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G Zettinig

Publications and source records attributed to G Zettinig.

12 recordsLinked to original sources
PubMed2003

Autoimmune diseases in vitiligo: do anti-nuclear antibodies decrease thyroid volume?

An increased prevalence of autoimmune thyroiditis (AT) in vitiligo patients is well known. The aim of this study was firstly, to evaluate the clinical course of patients with both vitiligo and AT and secondly, to identify additional autoimmune disorders affecting the thyroid gland in a large cohort of vitiligo patients. We analysed a study group of 106 vitiligo patients and 38 controls. A detailed thyroid examination including sonography was performed in all study participants. In addition, the study participants were HLA typed and screened for various autoimmune disorders. AT was significantly more frequent in vitiligo patients than in controls (21%versus 3%; P < 0.01). In 12 of the 22 patients with AT, vitiligo was the initial disease preceding AT by 4-35 years. In the other 10 patients with AT, both vitiligo and AT were diagnosed within one year. There were two individuals with diabetes mellitus type 1 and a single patient with Addison's disease. Anti-nuclear antibody (ANA), anti-smooth muscle cell antibody, and parietal cell antibody levels occurred with a similar frequency in patients and controls. In all vitiligo patients with both elevated ANA levels and AT (n = 6), the atrophic but not the goitrous variant was diagnosed. These vitiligo patients with both AT and elevated ANA levels had a significantly smaller thyroid volume compared to the vitiligo patients with AT whose ANA levels were normal (6.7 +/- 4.5 ml versus 13.4 +/- 9.1 ml, respectively; P < 0.05). The same was found in the entire study group: Thyroid volume of all vitiligo patients (with or without concomitant AT) was significantly smaller in the presence of ANA (6.9 +/- 5.3 versus 10.5 +/- 5.9 ml, respectively; P < 0.05). However, this phenomenon was not observed in the control group. There was a trend for a decreased frequency of HLA-DR3 (6.7%versus 23%) in our study group, but after correction for the number of comparisons, no HLA-allele was statistically significant associated neither with vitiligo nor with multiple autoimmune diseases in our patient sample. Our findings suggest that AT is the most frequent autoimmune disease associated with vitiligo. In our patients, AT presented simultaneously or after the onset of vitiligo but not before. Elevated ANA levels were associated with the atrophic variant of AT and may affect the volume of the thyroid gland, and there was no statistically significant association with the HLA system.

Adolescent↗
PubMed2003

18F-fluoro-deoxy-glucose positron emission tomography (18F-FDG-PET) for assessment of enteropathy-type T cell lymphoma.

BACKGROUND AND AIMS: Enteropathy-type T cell lymphoma (ETCL) represents a relatively rare disease, accounting for less than 1% of non-Hodgkin's lymphomas. ETCL is an aggressive lymphoma which may either present de novo or arise in the context of longstanding or untreated coeliac disease (CD). The aim of this study was to evaluate the potential of 18F-fluoro-deoxy-glucose positron emission tomography (18F-FDG-PET) for imaging of ETCL. Furthermore, we wished to evaluate whether the presence of CD might provide a potential diagnostic obstacle to imaging of lymphoma due to unspecific 18F-FDG uptake and whether accumulation of 18F-FDG within the gut correlates with activity of CD. PATIENTS AND METHODS: We retrospectively analysed patients with ETCL and individuals suffering from CD undergoing 18F-FDG-imaging at our PET unit. Material for histological reassessment by a reference pathologist had to be available for inclusion of patients in the analysis. Whole body 18F-FDG-PET scans were performed 40 minutes following injection of 300-380 MBq of 18F-FDG. Images were reconstructed iteratively. In areas with focally elevated FDG uptake and in case of diffusely elevated intestinal 18F-FDG accumulation, standard uptake values (SUVs) were calculated. RESULTS: During a period of two years, five patients (one male, four female) with a mean age of 56.4 years (range 44-62) with a diagnosis of ETCL underwent 18F-FDG-PET. Four of these patients were imaged before application of cytotoxic treatment while one patient had regular PET scans for follow up. All four patients undergoing pre-therapeutic imaging showed markedly elevated intestinal 18F-FDG uptake, with a maximal SUV of 6.4-8.0 (mean 7.15 (SD 0.82)). The patient imaged following surgery and cytotoxic therapy had no pathologic 18F-FDG uptake which was found to correlate with normal duodenal mucosa, as evidenced by repeated biopsies and conventional imaging methods. During the same time span, 12 patients (five male, seven female) with a mean age of 63.8 years (range 42-82) suffering from CD were imaged. Four of these patients showed no elevated intestinal 18F-FDG uptake while five had minor diffuse intestinal 18F-FDG accumulation with SUVs ranging between 2.2 and 4.6 (mean 3.4 (SD 0.89)). In the remaining three patients with diffuse intestinal 18F-FDG uptake, no SUV could be calculated. SUVs in patients with ETCL were remarkably higher than in patients suffering from CD (p=0.011), irrespective of the activity of CD at the time of imaging. CONCLUSION: In spite of the relatively small number of patients, our results clearly indicate the potential value of 18F-FDG-PET for diagnosing and imaging ETCL. In addition, the data also suggest that 18F-FDG-PET may lead to early diagnosis in individuals developing ETCL in the context of longstanding CD. This is due to the fact that 18F-FDG does not appear to significantly accumulate in the gut of patients with CD, irrespective of disease activity.

