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Biomedical subjects

C Reiners

Publications and source records attributed to C Reiners.

At least 127 records · Page 7Linked to original sources
PubMed1993

[Nuclear medicine pain therapy in osseous metastases of prostate cancer].

In patients with advanced prostate cancer, adequate palliation of pain from skeletal metastases is of primary importance. Radionuclide therapy offers an effective treatment with few side effects or risks after the primary therapeutic modalities, i.e. androgen deprivation, chemotherapy, and percutaneous radiation therapy, are exhausted. This review discusses the potential and limitations of radionuclide therapy and provides recommendations for patient selection and practical implementation of radionuclide therapy.

Bone Marrow↗
PubMed1993

[Experience with presymptomatic screening of patients with C cell carcinoma of the thyroid gland].

Presymptomatic screening of medullary thyroid carcinoma in MEN 2A families enables the early diagnosis of this tumor burdened by 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 provide curative treatment. Calcitonin measurement was carried out in 58 apparently unaffected family members at risk of 11 MEN 2A patients. In 9 individuals calcitonin elevation was detected. All 9 underwent thyroidectomy. Histological examination confirmed medullary thyroid carcinoma in 8 patients and in 1 case C-cell-hyperplasia. Postoperatively 8 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 the recognition of one apparently unaffected individual at risk as MEN 2A gene carrier. One family member at risk was scored as not carrying the gene and may be excluded from further screening.

Adolescent↗
PubMed1993

[Treatment of endometriosis with the GnRH analog triptorelin with special reference to the effect on bone density].

27 patients of the department of gynecology and obstetrics of the university of Essen received a six month therapy with the GnRH-analogon triptorelin because of endometriosis diagnosed by laparoscopy. All the patients experienced not only a significant improvement in their subjective symptoms but also in their rAFS-score which was used to classify the severity of the endometriosis of our patients. We could also show that no patient experienced any severe side effects under the therapy and those side effects such as hot flushes or sweating, which appeared, were almost tolerated very well by the patients. None of the patients did leave the study because of the side effects. We were also able to demonstrate that under the therapy there was no significant loss of the bone density. The introduction of the GnRH-analogon triptorelin is therefore a major step forward in the effective therapy of patients suffering from endometriosis.

Adult↗
PubMed1993

[Radiation exposure in diagnostic nuclear medicine: risk comparisons on the basis of effective doses].

The hypothetical risk of medical radiation exposure is often extrapolated to large population groups using arbitrary assumptions. To assess risk and benefit of diagnostic nuclear medicine and roentgenology, estimation of individual loss of life expectancy should be preferred. Employing ICRP 60 figures, diagnostic medical radiation exposure yields effective doses which commonly lie below or within the range of annual exposure from natural radiation (1-6 mSv). On an average, the individual medical exposure in Germany is estimated to be between 1 and 2 mSv which--extrapolated to total lifespan--leads to a hypothetical loss of life expectancy of 20-40 days. In the light of the rapid increase of life expectancy due to progresses in medical diagnostics and treatment after the introduction of X-rays, this figure is negligibly small.

Diagnostic Techniques, Radioisotope↗
PubMed1993

[Topodiagnosis of Creutzfeldt-Jakob disease using HMPAO-SPECT].

An 80-year old female presented with early stage Creutzfeldt-Jakob disease with clinical, neurophysiological and neuropathological findings suggesting a focal involvement of the brain. HMPAO SPECT disclosed asymmetries of regional cerebral perfusion, thus suggesting that it may be a further diagnostic instrument in this disease.

Aged↗
PubMed1993

[Diagnosis of urine transport disorders. Diuresis renography].

Congenital urinary tract malformations are frequently the cause of urinary transport disturbances. However, not all the malformations or obstructions presenting sonographically as hydronephrosis have to be treated surgically. The Whitaker test, an invasive diagnostic procedure to establish the urodynamic relevance of an obstruction, does not provide a reliable estimate of prognosis; spontaneous cures in cases of obstruction have been reported. Diuresis renography offers several advantages as compared with the Whitaker test, for example a more physiological basis, less observer dependency, better reproducibility and--last but not least--non-invasiveness. However, diuresis renography has to be carried out according to a strictly standardized protocol. Sufficient hydration (20 mg/kg body weight) and bladder catheterization (to rule our reflectory transport disturbances) are mandatory. Today, 123I-OIH or 99mTc-MAG3 are the radiopharmaceuticals of choice; the activity for children has to be reduced in relation to body surface. To stimulate diuresis, furosemide (0.5-1 mg/kg of body weight) has to be given. For the evaluation of diuresis renography, sequential scintigrams as well as functional curves have to be used. It is strongly recommended that diuresis renography be combined with clearance determinations separately for the two kidneys. The interpretation of diuresis renography should not rely only on quantitative curve parameters but--above all--on visual analysis of the functional curves. However, in cases of proven obstruction, diuresis renography--like the Whitaker test--cannot accurately predict the prognosis in any individual case. If renal function is normal and there is no difference between the left and the right kidney, a wait-and-see attitude seems to be justified.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1992

[Congenital malformations of the urinary tract. Rational postpartum diagnosis].

More than one third of the anomalies diagnosed antenatally by ultrasound comprises the urinary tract. The criteria of the diagnostic and therapeutic approach, which resulted from our experience in children with symptomatic urinary tract anomalies cannot be necessarily applied to asymptomatic newborns. Not all urinary tract anomalies are obstructive and need surgical correction. Therefore, rational diagnostic approach after birth is necessary, which starts with ultrasonography. The first radiological diagnostic procedure is always a voiding cystourethrography in order to diagnose or exclude infravesical obstruction or a vesicoureteric reflux. The dynamic radionuclide nephrography (123I-Hippuran) under standardized conditions with adequate hydration and Furosemide-induced diuresis is able to detect a significant obstruction at the pelvi-ureteric or uretero-vesical junction. The intravenous urography is limited to specific questions and a computerized tomography is rarely indicated. In rare cases when dynamic investigations are equivocal, antegrade pressure flow studies according to Whitaker can be reliably exclude or prove obstruction.

