The clinical characteristics of rai refractory differentiated thyriod cancer SUMMARY Objectives: to determine clinical characteristics of RAI refractory differentiated thyroid carcinoma patients. Material and method s: 30 post-surgical and treated with I-131 differentiated thyroid carcinoma patients, diagnosed RAI refractory were enrolled in the study in 108 Military Centre Hospital from January 2017 to Jun 2017. Results : RAI refractory differentiated thyroid carcinoma has more frequently seen in middle aged, female patients (female to male ratio 3.2/1). Papillary and folicullar carcinoma represents 86.7% and 6.7% respectively. 40% of patients were in stage I and 53.4% in stage VI (AJCC7). The distant metastases were detected in 13.3% of patients. The median of time from initial diagnosis to RAI refractory were 21.5 months. I-131 treatment courses were 2.47 ± 1.13. The mean total dose was 301,8 mCi. 70% of the patients were in group I; 10% in group II and the rate of group III and IV were 6.7 and 13.3% respectively according to the ATA RAI refractory classification of DTC. 80% of patients had one RAI refractory lesion; 76.8% had metastasis in the neck lymph nodes and 16.7% had recurrent malignant lesions in the thyroid bed. Keywords : differentiated thyroid carcinoma, RAI refractory differentiated thyroid carcinoma.

Report of several cases of treatment of calcific tendonitis by aspiration under ultrasound guidance SUMMARY Calcific tendonitis is a common disease caused by the deposition of canxi hydroxyapatite crystals in the tendons. The disease can occur in all tendons in the body and also in the ligaments, but the most common sites are the tendons of rotator cuffs , tendons around great trochanter, tendons around elbow joints, wrists... Normally, there is no pain. However, as calcification resorption occurs because the body releases enzymes that resolve calcification, patients develop severe and persistent pain. In terms of diagnosis, clinical symptoms are quite difficult to distinguish from other causes of musculoskeletal pain, but diagnostic imaging is easy with methods such as radiography, ultrasound, computer tomography, resonance imaging... On the treatment side, medical therapy is the first-line treatment with nonsteroidal anti-inflammatory painkillers. However, in fact, we found that there are many cases of persistant pain that resistant to NSAIDS drugs, because the calcific deposits are quite large (size up to 1-2 cm) so that the calcification resorption process persists for a long time. Percutaneous aspiration of calcification under ultrasound guidance is a minimally invasive treatment that reduces the progression of the disease due to nearly completely calcific aspiration. This technique is quite easy to implement and can be widely disseminated. We have also performed this technique for some patients diagnosed with calcific tendonitis at Hanoi Medical University Hospital and had achieve good clinical efficacy.

Initial effectiveness of radiofrequency ablation of the autonomously functioning thyroid nodules SUMMARY Objective: Some patients with autonomously functioning thyroid nodules (AFTN) are not suitable for surgery or radioiodine therapy. Therefore, minimally invasive alternative treatments, such as ethanol ablation or radiofrequency ablation (RFA), are necessary. Methods: This study included seven patients (7 toxic and 10 pretoxic patients; male to female ratio = 1:7.5; mean age, 46.47 ± 13 (range, 22–66) years) who were not eligible for surgery or radioiodine therapy. All of the patients showed hot nodule with suppression of normal thyroid gland in 99mTc pertechnetate scintigraphy. RFA was performed using a 18 gauge internally cooled electrode. Nodule volume, thyroid function, scintigraphy, symptom score (visual analogue scale, 0–10cm), cosmetic grading score (4 point scale), and complications were evaluated before treatment and at 1, 3, 6 months follow-up. Results: Mean volume of the index nodule was 13.07 ± 8.44 (range, 2.2–35.5) mL. After RFA, The volume reduction at 1month, 3 months, 6 months follow up was 42.77 % , 63. % và 78.3 % . Initial mean T3, FT4, and TSH were 2.59 ± 1.19nmol/L, 16.3 ± 5.78pmol/L, and 0.101 ± 0.178 mU/mL, respectively. A significant improvement of mean T3, FT4, and TSH were observed after 1month (T3: 2.18 ± 0.753 nmol/L, p = 0.001; FT4: 14.78 ± 2.86 pmol/L, p = 0.026; TSH: 1.464 ± 0.844 mU/mL, p = 0.001), after 6 months (T3: 2.07 ± 0.614 nmol/L, p = 0.012; FT4: 15.12 ± 2.0 pmol/L, p = 0.001; TSH: 1.269 ± 0.398 mU/ mL, p < 0.001). After ablation, 16 patients became a cold or normal scan and one patient uptake similar normal thyroid tissue. After 6 months, the mean symptom was reduced from 3.47 ± 1.9 to 0.12± 3.32 (p = 0.001) and cosmetic grading score was reduced from từ 3.59 ± 1.1 tới 1.41± 0.712 (p = 0.712) (p <0.001). No major complications were encountered. Conclusions: RFA was effective and safe for treating autonomously functioning benign thyroid nodules and it might be recommended for treating hot benign thyroid nodules as the first-line treatment