Adult↗
PubMed2002

Aerobic exercise for a patient suffering from metastatic bone disease.

A 48-year-old female patient suffering from advanced breast cancer with metastatic bone disease participated in an aerobic exercise program consisting of ergometer cycling three times a week for 1 year. Feasibility, safety and beneficial effects of the program were proven for the patient in this case study. VO(2)max (20.2% after 16 weeks, 52.7% after 12 months) and peak work capacity (15.5% after 16 weeks, 35.7% after 12 months) had increased. The patient experienced a marked improvement in physical performance and in quality of life. Aerobic exercise, initiated and executed with appropriate care, may serve as a useful additional means of palliative treatment in some cancer patients with bone metastases.

Bone Neoplasms↗
PubMed2002

Increased lead excretion in hypothyroid patients after levothyroxine medication.

In a recent publication we hypothesized that increased bone metabolism induced by thyroid hormones should increase lead excretion even in lead unexposed subjects. To examine this hypothesis, 10 hypothyroid patients were investigated before and after substitution therapy with levothyroxine. After a mean of 9 wk after onset of therapy (patients were then in an euthyroid state), lead concentrations in urine (PbU) corrected by the individual creatinine in urine were increased (p = .007), while lead concentrations in blood (PbB) were slightly decreased (3.44 +/- 1.73 vs. 2.74 +/- 1.38, p = .008). Desoxypyridinoline cross-links (Pyr), a sensitive marker for bone degradation and excreted in urine, correlated with PbU (r = .64, p = .002) but not with PbB. Additionally PbU significantly correlated with serum concentrations of free circulating T3 (fT3) or free circulating T4 (fT4). Thus, we may suspect that increased lead excretion was induced by accelerated bone metabolism, since Pyr was increased after therapy (3.21 +/- 1.19 vs. 6. 10 +/- 1.81 nM/mM Cr, p < .001), too.

Adult↗
PubMed2002

[Value of a structured report for the interpretation of parathyroid scintigraphy in primary essential hyperthyroidism].

