Changes in articular synovial lining volume measured by magnetic resonance in a randomized, double-blind, controlled trial of intra-articular samarium-153 particulate hydroxyapatite for chronic knee synovitis.
OBJECTIVE: Magnetic resonance techniques have recently been investigated as tools with which to monitor inflammatory joint disease. Our aim was to use a contrast-enhanced T1-weighted protocol to monitor the short-term changes in knee synovial lining volume in a double-blind, randomized, controlled trial of intra-articular samarium-153 particulate hydroxyapatite (Sm-153 PHYP). METHODS: Twenty-four out-patients with chronic knee synovitis, from a cohort who had been recruited to a long-term clinical efficacy trial, were recruited for this study. Patients received either intra-articular Sm-153 PHYP combined with 40 mg triamcinolone hexacetonide or 40 mg intra-articular triamcinolone hexacetonide alone. Synovial lining volumes were calculated from three-dimensional T1-weighted contrast-enhanced images made before and after contrast enhancement with thresholding and pixel counting, immediately before and 3 months after treatment. RESULTS: Paired pre- and post-treatment magnetic resonance data were obtained for 18/24 (75%) patients. There was no significant difference in mean pre-treatment synovial volume between the two treatment groups (139 vs 127 ml). A mean reduction in synovial lining volume was detected in the Sm-153 PHYP/steroid-treated group (139 to 110 ml, P = 0.07) and in the steroid-treated group (127 to 58 ml, P < 0.001). The reduction was significantly greater in the steroid-treated group (-61% vs -23%, P < 0.05). CONCLUSIONS: Short-term changes in articular synovial lining in response to intra-articular treatment for chronic synovitis may be monitored by magnetic resonance imaging. After 3 months, a greater mean reduction in synovial lining volume had occurred in response to intra-articular steroid alone compared to combined Sm-153 PHYP/steroid injection. (+info)
Chromosomal analysis of peripheral lymphocytes of patients before and after radiation synovectomy with samarium-153 particulate hydroxyapatite.
OBJECTIVE: Radiation synovectomy may be indicated for the treatment of chronic synovitis. A number of factors may affect its current use, including availability, limited evidence for its efficacy compared to intra-articular glucocorticoid, and concerns regarding the potential long-term effects of radiation exposure, particularly in younger patients. Specific chromosome-type abnormalities in peripheral lymphocytes can be useful indicators of whole-body radiation exposure. The frequency of these aberrations has been shown to increase in patients who have had radiation synovectomy using yttrium-90 by up to five times compared to baseline levels. Samarium-153 particulate hydroxyapatite (Sm-153 PHYP) is a new radiopharmaceutical currently on trial which appears to have less extra-articular leakage than yttrium-90 compounds. The aim of this study was to identify any increase in specific chromosome-type abnormalities, using published criteria, in patients following Sm-153 PHYP synovectomy of the knee. The 10 patients (five men, five women) in whom the analyses were performed had a mean age of 47 yr (range 28-70 yr). RESULTS: There was no increase in scored chromosome-type abnormalities after Sm-153 PHYP synovectomy. CONCLUSION: This study further supports the relative safety of Sm-153 PHYP compared to other radiopharmaceuticals. (+info)
Double blind glucocorticoid controlled trial of samarium-153 particulate hydroxyapatite radiation synovectomy for chronic knee synovitis.
BACKGROUND: Samarium-153 particulate hydroxyapatite (Sm-153 PHYP) is a relatively new radiation synovectomy agent developed for the treatment of chronic synovitis. Although it has been shown that the levels of unwanted extra-articular radiation are lower after intra-articular injection of Sm-153 PHYP than yttrium-90 colloid, its clinical efficacy has not been rigorously studied. OBJECTIVES: To establish whether Sm-153 PHYP radiation synovectomy results in a clinically useful benefit sustained at one year. METHODS: In a randomised double blind study, patients received either intra-articular 40 mg triamcinolone hexacetonide alone or 40 mg triamcinolone hexacetonide combined with Sm-153 PHYP in an outpatient clinic. RESULTS: Sixty patients (28 male, 32 female), median age 51 (18-75) with chronic knee synovitis were studied. Diagnoses included: rheumatoid arthritis (n=29); psoriatic arthritis (n=9); ankylosing spondylitis (n=3); reactive arthritis (n=2); undifferentiated seronegative oligoarthritis (n=13) and miscellaneous inflammatory conditions (n=4). More patients who received Sm-153 PHYP/triamcinolone hexacetonide sustained clinical benefit a year after treatment compared with patients who received corticosteroid alone (12 of 31 (39%) v 6 of 29 (21%), a difference of 18% more patients (95% CI -5% to 41%)) though the difference was not significant (chi(2)=2.31, 0.2>p>0.1, n=60). Despite the variation in injected activity (median 563 MBq, range 218-840 MBq), there was no obvious relation between low levels of injected activity (<555 MBq) and relapse within 12 months of treatment (chi(2) =2.61, 0.2>p>0.1, n=31). CONCLUSIONS: There was no clear beneficial clinical effect of combined Sm-153 PHYP/triamcinolone hexacetonide injection over triamcinolone hexacetonide alone a year after treatment for chronic knee synovitis. (+info)
Variation in oncologic opinion regarding management of metastatic bone pain with systemic radionuclide therapy.