T he results of Y90 radioembolization in treatment of hepatocellular carcinoma SUMMARY Background : Hepatocellular carcinoma (HCC) is aggressive primary malignancy of the liver that most commonly presents late in the disease course. As a result, the majority of patients are not candidates for curative therapies. Locoregional therapies including Yttrium-90 (Y-90) radioembolization play an important role in management of the vast majority of patients with HCC. Methods : Patients with unnresectable HCC (n=41) treated with Y-90 radioembolization from 2013 to 2016 were evaluated retrospectively. Data was abstracted from medical records including patient charts, laboratory data, and imaging. Results : The most common clinical toxicity among all patients was fatigue (58.5%). A clinical benefit, defined as patients achieving PR was seen in 95.13% of cases; was seen complete reponse (CR) in 4.87%. The mean overall survival from the time of diagnosis was 18.4 months. Conclutions : For patients with HCC, Y-90 radioembolization is a safe and well-tolerated procedure. Our experience suggests that a significant percentage of patients achieve clinical benefit including many with PR. Prospective, randomized data is required to compare radioembolization with other therapies including chemoembolization and systemic therapy with sorafenib. Keywords : Radioembolization, Yttrium-90 microspheres, SIR-spheres, Hepatocellular carcinoma, Transarterial radioembolization, SIRT.

Absent left main coronary artery on MDCT 256 Slices: a case report and literature review SUMMARY Absent left main coronary artery is rare congenital cardiacvascular anomalous. Absent LMCA has been detected by digital substration angiography (DSA) or operating. Nowadays,multi detector computer tomography (MDCT) can be easily findingand non - invasive procedure. We report a 80 - year – old male was admitted to our hospital with atypical chest pain. An MDCT 256 slices showedseparate origin of left anterior descending (LAD) and left circumflex artery (LCx) from left sinus of Valsalva, absent LMCA. Keywords : Absent left main coronary artery, anomalus congenital cardiacvascular, multi detector computer tomography (MDCT).

SUMMARY Background: Transvenous coil embolization via inferior petrous sinus (IPS) is a curative and safe method to manage cavernous sinus dural arteriovenous fistulas (CSDAVFs). However, this access will be challenging in case of CSDAVFs associated with angiographic occlusive IPS. Purpose: To report our primary results and experience of transvenous embolization of the CSDAVFs by recanalisation of angiographic occlusive IPS. Methods: Retrospective study of the cases of 12 patients (1 man and 11 women, ranging from 38 years to 79 years of age (mean, 62 years)) who underwent transvenous embolization by recanalisation of angiographic occlusive IPS over a 18 month period. The angioarchitecture of the CSDAVFs, the angiographic as well as the clinical outcomes after embolization and the periprocedural complications were analyzed. Results: True occlusive IPS was found in 12 of the patients. The microcatheter was successfully navigated to the fistula site of the CS in 10 patients (83,3%), while such navigation failed in 2 patients following numerous attempts.The rate of complete occlusion of CSDAVFs was 75%. One case with fatal complication due to MCA occlusion. Conclusion: Angiographic occlusive IPS of CSDAVF may be related to true occlusion of IPS. Transvenous embolization via recanalisation of angiographic occlusive IPS is a safe and effective method to manage CSDAVFs.

The treatment results of differentiated thyroid carcinoma post-thyroidectomy with 131I at Thai Nguyen oncology centre SUMMARY Objectives: 1.To evaluate treatment results of differentiated thyroid carcinoma patients post-thyroidectomy with 131I. 2. To study some factors related to treatment results. Materials and method: A descriptive study was conducted on 87 diffentiated thyroid carcinoma patients treated at Thai Nguyen oncology centre from 2011 to 2018. Results : Medial age of patients was 47.3 ± 12.7, female : male = 4.8 : 1. 67 % were papilliary thyroid carcinoma, 63.2 % had no metastases, 32.2 % had cervical nodal metastases, 4.6 % had distant metastases. 95.4 % of patients were in stage I, II, III. Post-operative thyroid remnants were 3.52 ± 1.73 g. The rates of patients responding completely after 1, 2, 3 and over 3 doses of 131I were 60.9 %, 79.3 %, 87.4 % and 92 % respectively. Medial total treatment dose of 131I used was 112.5 ± 31.2 mCi, medial treatment times were 1.83 ± 0.3 times. In patients with no distant metastases, the thyroid remnant ablation of 131I with doses from 30 to 50 mCi was as well as with dose of 100 mCi. The treatment results in patients under 45 years were better than in patients over 45 years, in patients with no metastases and cervical nodal metastases were better than in patients with distant metastases, in patients in stage I, II and III were better than in patients in stage IV, in patients with thyroid remnants < 2 g were better than in patients with those ≥ 2 g, in patients with serum Tg < 10 ng/dL or serum TgAb < 100 IU/mL were better than in patients with those ≥ 10 ng/dL or ≥ 100 IU/mL respectively. Conclusion: The treatment effectiveness of 131I with low dose (30 – 50 mCi) was equivalent to high dose of 100 mCi in patients with no distant metastases. 60.9 % of patients had good results after only 1 dose of 131I. With medial dose of 112.5 ± 31.2 mCi of 131I, after 1.83 ± 0.3 treatment times, 92 % patients was responded completely\. Patients were younger than 45 years, patients with no distant metastases, in earlier stages of cancer, with less thyroid remnants, with lower levels of serum Tg or serum TgAb responded better than to the treatment. Keywords : Differentiated Thyroid Carcinoma (DTC), 131I, Thyroglobulin (Tg), Anti Thyroglobulin (TgAb), Whole Body Scan (WBS).