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Biomedical subjects

A Frilling

Publications and source records attributed to A Frilling.

At least 19 recordsLinked to original sources
PubMed1992

Are CAT-scans necessary for preoperative localization of insulinomas?

OBJECTIVES: Do CAT-scans provide useful information in terms of preoperative localization of insulinomas after a biochemical diagnosis is established or may CAT-scan imaging be safely abandoned? PATIENTS AND METHODS: CAT-scan results from 30 consecutive patients between 1980-1990 with established insulinomas were retrospectively evaluated with regard to actual tumour size (volume) and identification and localization as verified during surgery. RESULTS: In all patients, the tumours were easily detected by manual palpation during surgery, although the size of 67% of the tumours (n = 20) was less than 2.5 cm3. In only 7 patients (23%) the tumour had been correctly localized by computer tomography. Detected tumours were significantly larger than undetected tumours (median size 5.3 vs 1.3 cm3; p < 0.005). CONCLUSION: Despite the low sensitivity of computer tomography as documented in this study, all patients with an insulinoma were definitely cured after surgical intervention. Thus, CAT-scans are neither necessary nor helpful for preoperative localization of insulinomas.

Adult↗
PubMed1992

Unusual features of multiple endocrine neoplasia.

In addition to the common presentations of the multiple endocrine neoplasia (MEN) syndromes, unusual organ involvement as rare manifestations of a single disease may occur. Among our patients we have identified four cases in which unusual features of MEN were present. In the first patient, bilateral adrenal cortical adenoma, parathyroid adenoma, multiple pancreatic tumors, and follicular thyroid carcinoma were observed. The second patient suffered from thymic carcinoid, parathyroid hyperplasia, gastrinoma, and pituitary adenoma. Additionally, one family was discovered in which medullary thyroid carcinoma (MTC), Hirschsprung's disease, and pheochromocytoma occurred and another family had MTC and ovarian cancer. Based on these observations, we stress the importance of screening for MEN syndromes in all patients with pathologic findings in any endocrine organ.

Adolescent↗
PubMed1990

[Subtotal thyroid gland resection as therapy for thyrotoxic crises].

Thyrotoxic crises occurred in six patients (four women aged 51, 63, 72 and 76 years; two men aged 52 and 63 years). In four patients the crisis was triggered by a contrast medium containing iodine, and in one by amiodarone. The cause of the crisis in the 51-year-old woman remained uncertain. After a latent period of up to two months, T3 and T4 concentrations rose in all the patients, and abnormal findings such as tachycardia, increased blood pressure, dehydration, tremor, restlessness, hallucinations and coma ensued. Because of ineffective conservative treatment, five patients underwent subtotal thyroidectomy. In all five the symptoms and signs of hyperthyroidism were promptly relieved, and the postoperative course was uneventful. The 76-year-old woman was considered unfit for surgery because of her cardiac condition, and she died of left ventricular failure resistant to therapy.

Aged↗
PubMed1990

[A registry of medullary thyroid cancer in West Germany].

A register for medullary thyroid carcinoma (MTC) in FRG has been set up by the "German Medullary Thyroid Carcinoma Study Group" in 1988. The aim is to provide a basis for collaborative work on MTC especially in the hereditary forms (i.e. multiple endocrine neoplasia [MEN] type IIa, IIb). For these hereditary varieties reliable screening tests exist and, if the disease is detected by family screening in an early stage, curative surgery is possible. Until now 408 patients (234 female, 174 male) with MTC have been reported by 17 cooperative centers. The mean age at diagnosis was 45.5 years. 25% (n = 104) are hereditary forms, most of them MEN IIa (n = 86), 13 are MEN IIb and 18 belong to the familial variety without other endocrinopathy. The mean age at diagnosis for MEN IIa was 36.5 years, MEN IIb 26.9 and for the pure familial form 27.5 years. As 33 patients per year have been diagnosed since 1982, nearly 25% of all expected cases of MTC in FRG have been registered.

Adult↗
PubMed1990

Growth regulation of normal thyroids and thyroid tumors in man.

Our studies using thyrocyte membranes from different human thyroid tissues, monolayer cultures of human thyrocytes, and the permanant cell line FTC-133 demonstrate the stimulatory effect of TSH on metabolism, DNA synthesis, and cell growth in human thyrocytes. Up- and down-regulation of cAMP cell content fails to show direct effects on DNA synthesis and cell growth in primary thyrocyte cultures in man. Increased AC responsiveness to TSH in adenomatous human thyroid tissues, when compared to normal thyroids of the same patient (p less than 0.005), is thus of only questionable importance for thyroid tumor growth. The permanant cell line FTC-133 was established from differentiated follicular human thyroid cancer cells. FTC-133 cells proved to be of particular usefulness in assessing growth regulation of human thyroid tissue. These cells could be propagated in serum free medium, showed thyroglobulin immunoreactivity and EGF receptors, lacked any fibroblast contamination, and responded to TSH and local active growth factors such as EGF and IGF with a stimulated [3H]thymidine incorporation. The latter could be shown in primary cell cultures of normal and pathological human thyrocytes as well. Additional to the stimulatory effect of TSH and IGF on [3H]thymidine incorporation, these substances show an additive effect when incubated simultaneously. Locally active growth factors and endocrine growth stimulation by TSH therefore act synergistically on thyrocyte growth in human thyrocyte cultures. Whether the TSH effect on cell growth is related to its stimulation of AC remains as yet questionable.