The objective of this study was to determine whether there is consistency of opinion regarding the management of metastatic bone disease pain among medical oncologists who are given the option of using systemic radionuclide therapy (89Sr, 153Sm). METHODS: One hundred board-certified medical oncologists were given a brief clinical summary of three patients with metastatic cancer. Management options included oral, parenteral and transdermal delivery forms of opioid analgesics; external beam irradiation; and systemic radionuclide therapy. The oncologists rated, in whole numbers from 1 (most appropriate) to 10 (least appropriate), their opinions on the appropriateness of each proposed intervention for each patient. RESULTS: Systemic radionuclide therapy was perceived consistently as having low appropriateness for palliation of metastatic bony pain compared with opioid analgesics. A slight increase in appropriateness for systemic therapy was indicated for the patient with widespread metastatic disease, who, on the basis of literature reports, was unlikely to benefit from such therapy. The oncologists rated the appropriateness of systemic therapy as low in the patient with limited early disease, in which the literature indicates the greatest benefit will be derived from such intervention. CONCLUSION: Referring oncologists perceive the appropriateness of systemic radionuclide therapy as low. Their perception of its appropriateness increases with extent of disease. As a result, this palliative option is underutilized or used in less-than-optimal disease settings. (+info)
The first synthesis of herbicidin B, a tricyclic-sugar adenine nucleoside antibiotic, using samarium diiodide-promoted aldol-type C-glycosidation reaction as a key-step.
A first total synthesis of the nucleoside antibiotic herbicidin B (1) was achieved in which a novel aldol-type C-glycosidation reaction promoted by samarium diiodide (SmI2) was used as a key step. Construction of the desired stereochemistry of the tricyclic-sugar moiety was successfully achieved by conformational restriction strategy based on repulsion between adjacent bulky protecting groups on the pyranose ring. (+info)
The covalent and three-dimensional structure of concanavalin A. III. Structure of the monomer and its interactions with metals and saccharides.
The three-dimensional structure of the lectin concanavalin A (Con A) has been determined at 2.0-A resolution by x-ray diffraction analysis. The protomers are ellipsoidal domes of dimensions 42 times 40 times 39 A. Folding of the polypeptide backbone is dominated by the presence of two antiparallel pleated sheets, a twisted sheet of seven strands passing through the center of the molecule and a bowed sheet of six strands which forms the back surface of the monomer. Manganese and calcium ions bind to the protein at adjoining sites to form a binuclear complex of two octahedra sharing a common edge. The ligands for each metal ion are four groups from the NH2-terminal region of the protein and 2 water molecules. The binding site for the inhibitor beta-(o-iodophenyl)-D-glucopyranoside is in a deep cavity which contains distinct hydrophobic and hydrophilic binding subsites. Studies of the binding of beta-(o-iodophenyl)-D-glucopyranoside to Con A in the crystalline state and in solution have indicated that the binding behavior of the protein is somewhat different in the two states. (+info)
Reduction of acetals with samarium diiodide in acetonitrile in the presence of Lewis acids.
Transformation of acetals into ethers by partial reduction using a samarium diiodide-Lewis acids-acetonitrile system is described. The reaction with aromatic acetals occurred in good yields in the presence of aluminum chloride (2 eq) whereas the corresponding aliphatic, vinylic, and alkynyl derivatives did not afford ethers under the same conditions. Beta-elimination to give an enol ether becomes predominant when aliphatic acetals that possess a hydrogen at the 2-position are treated with iodotrimethylsilane in the presence of SmI2 or SmI3. (+info)
A comparative analysis of distal maxillary molar movement produced by a new lingual intra-arch Ni-Ti coil appliance and a magnetic appliance.
The aim of the study was to evaluate cephalometrically the dental and skeletal treatment effects of a new lingual intra-arch Ni-Ti coil appliance for molar distalization and to compare these with those of an established intra-arch appliance that uses repelling magnets for distal molar movement. Two groups of 21 adolescents, all girls, participated in this retrospective study. One group was treated with the new lingual Ni-Ti coil appliance for 6.5 months and the other with the magnetic appliance for 5.8 months. The treatment effects were analysed by measurements on lateral head radiographs at the start of treatment and after the molar distalization was completed. The mean amount of distal molar movement was 2.5 mm (SD 0.69) in the lingual coil group and 2.6 mm (SD 0.51) in the magnet group. A significantly higher degree of distal molar tipping was found in the magnet group, -8.8 degrees, compared with -2.2 degrees for the lingual coil group. Due to anchorage loss, the maxillary incisors moved forwards, and the overjet was increased by an average of 1.2 mm in the lingual coil group and 1.7 mm in the magnet group. The results indicate that the new lingual Ni-Ti coil appliance was better choice than the magnet appliance for distal bodily movement of maxillary molars. The benefits of the new Ni-Ti appliance were due to the design preventing molar tipping and its single activation. (+info)