Background: The surgical treatment of extensive diffuse Pigmented Villonodular Synovitis (PVNS) of large joints alone, is unsatisfactory, with high rates of local recurrence Postsynovectomy adjuvant treatment with external beam radiation therapy or intraarticular injection of Yttrium90 (Y90) yielded better results Aims: Experience with 10 cases treated with debulking surgery followed by intraarticular injection of Y90 is reported Methods: Between January 1989 and June 1998, 10 patients (8 males and 2 females aged 15049 years) with extensive diffuse PVNS were treated In 6 patients the knee joint, in 3 patients the ankle joint, and in 1 patient the hip joint were involved The 10 patients underwent 15 operations, 1 patient had 3 surgical procedures, and 3 patients underwent 2 surgeries (interval between re-operations for local recurrence were 2–4 years) All patients had an intraarticular injection of 15–25 mCi of Y90, 6–8 weeks after the last surgery Results: Follow up time was 25–12 years (mean 6 years) All patients were followed by repeated computerized tomography (CT) scans, magnetic resonance imaging (MRI), plain X-ray films and bone scans semi-annually In 9 patients no evidence of disease and no progression of bone or articular destruction have been noted In 1 patient stabilization of disease was achieved with no further evidence of bony or articular damage No complications were noticed after surgery, nor after the intraarticular Y90 injection Conclusions: A combination of debulking surgery with intraarticular injection of Y90 for extensive diffuse PVNS of major joints is a reliable way of treatment with good results

The use of surgery and yttrium90 in the management of extensive and diffuse pigmented villonodular synovitis of large joints

Options to meet the future global demand of radionuclides for radionuclide therapy

Abstract The IUPAC (International Union of Pure and Applied Chemistry) Periodic Table of the Elements and Isotopes (IPTEI) was created to familiarize students, teachers, and non-professionals with the existence and importance of isotopes of the chemical elements. The IPTEI is modeled on the familiar Periodic Table of the Chemical Elements. The IPTEI is intended to hang on the walls of chemistry laboratories and classrooms. Each cell of the IPTEI provides the chemical name, symbol, atomic number, and standard atomic weight of an element. Color-coded pie charts in each element cell display the stable isotopes and the relatively long-lived radioactive isotopes having characteristic terrestrial isotopic compositions that determine the standard atomic weight of each element. The background color scheme of cells categorizes the 118 elements into four groups: (1) white indicates the element has no standard atomic weight, (2) blue indicates the element has only one isotope that is used to determine its standard atomic weight, which is given as a single value with an uncertainty, (3) yellow indicates the element has two or more isotopes that are used to determine its standard atomic weight, which is given as a single value with an uncertainty, and (4) pink indicates the element has a well-documented variation in its atomic weight, and the standard atomic weight is expressed as an interval. An element-by-element review accompanies the IPTEI and includes a chart of all known stable and radioactive isotopes for each element. Practical applications of isotopic measurements and technologies are included for the following fields: forensic science, geochronology, Earth-system sciences, environmental science, and human health sciences, including medical diagnosis and treatment.

/pdf/iupac-periodic-table-of-the-elements-and-isotopes-iptei-for-921e9uozqu.pdf

IUPAC Periodic Table of the Elements and Isotopes (IPTEI) for the Education Community (IUPAC Technical Report)

Radiosynoviorthesis (RSO) with an yttrium-90 colloid offers a local and minimally invasive therapy for treating inflammatory hypertrophy of the synovial membrane of the knee that has arisen from numerous kinds of disorder: these include rheumatoid arthritis (RA), osteoarthritis (OA), spondyloarthropathy, villonodular synovitis and others. There is substantial evidence that this treatment is efficacious and that, in view of the benefits that it offers, its tolerability and safety are very good. Administration should be restricted to patients in whom other therapies (including locally injected corticoids) have failed, and proper attention must be paid to correct administration, including post-treatment immobilization and the co-administration of corticoids, to minimize the risk of leakage and of efflux through the puncture channel.

/pdf/therapeutic-status-of-radiosynoviorthesis-of-the-knee-with-13ycvujp3j.pdf

Therapeutic status of radiosynoviorthesis of the knee with yttrium [90Y] colloid in rheumatoid arthritis and related indications

https://onlinelibrary.wiley.com/doi/pdf/10.1002/art.11056

Aspiration and injection therapies for joints.

Objective. To perform a systemic review and meta-analysis on the effectiveness of radiosynoviorthesis (RSO). Methods. A search of medical databases was conducted. Criteria for inclusion: articles in English, minimum follow-up of 6 months, specification of joint disease, reported outcome of at least 5 RSOs. The studies were scored for quality by the Oxford Centre of Evidenced-based Medicine Levels of Evidence, from 1 to 4. Results. Twenty-one (21) studies were included (3 quality 1b, 5 2b and 13 4), analysing 169 Erbium/ 186 Rhenium-RSO used predominantly in small joints and 49 (1 quality 1b, 10 2b and 38 4) on 90 Yttrium-RSO used predominantly in knee joints. The reported success rates of 169 Erbium/ 186 Rhenium-RSO ranged from 69-100% at 6 months, and from 54-100% at ≥12 months; for 90 Yttrium they were 24-100% and 29-94%, respectively. Studies comparing the effect of RSO with that of glucocorticoid (GC) or saline injection alone were pooled. At 6 months, the pooled odds ratio favouring RSO of the knee with Yttrium over control is 4 (confidence interval (CI) 95% 1.2-14), p=0.02, but at 12 months the ratio was 1.7 (CI95% 0.69-4), p =0.26. For RSO of small joints with Erbium/Rhenium compared to controls, the pooled odds ratio at 6 months is 2 (CI95% 0.66-6), p=0.22 and at 12 months 2 (CI95% 1.09-3.5), p=0.03. Conclusion. Reported success rates of RSO are high, but differences in effect with GC injection are less evident, although there is marked heterogeneity in study design of the (small number of) comparative studies.