Congenital Abnormalities↗
PubMed1991

[Frequency of thyroid gland carcinoma in hyperthyroidism].

From 1980 to 1989, 226 patients (199 females, 27 males, median age 41 [18-76] years) underwent surgery because of clinical hyperthyroidism. 152 patients had autoimmune thyrotoxicosis, and 74 functional autonomy. Histological examination of resected thyroid tissue revealed carcinoma in 6 cases (2.6%): 3 (2%) in autoimmune hyperthyroidism, and 3 (4%) in functional autonomy. Five tumours fulfilled the criteria for occult papillary thyroid carcinoma (highly differentiated, less than 1.5 cm diameter). One woman had both a multilocular papillary carcinoma and a medullary carcinoma without proven metastases. In none of the cases was a malignant tumour suspected preoperatively from sonography or scintigraphy studies. In the patients with occult carcinomas, extended bilateral subtotal resection was regarded as curative. In the patient with papillary and medullary carcinoma, remaining thyroid therapy was given. One patient with Basedow's (Graves') disease and a papillary carcinoma of diameter 1.3 cm received radioiodine at her own request. She and the four remaining patients received suppression therapy (150-200 micrograms L-thyroxine daily), with frequent follow-up. During follow-up for a mean period of 24 months (range 6-51 months) there were no metastases or tumour recurrences.

Adult↗
PubMed1991

Radioiodine treatment of Basedow's disease: interference and influence factors, risk estimation.

I-131 treatment of Basedow's disease is effective and safe. Relatively high energy doses to the thyroid in the range of 150-200 Gray are needed in endemic goiter areas, where immunogenic hyperthyroidism may coincide with functional autonomy. Induction of euthyroidism by low doses of antithyroid drugs (methimazole, carbimazole) before I-131 treatment prevents complications and has no significant influence on outcome of I-131 therapy. As compared to alternative therapeutic modalities, the risks of I-131 are low.

Dose-Response Relationship, Radiation↗
PubMed1990

Survival rates in patients with differentiated thyroid carcinoma. Influence of postoperative external radiotherapy.

Nine hundred thirty-two patients with papillary and follicular thyroid carcinomas were seen at the Departments of Medicine, Surgery, and Radiology of the University of Essen, Essen, Germany, between 1970 and 1986. In addition to standard treatment by surgery, radioactive iodine and medical thyroid stimulating hormone (TSH) suppression, 346 patients had received conventional external irradiation to the neck (mostly 40-60 Gy) before referral to our institutions, whereas 586 patients had not received radiotherapy. From the follow-up data of these patients, survival rates were calculated separately for tumor Stages T1 (n = 203), T2 (n = 552), and T3/T4 (n = 277) using life-table analysis. Distribution of risk factors (histologic type of tumor, grading of malignancy, presence of distant metastases, age and sex) was similar in all groups with the one exception, that the radiotherapy patients with Stage T3/T4 were older. There was no significant difference in the life expectancy of irradiated and not irradiated patients by Breslow and Mantel-Cox tests. In Stages T1, T2, and T3/T4, 75% of the radiotherapy patients survived for 10.6 +/- 0.32, 11.5 +/- 0.61, and 6.71 +/- 0.85 years, respectively; the figures for the nonirradiated patients were 9.4 +/- 0.17, 10.8 +/- 0.37, and 6.26 +/- 0.51 years, respectively. When survival rates were calculated separately for patients with Stage T3/T4 older and younger than 40 years, there was no obvious effect of radiotherapy in the younger group, whereas in the older patients, improvement of survival by radiation just failed to reach statistical significance (P less than 0.09). In conclusion, this retrospective analysis failed to prove that survival is prolonged in patients with differentiated carcinoma by administration of conventional external radiotherapy after surgery. A benefit to older patients with locally advanced tumors has still to be demonstrated.

Adenocarcinoma↗
PubMed1990

Incidence of hypothyroidism after irradiation of the neck with special reference to lymphoma patients. A retrospective and prospective analysis.

Twenty-eight patients were studied prospectively in order to determine the incidence of hypothyroidism after mantle irradiation for malignant lymphoma. This group was compared with a historical group of 65 patients, among them 36 patients with malignant lymphoma. The mean follow-up was 30 months for the prospective group and 46 months for the retrospective group. The mean thyroid dose for irradiated malignant lymphomas in the prospective and the retrospective group was 45 Gy and 43 Gy respectively. For other tumors with neck irradiation (retrospective group) the mean thyroid dose was 53 Gy. There were no cases of clinical hypothyroidism in our study. As for subclinical hypothyroidism which is characterised by elevated TSH, the incidence was 22% in the prospective group and 3% in the retrospective group, i.e. 8/93 patients showed a hypothyroid dysfunction. Three of the 8 patients with subclinical hypothyroidism had undergone lymphangiography before radiotherapy. Due to the elevated iodine pool a lymphangiogram is considered as a risk factor for hypothyroidism as well as for hyperthyroidism, which we observed twice in the prospective group. Evaluation of the thyroid function before lymphangiography and irradiation as well as regular thyroid function studies during the follow-up are recommended in order to detect hypothyroidism in time.

Adolescent↗