[Iodine-induced crisis in thyroid autonomy: a surgical emergency].
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Amiodarone↗
Biomedical subjects
A Frilling
Publications and source records attributed to A Frilling.
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↗
[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↗
[Intrathoracic struma].
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Goiter, Substernal↗
[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↗
Thyroid-stimulating antibodies of Graves' disease in thyroid cancer.
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Autoantibodies↗
[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↗
[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↗
[Cold struma nodule--an absolute surgical indication?].
From 1969 to 1984 3,972 operations of the thyroid gland were performed. 3,540 scintigraphic findings were evaluated retrospectively. In 2,013 (57%) cases one or more so-called cold thyroid nodules were found. The malignancy rate in these nodules was 5.6%. The fine needle biopsy and cytology gave in 17.9% false-negative results. Based on a malignancy rate of 5.6%, rather high false-negative results of fine needle biopsy and acceptable postoperative complication rate we estimate strict operative indication.
Biopsy, Needle↗
[Reoperation following correction of partial defects of the endocardial cushion (indication, incidence, results)].
In the period between 1955 and 1982, 297 patients underwent surgical correction of a partial AV-canal. Closure of the ostium primum defect was performed either by direct suture or by patch (prosthetic material or pericardium). Only in cases with severe mitral incompetence was the cleft in the anterior leaflet of the mitral valve surgically treated. At an average of 6 years (range: 3 months - 22 years) after the initial procedure 21 patients (7.8 per cent) underwent reoperation. In 20 patients reoperation was necessary for hemodynamic reasons (recurrence of ASD: n = 8; severe AV-valve regurgitation: n = 3; or both: n = 9). One patient with moderate mitral valve incompetence suffered from severe "patch-hemolysis" due to direction of the blood-jet towards the prosthetic patch. Residual or recurrent atrial septal defects were closed by using a patch in cases with previous direct suture (39 patients - 8 reoperations) or by reinsertion or enlargement of the present patch (258 patients - 13 reoperations). AV-valve incompetence could be treated in all cases but two with reconstructive methods. In two patients implantation of a prosthetic valve was necessary. In the single case with "patch-hemolysis" the previous prosthetic patch was replaced by a pericardial one, together with a suture of the mitral cleft 3 months after operation. Mortality of reoperation was 14.5 per cent (3 early deaths). Major complications in the surviving patients did not occur, with one exception: one patient with postoperative total AV-block received a permanent pacemaker.
Adolescent↗
Presymptomatic screening for medullary thyroid carcinoma in patients with multiple endocrine neoplasia type 2A.
Presymptomatic screening of medullary thyroid carcinoma in MEN IIA families enables the early diagnosis of this tumor with its significant morbidity. Biochemical screening consists of basal and stimulated serum calcitonin evaluation. Genetic screening is based on DNA analysis using linked DNA markers. Thyroidectomy at an occult tumor stage may be curative. Calcitonin measurement was carried out in 58 apparently unaffected family members at risk and 11 MEN IIA patients. Calcitonin elevation was detected in nine individuals. All nine underwent thyroidectomy. Histologic examination confirmed medullary thyroid carcinoma in eight patients and in one case C cell hyperplasia. Postoperatively, eight patients (89%) are clinically and biochemically tumor-free (mean follow-up 30 months). DNA screening results in one affected family are presented. DNA analysis allowed recognition of one apparently unaffected individual at risk as a MEN IIA gene carrier. One family member at risk was found not to carry the gene and may be excluded from further screening.
Adolescent↗
The influence of surgery on endocrine ophthalmopathy.
Since the pathogenesis of endocrine ophthalmopathy is unclear, there has been little agreement on the treatment of the disease. The influence of thyroid surgery on endocrine ophthalmopathy is controversial. To evaluate the effect of thyroid surgery on the course of the disease, we developed a special ophthalmopathy index. As a standard procedure, subtotal thyroidectomy with thyroid remnants of 3-5 g was performed. A total of 176 patients with Graves' disease underwent the above treatment between 1986 and 1988. In 78 patients suffering from concomitant endocrine ophthalmopathy, ocular status was examined prior to operation and postoperatively. The history of endocrine ophthalmopathy had been present less than 2 years preoperatively in 74% of the patients. Follow-up ranged from 6 to 36 months. Postoperatively, 54 (69%) patients showed a marked improvement of their eye symptoms. In 18 (23%), there was no change and, in 6 (8%) patients, the severity of the eye symptoms increased after the operation. As a result of these data, a cautious and preliminary conclusion may be justified--that subtotal thyroidectomy may have a positive effect on endocrine ophthalmopathy.
Adult↗