ROC-analysis (True-Positive-Fraction test, specificity 90%). Results: There was no significant difference (sensitivity 75% versus 64%; p = 0.55) for patients above and below 5 ng/ml under TSH suppression and a just significant difference (sensitivity 80% versus 58%; p = 0.04) for patients above and below 50 ng/ml under TSH stimulation. In 18 patients from our sample with tumor, Tg under TSH suppression was negative, but 201-TICI-scan was able to detect tumor in 12 patients. Conclusion: Our results demonstrate only a moderate dependence of tumor detectability on Tg level, probably without significant clinical relevance. Even in patients with slight Tg elevation 201-TICI scintigraphy is justified.

Summary Aim: In this study the incidence rate of familial nonmedullary thyroid carcinoma was investigated in the first and second grade relatives of patients registered at the Clinic and Policlinic for Nuclear Medicine, University of Würzburg. Patients and Methods: In this study 596 patients with differentiated thyroid carcinoma were enclosed, who were treated between 01.01.81 and 31.12.95. The data concerning a familial occurrence were studied by a retrospective survey-based analysis. These data were compared to a literature analysis for familial non-meduilary thyroid carcinoma. Results: 14 patients of the 596 patients treated showed a familial occurrence (2,3%). All these patients suffered from papillary thyroid carcinoma. According to the prognostic factors (tumor state, lymph node involvement, metastastic disease) no differences could be evaluated in the different groups (sporadic versus familial non-medullary thyroid disease). Conclusion: A familial occurrence of differentiated thyroid carcinomas is not frequently observed, but should be considered due to further genetic diseases.

In Germany, approximately 30,000 treatments with radioiodine are performed yearly in patients with benign or malignant thyroid diseases. These are carried out generally in specialized therapy wards which are equipped with radiation protection facilities. Ambulant (fractionated) radioiodine treatment is not permitted in Germany, More recently, the situation has been that the discharge of patients is permitted, when they have spent a stay of at least 48 hours in the ward without the dose rate exceeding 3.5 μSv/hour at 2 meters distance from them, corresponding to 1 mSv/year (this correlates to a residual activity in the body of the patient of 250 MBq). The radiation exposure of personnel in the therapy ward due to both external and internal exposure lies within a range of a few mSv per year According to recent studies, the exposure to family members and close friends via external exposure, inhalation or incorporation does not exceed the effective dose of 1 mSv/ year, provided the patient has been treated at least for 48 h as an in-patient. This value has been laid down in a recommendation by the European Union as the dose constraint for children; for adults younger than 60 years of age, 3mSv are recommended, for older persons 15 mSv.

The radiation exposure of a patient in diagnostic nuclear medicine is influenced by different factors, which may be separated into direct and indirect determinants of exposure. The radiation burden is directly related to the radionuclide used (beta, gamma radiation, energy of radiation, physical half-life) and the activity used. In addition, the radiation exposure is strongly influenced by the type of radiolabelled compound (radiopharmaceutical) and its metabolic behaviour. The metabolism of a radiopharmaceutical, however, depends not only on the general principles of its biodistribution but also on individual parameters of its biokinetics (i.e. patient's age, sex, weight, organ uptake and excretion). Optimisation in radiation protection requires a careful selection of activity, radionuclide and radiopharmaceutical compound for a patient. The radiation exposure of a patient may be influenced considerably by disturbance factors which can be controlled by means of quality assurance measures. Conceming the radiopharmaceutical, radiochemical and chemical impurities have to be ruled out before administration. Activity meters and gamma cameras must he checked by appropriate quality control procedures, The check of the gamma cameras includes background, efficiency, uniformity, linearity and resolution and has to be an integral part of a routine quality control programme in a nuclear medicine department.

The results of serial dimercaptosuccinic acid (DMSA) imaging over 5 years are reported in 287 children with severe vesico-ureteral reflux entered into the European Branch of the International Reflux Study in Children. The children were randomly allocated to medical (n=147) or surgical (n=140) management and DMSA studies were performed during the follow up period at least 6 months after any urinary tract infection. Abnormal images were classified into four types: (1) large polar hypodensity with normal renal outline; (2) peripheral photon deficient defect(s) in a non-deformed kidney; (3) small renal image with normal contour; and (4) peripheral defect(s) with resultant irregularity of the renal outline. The DMSA findings were abnormal at entry in 235 (82%) with no difference in incidence or severity between the two treatment groups. During follow up, deterioration was observed in 25 medically and 23 surgically treated patients and comprised image deterioration alone in 17, image deterioration with corresponding reduction in differential function in 16 and reduction in relative function without image change in 15, with similar distribution between the two treatment groups. Deterioration was more frequent in children entering the study under the age of 2 years and in those with grade IV rather than grade III reflux. These findings, showing no difference in outcome between children managed surgically or medically, are consistent with the radiological results already published.

Zusammenfassung Ziel: Patienten exhalieren 1-131 nach Radioiodtherapie. Ziel der vorliegenden Studie ist die Bestimmung der von Angehörigen von Radio- iodtherapiepatienten nach Entlassung aus der Therapiestation inkorporierten Aktivität und der daraus resultierenden Schilddrüsendosis. Methoden: Bei 31 Angehörigen von Radioiodtherapiepatienten wurde die Schilddrüsenaktivität mittels der Schilddrüsensonde eines Ganzkörperzählers gemessen und daraus Dosiswerte bestimmt. Ergebnisse: Bei 11 der 31 Messungen wurde keine Aktivität oberhalb der Nachweisgrenze von 13 Bq festgestellt. Im Mittel wurde bei den restlichen Personen 104 Bq gemessen, entsprechend einer daraus resultierenden mittleren Schilddrüsendosis von 0,2 mSv (Maximalwert: 2 mSv). Schlußfolgerung: Die Zufuhr von 1-131 bei Angehörigen von Radioiodtherapiepatienten nach deren Entlassung ist gering und führte in keinem Fall zu einer effektiven Dosis von mehr als 1 mSv.