Adenylyl Cyclases↗
PubMed1990

[Progress in the diagnosis and therapy of C cell carcinoma of the thyroid gland].

Between 1986 and 1989 172 patients were operated on thyroid cancer. Twenty-nine (17%) of them had a medullary carcinoma. In 20 of these patients (69%) the carcinoma occurred in a sporadic and in 9 (31%) patients in a familial form. Eighteen patients (62%) had to be operated because of tumor recurrence and in 4 of them additional surgery was necessary because of distant metastases. Due to tumor recurrence 7 patients underwent multiple operations during the above period. Adequate first operation was performed only in 6 patients (33%). Based on family screening a carcinoma was diagnosed in 4 patients in its occult stage. Diagnostic methods include biochemical and imaging methods. Calcitonin is the most sensitive tumor marker. Basal and stimulated serum calcitonin analysis provides a very efficient method to detect medullary carcinoma in early tumor stage and to treat the disease curatively. DNA-analysis improves early diagnosis of persons at risk.

Adenocarcinoma↗
PubMed1990

[Therapeutic strategy and prognosis of malignant struma].

The systematic application of combined treatment modalities including surgery, radiotherapy and suppressive hormone administration is based on a biologically relevant histomorphologic tumour classification. Although the principle of an aggressive therapeutic approach is still valid meantime a limited radicality has proven equally successful for selected early cases. On the other hand an even extended radical strategy is followed by repeated surgery for local recurrencies and metastatic lesions.

Combined Modality Therapy↗
PubMed1989

The importance of screening for medullary thyroid carcinoma in families of patients with MEN 2.

Family screening for medullary thyroid cancer (MTC) is important for detecting members of multiple endocrine neoplasia type 2 (MEN 2) families who may be gene carriers but show no clinical evidence of the disease. Most members of our MEN 2 families are screened yearly by measuring basal and pentagastrin-stimulated calcitonin (CT) levels. A 15-year-old first-degree relative of an affected member of the D-kindred showed a normal basal and an elevated stimulated CT level. Clinical examination, ultrasonography, and scintigraphy were normal. Thyroidectomy and bilateral neck dissection revealed a multicentric MTC with no lymph node involvement. In the O-kindred we detected elevated basal and/or stimulated CT levels in three asymptomatic first-degree relatives. At surgery we found a small multicentric MTC in one family member, C-cell hyperplasia in another member, and bilateral lymph node metastases in one member who had been previously thyroidectomized. Basal and stimulated CT estimations in MEN 2 family members provide an effective method for detecting MTC in early, treatable stages.

Adolescent↗
PubMed1989

[Indications for and basic principles of the surgical treatment of thyroid diseases].

Surgical treatment is indicated for patients with nodular goiter if malignancy seems possible, if there are mechanical reasons, or on request from the patient. In patients with goiter and hyperthyroidism, surgery and radioiodine are alternatives. In contrast, thyroid autonomy always requires surgery. The treatment of patients suffering from differentiated thyroid cancer includes thyroidectomy and radioiodine, and in those with anaplastic thyroid cancer external radiation and surgery should be performed. Apart from the classic indications and surgical procedures, in recent years selective resection of multinodular goiter, more conservative surgery of small papillary thyroid cancer and surgical treatment of iodine-induced thyrotoxicosis have become established.

Humans↗
PubMed1989

[Various strategies in the diagnosis and therapy of thyroid gland cancer. Results of a survey].

In a questionnaire we compared generally adviced therapeutical and technical procedures in patients with thyroid carcinomas with the actually favorized strategy of the clinically active surgeons. At present, sonography and cytology are not favored as preoperative diagnostic tools by the questioned surgeons. Hemithyreoidectomy as primary procedure in suspicious nodules is performed only seldomly. In the treatment of thyroid carcinoma total thyroidectomy is the accepted procedure and the possibility of restricted radicality in the treatment of papillary thyroid carcinomas has gained wide acknowledgement. Most surgeons prefer to visualize the recurrent nerve and at least one or two parathyroid glands. Autotransplantation of parathyroid glands with insufficient blood supply is considered only seldomly.

Adenocarcinoma↗
PubMed1988

[Persistent postoperative hyperthyroidism--a surgical problem].

The rate of persistent or recurrent hyperthyroidism after surgical treatment of Graves' disease correlates with the size of a thyroid remnant. Reoperation should be viewed as a last resort because of a high complication rate. A subtotal thyroidectomy with a thyroid remnant of 5 to 8 g is recommended.

Graves Disease↗
PubMed1986

[Primary retroperitoneal tumors].

73 patients, 41 males and 32 females, were treated for primary retroperitoneal tumours between 1974 and 1984. Mean age of the patients was 45.9 years (range: 1 day-79 years). Early symptoms of the tumours were atypical. Initial diagnosis showed a palpable abdominal tumour in 47 patients. Computed tomography is the most important radiologic tool for the diagnosis. In 32 patients the tumour could be removed completely. Intraoperatively, at least one additional organ had to be removed in all patients to ensure radicality of extirpation. Histology showed most tumours to be lymphomas or sarcomas. At the time of diagnosis, 21 patients were found to have metastases. Operative mortality rate was 11%. The overall prognosis in patients with primary retroperitoneal tumours is poor; the 5-year survival rate for malignant tumors was 9%. Combination of radio- and chemotherapy has somewhat improved this dim prognosis in recent years.

Adolescent↗