phosphorus-radioisotopes and Postoperative-Complications

The authors report the results of surgery alone or in combination with radiotherapy in the management of craniopharyngiomas in children.. The authors retrospectively reviewed the outcomes in 31 patients treated for craniopharyngiomas at the Department of Radiation Oncology at Washington University in St. Louis and the St. Louis Children's Hospital. The median age at diagnosis was 8.1 years (range 1.1-21 years). Fourteen patients underwent gross-total resection (GTR) with observation, and 6 patients underwent subtotal resection (STR) with observation. Ten patients underwent STR or cyst aspiration followed by external-beam radiotherapy, and 1 patient underwent cyst aspiration followed by intracystic 32P installation.. The median follow-up for all surviving patients was 78.2 months. Overall survival and local control rates at 10 years were 96 and 58%, respectively. One patient died of the disease, and 12 patients had subsequent recurrences. Of those with recurrences, 6 patients had undergone initial STR with observation and 6 had been treated with GTR and observation. The median time to progression was 17.9 months in the patients who underwent limited resection, and 55 months for those who underwent GTR. There were no recurrences in the patients who received radiotherapy at the time of initial diagnosis.. Radiotherapy delivered as part of the initial management of craniopharyngiomas in children or at the time of recurrence provides effective local control.

Topics: Adolescent; Adult; Brachytherapy; Child; Child, Preschool; Craniopharyngioma; Disease Progression; Disease-Free Survival; Female; Follow-Up Studies; Humans; Infant; Longitudinal Studies; Male; Neoplasm Recurrence, Local; Phosphorus Radioisotopes; Pituitary Neoplasms; Postoperative Complications; Radiopharmaceuticals; Radiotherapy, Adjuvant; Radiotherapy, Conformal; Radiotherapy, High-Energy; Retrospective Studies; Survival Rate; Treatment Outcome

Patients undergoing successful kidney transplantation often manifest overt hypophosphatemia associated with exaggerated phosphaturia during the early post-transplant period (2 weeks to 3 months). The mechanism for this phenomenon has not been fully elucidated. We tested the hypothesis that a circulating serum factor [non-parathyroid hormone (non-PTH)], which operates during chronic renal failure (CRF) to maintain phosphate (Pi) homeostasis, can increase fractional excretion of Pi (FE(PO4)) in normal functioning kidney grafts during the early post-transplant period, thereby causing phosphaturia and hypophosphatemia.. Five groups of patients were studied: control subjects (group 1, N = 16), "early" (2 weeks to 1 month) post-transplant patients (group 2, N = 22), "late" (9 to 12 months) post-transplant patients (group 3, N = 14), patients with advanced CRF (glomerular filtration rate = 30 to 40 mL/min; group 4, N = 8), and patients who suffered from end-stage renal failure and were treated by chronic hemodialysis (group 5, N = 14). Group 2 manifested significant hypophosphatemia and phosphaturia when compared with groups 1 and 3 (Pi = 0.9 +/- 0.003 mg/dL, FE(PO4) = 68+/- 5%, P < 0.0005 vs. groups 1 and 3). Sera were taken from each of the five subject groups and applied to the proximal tubular opossum kidney (OK) cells. The activity of Na/Pi-type 4 (that is, OK-specific type II transporter) was evaluated by measuring Na(+)-dependent (32)Pi flux. The expression of Na/Pi type II mRNA and the abundance of Na/Pi protein were determined by Northern and Western blot assays, respectively.. When compared with sera from groups 1 and 3, 10% sera taken from groups 2, 4, and 5 (incubated overnight with OK cells) inhibited (32)Pi flux by 25 to 30% (P < 0.0003). Both Na/Pi mRNA and the expression of Na/Pi protein were markedly augmented under the same conditions (P < 0.05 groups 2, 4, and 5 vs. groups 1 and 3). Time-course analysis revealed that the up-regulation of Na/Pi protein by sera from groups 2, 4, and 5 was observed as early as four hours of incubation, whereas augmented abundance of Na/Pi mRNA was only seen after eight hours of incubation. The addition of PTH (1-34) to sera from groups 2, 4, and 5 abolished the augmented expression of NaPi protein. We labeled OK cell surface membrane proteins with N-hydroxysuccinimide bound to biotin (NHS-SS-biotin). Biotinylated transporters incubated with the different sera were precipitated by strepavidin and identified by Western blot analysis. Cells incubated in sera from group 2 showed increased membrane bound transporter when compared with control sera, whereas the intracellular pool of the transporter was comparable between the two groups.. A non-PTH circulating serum factor (possibly phosphatonin) that increases FE(PO4) during CRF is also responsible for phosphaturia and hypophosphatemia in the early period following successful kidney transplantation. The putative factor inactivates Na/Pi activity along with inhibition of the transporter trafficking from the cell membrane into the cytosol.