Radiation synovectomy with (90)Yttrium, (186)Rhenium and (169)Erbium: a systematic literature review with meta-analyses.

Objective To investigate and compare the effects of radiation synovectomy of various joints in a rheumatological practice. Methods Consecutive patients referredfor radiation synovectomy to Medical Center Alkmaarfrom 1993 till 1996 were analyzed (n = 138). Patients had to have persistent arthritis despite at least two intra-articular glucocorticoid injections with 20 mg triamcinolone hexacetonide. The knees were treated with 185 MBq Yttrium-90; shoulders, elbows, wrists, hips and talocrural joints received 185 MBq Rhenium-186 and meta-carpophalangeal joints and proximal interphalangeal joints 37 MBq Erbium-169. The radionuclide injection was followed by injection of 20 mg triamcinolone in order to prevent flare-up of synovitis (due to chemical irritation) and needle-track burn. The clinical effect was assessed by evaluating VAS pain (0-10 point scale), functional disability, tenderness and swelling of the treated joint and patient's and physician's global assessments of the effect of therapy (each on a 4-point scale). Results The overall success rate for radiation synovectomy one year after treatment was 70% with a significant improvement in the variables VAS pain, functional disability and joint tenderness and swelling, when compared to baseline values (p 50% of cases. Wrists and shoulders were the joints with highest success rate of treatment, followed by the elbows. Lowest success rates were found for hips and ankles. In RA treatment was effective in 76% of cases whereas patients with OA exhibited a success rate of 50%. In RA all treated joints, except the ankles, exhibited a success rate of > or = 75%. No short-term clinical adverse side effects were noted. Conclusion Radiation synovectomy seems to be a successful treatment for persistent arthritis when other therapeutic modalities have failed.

/pdf/the-effect-of-radiation-synovectomy-in-patients-with-24vdpdjbos.pdf

The effect of radiation synovectomy in patients with persistent arthritis: a prospective study.

To compare the clinical efficacy of radiosynoviorthesis (RSO) with intra-articular radionuclide plus glucocorticoid (GC) injection (group A) with that of placebo plus GC injection (group B) for the treatment of persistent synovitis in joints of the upper extremity. At baseline and at 6 and 12 months after intra-articular injection, six clinical parameters were scored. Changes in clinical values over time were summed to provide a change composite index (CCI), ranging from 0 (no effect) to 12 (maximal effect). A CCI ≥6 was considered to indicate successful treatment. Differences in response rate and CCI between groups A and B were examined. Regression analyses were performed to explore whether baseline variables could predict therapeutic effect. Sixty-eight joints in 44 patients were treated. Six months after intra-articular injection, response rates (CCI ≥6) were 69% (25/36) in group A and 29% (9/31) in group B (p=0.001). The mean CCIs ± standard deviation at 6 months were 6.7±3.2 for group A and 3.3±3.8 for group B (p=0.001). At 12 months the response rates were 69% (25/36) in group A and 32% (8/25) in group B (p=0.004). The mean CCIs at 12 months were 6.8±3.3 for group A and 4.2±4.7 for group B (p= 0.046). None of the baseline variables predicted the therapeutic effect. RSO (radionuclide plus GC) of upper extremity joints with immobilisation for 72 h shows a significantly better response rate than placebo plus GC in patients with persistent synovitis after at least one failed outpatient intra-articular GC injection.

Clinical effect of radiation synovectomy of the upper extremity joints: a randomised, double-blind, placebo-controlled study

Radiation synovectomy of the upper extremity joints: does leakage from the joint to non-target organs impair its therapeutic effect?

Seventy per cent of the included studies were of Yttrium; others were of Erbium and/or Rhenium. Most studies were in patients with rheumatoid arthritis. Other joint diseases included psoriatic arthritis, haemophilic haemarthrosis, osteoarthritis, inflammatory arthritis, pigmented villonodular synovitis and pyrophosphate arthropathy. Affected joints included shoulder, elbow, wrist, finger, knee, hip, ankle and metatarsophalangeal joints. Comparators, where applicable, included saline, triamcinolone, methylprednisolone, saline and prednisolone, osmic acid, cortivazol, surgical synovectomy, non-radioactive Yttrium, Dysprosium, placebo and glucocorticoid injection. The outcome of interest appeared to be the success percentage at six months and at 12 months; success was not defined by the authors.

Radiation synovectomy with yttrium-90, rhenium-186 and erbium-169: a systematic literature review with meta-analyses

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