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Recombinant human thyrotropin (rhTSH) injections do not stimulate RAI uptake sufficiently to prepare patients with stage II IV cancer for 131I ablative therapy of thyroid cancer Also, patients receiving thyrotropin injections are euthyroid and have a high renal clearance of RAI, reducing the effectiveness of 131I therapy However, many centers are using rhTSH to stimulate 131I uptake for thyroid remnant ablation in patients with stage I cancer Such patients can also have T4 withdrawn for 1 week before the rhTSH and 131I therapy to allow endogenous TSH levels to rise and provide additional stimulation of RAI uptake Thyrotropin stimulation is also useful for patients with functional metastases whose serum TSH is always suppressed Patients must follow a low-iodine diet for 2 weeks before 131 I therapy Just before therapy, serum is obtained for measurement of TSH (to make certain it is > 30 mcU/mL), thyroglobulin, and hCG (in all reproductive-age women) Pregnant women may not receive RAI therapy Women are advised to avoid pregnancy for at least 4 months following 131I therapy Men have been found to have abnormal spermatozoa for up to 6 months following 131I therapy and are advised to use contraceptive methods during that time Sodium 131I, 30 50 mCi (1110 1850 MBq), is administered orally to patients with an original papillary or follicular carcinoma 15 cm in diameter and also to patients having persistent RAI uptake in the thyroid bed following near-total thyroidectomy Patients with extrathyroidal uptake from metastatic disease are given larger doses of about 125 150 mCi (5550 MBq) 131I orally in the hospital A posttherapy whole-body scan performed 1 week after 131I treatment will often detect metastases that were not visible on pretreatment scans Four days following 131I therapy, Cytomel is resumed at a dose of 25 mcg orally twice daily for 1 week, reduced to 125 mcg twice daily for the next week At the same time, T4 is resumed and continued at a full thyroid replacement dose About 35% of patients with metastatic differentiated thyroid carcinoma have poor uptake of RAI into metastases Lithium inhibits the release of 131I from differentiated thyroid cancer and may increase the absorbed radiation dose; however, prospective treatment trials are lacking 131 I therapy in doses over 100 mCi (3799 MBq) can cause gastritis, temporary oligospermia, sialadenitis, and xerostomia RAI therapy can cause neurologic decompensation in patients with brain metastases; it is advisable to treat such patients with prednisone 30 40 mg orally daily for several days before and after 131I therapy Cumulative doses of 131I over 500 mCi can cause infertility, pancytopenia (4%), and leukemia (03%) The kidneys excrete RAI To reduce the risk of radiation-induced side effects, patients receiving dialysis for renal failure require a dosage reduction to only 20% of the usual dose of 131I.

As account determination follows the condition technique, it is understandable there may be a need to change the condition table that is used in the access sequence to find the correct condition record (that is, the correct account number) This is possible by defining dependencies of revenue account determination

Pain along the course of a nerve followed by grouped vesicular lesions (Plate 11) Involvement is unilateral; some lesions (< 20) may occur outside the affected dermatome Lesions are usually on face or trunk Direct fluorescent antibody positive, especially in vesicular lesions

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Herpes zoster is an acute vesicular eruption due to the varicella-zoster virus It usually occurs in adults With rare exceptions, patients suffer only one attack Dermatomal herpes zoster does not imply the presence of a visceral malignancy Generalized disease, however, raises the suspicion of an associated immunosuppressive disorder such as Hodgkin s disease or HIV infection HIV-infected patients are 20 times more likely to develop zoster, often before other clinical findings of HIV disease are present A history of HIV risk factors and HIV testing when appropriate should be considered, especially in patients with zoster who are younger than 55 years

Pain usually precedes the eruption by 48 hours or more and may persist and actually increase in intensity after the lesions have disappeared The lesions consist of grouped, tense, deepseated vesicles distributed unilaterally along a dermatome The most common distributions are on the trunk or face Up to 20 lesions may be found outside the affected dermatomes Regional lymph glands may be tender and swollen

In general, topical therapy is not effective It is strongly urged that 5% acyclovir ointment, if used at all, be limited to the restricted indications for which it has been approved, ie, initial herpes genitalis and mucocutaneous herpes simplex infections in immunocompromised patients Penciclovir cream, to be applied at the first symptom every 2 hours while awake for 4 days for recurrent orolabial herpes, reduces the average attack duration from 5 days to 45 days

Since poison oak and poison ivy dermatitis can occur unilaterally, they must be differentiated at times from herpes zoster Allergic contact dermatitis is pruritic; zoster is painful One must differentiate herpes zoster from lesions of herpes simplex, which occasionally occurs in a

and are healed or almost healed (up to 2 weeks) Because corticosteroids increase the risk of dissemination, they should not be given adjunctively in immunosuppressed patients Progression of disease may necessitate intravenous therapy with acyclovir, 10 mg/kg intravenously, three times daily After 3 4 days, oral therapy may be substituted if there has been a good response to intravenous therapy Adverse effects include decreased renal function from crystallization, nausea and vomiting, and abdominal pain Foscarnet, administered in a dosage of 40 mg/kg two or three times daily intravenously, is indicated for treatment of acyclovir-resistant varicella-zoster virus infections

dermatomal distribution Doses of antivirals appropriate for zoster should be used in the absence of a clear diagnosis Facial zoster may simulate erysipelas initially, but zoster is unilateral and shows vesicles after 24 48 hours The pain of preeruptive herpes zoster may lead the clinician to diagnose migraine, myocardial infarction, acute abdomen, herniated disc, etc, depending on the dermatome involved

Functions | Account Assignment/Costing | Revenue Account Determination | Define Dependencies of Revenue Account Determination Here you can create or change a condition table However, you must be careful as there are not many fields to select from in order to create this condition table Please refer back to pricing and condition tables in this chapter for more information on creating and changing condition tables After ensuring your condition tables exist as required, you need to ensure the access sequence and condition types are maintained as required too

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