Topics: Adult; Aged; Animals; Biological Transport; Blood; Carrier Proteins; Cell Line; Female; Humans; Hypophosphatemia; Kidney Failure, Chronic; Kidney Transplantation; Male; Middle Aged; Opossums; Phosphorus Radioisotopes; Postoperative Complications; RNA, Messenger; Sodium-Phosphate Cotransporter Proteins; Sodium-Phosphate Cotransporter Proteins, Type II; Symporters; Thymic Factor, Circulating

Topics: Bacterial Infections; Blood Coagulation Disorders; Disease Susceptibility; Gallium Radioisotopes; Humans; Lupus Erythematosus, Systemic; Nervous System Diseases; Phosphorus Radioisotopes; Postoperative Complications

Systemic mastocytosis occurred as a fatal event in a patient with long-standing polycythemia vera. The patient had been treated over the course of 21 yr with radioactive phosphorus. Possible relationships between mastocytosis and polycythemia vera, and also between mastocytosis and treatment with ionizing radiation, are discussed. Histopathologic and electron microscopic findings are illustrated. Difficulties in establishing the diagnosis of mast cell disease in this setting are also described.

Topics: Biopsy; Gastrointestinal Hemorrhage; Humans; Liver; Male; Middle Aged; Phosphorus Radioisotopes; Polycythemia Vera; Postoperative Complications; Psoriasis; Splenectomy; Splenomegaly; Urticaria Pigmentosa

The addition of intraperitoneal colloidal radioactive chromic phosphorus following total abdominal hysterectomy, bilateral salpingo-oophorectomy, and omentectomy in women with Stage I ovarian cancer does not cause significant morbidity. Moreover, our preliminary results suggest that this regimen appears to increase the rate of local control of disease. In 21 unselected patients, there was 1 incident of small bowel obstruction. Fourteen of these patients have been followed for at least 1 1/2 years; all are alive without evidence of disease. These facts suggest that a national prospective study to investigate the efficacy of this treatment for Stage I ovarian cancer is warranted.

Topics: Adult; Aged; Castration; Colloids; Fallopian Tubes; Female; Humans; Hysterectomy; Middle Aged; Omentum; Ovarian Neoplasms; Phosphorus Radioisotopes; Postoperative Complications; Prospective Studies; Radiotherapy Dosage; Time Factors

During the past decade the diagnostic use of blood volume determinations has declined as a result of the generation of largely inaccurate results and inappropriate normalization and interpretation. After historical development of more than 50 years, current methodology employs 125I-labeled human serum albumin and 51Cr-labeled red blood cells to determine plasma volume and red cell volume, respectively. Accurate blood volume determinations require (1) abandoning the use of the mean body hematocrit:venous hematocrit ratio and using simultaneous independent measurements of both volumes; (2) delaying multiple postinjection patient samples until complete mixing and equilibration are complete; (3) backextrapolation of plasma concentrations of 125I to account for albumin loss from the plasma, and, rarely, back-extrapolation of red cell concentrations to account for dilution by red cells transfused during the procedure; (4) normalization of volumes by adjusting patient weight to normal correspondence with lean tissue mass, whenever necessary. A rapid, routine method that fulfills these four requirements is presented. A number of surgical and medical conditions in which blood volume determinations are very useful in diagnosis and therapy are discussed. Recently developed techniques for blood volume measurements include neutron acativation analysis and fluorescent excitation analysis. Correct normalization of accurate blood volume measurements will provide a valuable service to the entire medical community.

Topics: Aged; Blood Volume Determination; Body Constitution; Carbon Monoxide; Central Venous Pressure; Chromium Radioisotopes; Diagnostic Errors; Erythrocytes; Hematocrit; Hormones, Ectopic; Humans; Hyperaldosteronism; Hypertension; Indium; Iron Radioisotopes; Male; Phosphorus Radioisotopes; Plasma Volume; Polycythemia; Postoperative Complications; Potassium Radioisotopes; Radioisotope Dilution Technique; Serum Albumin, Radio-Iodinated; Shock; Technetium; Time Factors; Transferrin; Vasopressins

Topics: Aged; Blood Platelets; Blood Transfusion, Autologous; Bloodletting; Busulfan; Erythrocyte Count; Female; Hematocrit; Hemorrhage; Humans; Male; Middle Aged; Peptic Ulcer; Phosphorus Radioisotopes; Polycythemia Vera; Postoperative Complications; Surgical Procedures, Operative; Thrombosis