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- Author or Editor: Craig D. Long x
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Abstract
Objective—To evaluate the efficacy and safety of ultrasonographically guided radiofrequency heat ablation of parathyroid masses in dogs with primary hyperparathyroidism.
Design—Clinical trial.
Animals—11 dogs.
Procedure—In all dogs, either 1 or 2 parathyroid masses were evident ultrasonographically. Dogs were anesthetized, and a 20-gauge over-the-needle catheter was directed into the parathyroid mass via ultrasonographic guidance. Radiofrequency heat was applied to the stylet of the catheter until there was sonographically apparent change to the entire parenchyma of the mass. Serum total and ionized calcium and parathyroid hormone concentrations were monitored daily for 5 days after the ablation procedure and again at 1, 2, and 3-month intervals, if possible. Dogs were monitored for adverse effects.
Results—One treatment was required in 6 dogs, 2 treatments were required in 2 dogs, and treatment was unsuccessful in 3 dogs. Serum total and ionized calcium concentrations were within reference ranges within 2 days of the last procedure in all 8 successfully treated dogs. Serum parathyroid hormone concentration was decreased 24 hours after treatment in all 8 dogs. Hypocalcemia developed in 5 of the 8 successfully treated dogs, all of which required treatment. One dog had a transient voice change. Other adverse effects were not reported.
Conclusions and Clinical Relevance—Ultrasonographically guided radiofrequency heat ablation of parathyroid masses is a safe and effective alternative to surgery in dogs with primary hyperparathyroidism. (J Am Vet Med Assoc 2001;218:1106–1110)
Abstract
Objective—To determine interoperator variance in shunt fraction calculation.
Design—Case series.
Sample Population—101 transrectal portoscintigraphic studies.
Procedure—Results of dynamic portoscintigraphic studies were reviewed by 4 radiologists without knowledge of signalment, history, or medical profile. Results were judged to be negative or positive on the basis of the dynamic scan. Composite images were formulated, and hand-drawn regions of interest were determined for the heart and liver. Time-activity curves were generated, time-zero points were selected, curves were integrated during a 10-second interval, and shunt fractions were calculated.
Results—Radiologists were in agreement regarding positive versus negative results for 99 of 101 studies. Interoperator variance in shunt fraction calculation ranged from 0.4 to 59.6%. For 51 studies with positive results, variance ranged from 2.5 to 59.6% (mean ± SD, 22.8 ± 14.5%); differences among reviewers were significant. For 48 studies with negative results, variance in shunt fraction ranged from 0.4 to 25.9% (mean, 5.3 ± 5.8%); significant differences among reviewers were not detected. Shunt fraction calculations were not exactly reproducible among radiologists in 94 and 100% of studies with negative or positive results, respectively.
Conclusions and Clinical Relevance—Results suggest that shunt fraction values are not reproducible among operators. Range in variability was greater in studies with positive results. This factor may be of particular clinical importance in reassessment of patients after incomplete shunt ligation. (J Am Vet Med Assoc 2001;218:1116–1119)
Abstract
Objective—To determine the efficacy and safety of percutaneous ethanol injection (PEI) for the treatment of hyperthyroidism caused by bilateral hyperplastic thyroid nodules in cats.
Design—Prospective study.
Animals—7 cats.
Procedure—Hyperthyroidism was diagnosed on the basis of clinical signs and increased serum total thyroxine (TT4) concentrations. The presence of 2 cervical thyroid nodules was confirmed by use of ultrasonography and technetium Tc 99m albumin thyroid scans. After the death of 1 cat that received PEI in both thyroid nodules at the same time, the protocol was changed to injecting ethanol into 1 nodule at a time, with at least 1 month between injections. Clinical signs, serum TT4 concentrations, serum ionized calcium concentrations, laryngeal function, findings on ultrasonographic examinations of the ventral cervical region, and results of thyroid scans were monitored.
Results—Serum TT4 concentrations transiently decreased in all 6 cats (into the reference range in 5 of 6 cats) within 4 days of the first staged ethanol injection. Each subsequent injection resulted in a transient decrease in serum TT4 concentration. The longest period of euthyroidism was 27 weeks. Adverse effects included Horner's syndrome, dysphonia, and laryngeal paralysis. One cat died of unrelated causes. One cat underwent bilateral thyroidectomy, 2 cats were treated with methimazole, and 2 cats that had increased serum TT4 concentrations were not treated further, because they remained clinically normal.
Conclusions and Clinical Relevance—Percutaneous ethanol ablation of bilateral thyroid nodules as a treatment for cats with hyperthyroidism is not recommended. This treatment is not as efficacious as the medical and surgical treatments presently used. (J Am Vet Med Assoc 2001;218:1293–1297)