The aim of the study was to evaluate whether a four-stage report scheme increases the diagnostic accuracy of dual phase Tc-99 m sestamibi scintigraphy (MIBI-scintigraphy) in patients with primary hyperparathyroidism (pHPT). We analysed the scans of 35 patients with primary hyperparathyroidism referred for Tc-99 m sestamibi scintigraphy and compared them with the sonographic and surgical findings. All scans were interpreted following a four-stage report scheme: Group A--typical scintigraphic findings of a single gland disease, group B--scan consistent with single gland disease, group C--multiple gland disease, group D--non diagnostic scan. Twenty-three scans were ranked in group A. In all these patients, scintigraphy diagnosed both the side and the localization of the adenoma correctly. Sonography made the correct diagnosis in 21/23 individuals and showed false-positive results in 2/23 cases. Group B included 10 scans. In 7/10 individuals, both the side and the localization of the adenoma were diagnosed correctly, whereas in 2/10 patients only the side was diagnosed. The scan of a single patient with hyperplasia of all 4 parathyroid glands was falsely interpreted as "consistent with a left caudal single gland disease". Sonography made the correct diagnosis in 8/10 cases, two individuals were diagnosed as false positive and false negative, respectively. No scan was interpreted as multiple gland disease (group C) and two scans were non diagnostic (group D). Both patients of the last group were correctly diagnosed by sonography. These findings suggest that in case of typical scintigraphic findings of single gland disease, scintigraphy but not sonography should be the primary localization technique for minimally invasive parathyroidectomy.

Adenoma↗
PubMed2002

Introduction of helical computed tomography affects patient selection for V/Q lung scan.

AIM: Retrospective analysis for determination of the effect of helical computed tomography (HCT) on utilization of V/Q lung scanning to diagnose pulmonary embolism (PE) in a large general hospital. METHODS: A total number of 2676 V/Q scans of in- and out-patients referred to our department between March 1992 and December 1998 and between April 1997 and December 1998 were analyzed by an identical group of nuclear physicians. RESULTS: Neither the total number of annually performed V/Q scans (446 +/- 135) nor the mean age of patients (56 years +/- 17) changed significantly since the introduction of HCT. However, the referral pattern was different. The percentage of patients with high and intermediate probability for PE decreased significantly from 15.2% to 9.4% (p < 0.01) and from 10.2% to 7.3% (p < 0.05), respectively. Low probability scans significantly increased from 37.8% to 42.7% (p < 0.05). The percentage of normal scans did not change significantly, however, there was a highly significant increase summarizing patients with normal and low probability scans (74.6% to 83.3%; p < 0.01). CONCLUSION: The introduction of HCT affected the selection of patients referred for V/Q lung scanning since V/Q scanning was primarily used to exclude rather to confirm PE.

Age Distribution↗
PubMed2001

FDG positron emission tomographic, radioiodine, and MIBI imaging in a patient with poorly differentiated insular thyroid carcinoma.

Poorly differentiated insular thyroid carcinoma is now classified as a separate entity among other tumors of the thyroid gland. Its histologic pattern and its clinical course are regarded as intermediate between well differentiated and anaplastic thyroid cancer. Insular carcinoma accumulates I-131, but no data exist regarding its fluorodeoxyglucose (FDG) positron emission tomographic (PET) uptake. The authors report F-18 FDG PET, Tc-99m MIBI, and radioiodine imaging features in a 63-year-old patient with metastatic insular thyroid carcinoma. After total thyroidectomy (for poorly differentiated insular carcinoma pT3a), the patient was referred for radioiodine ablation. No signs of recurrence were present until 16 months later, when thyroglobulin levels increased. An I-131 scan showed a single lesion in the right lung, and further radioiodine treatment was administered (cumulative dose [530 mCi], 19,610 MBq I-131). Three years after the initial diagnosis, FDG-PET and Tc-99m MIBI scans were performed within 5 days during thyroxine treatment. After that, thyroxine substitution was withdrawn; 6 weeks later, an I-131 whole-body scan was performed. Both radioiodine and MIBI images showed increased tracer uptake in the known lung lesion. However, FDG PET showed a normal tracer distribution. Magnetic resonance and computed tomographic imaging confirmed a 12-mm lesion in the right upper lobe. These findings support the concept of the "flip-flop phenomenon" in insular thyroid carcinoma, an alternating pattern of metastases with either I-131 or FDG-uptake. Despite poorly differentiated histologic findings, glucose metabolism was not increased in this patient with an insular tumor.

Carcinoma↗
PubMed2000

Dermatitis herpetiformis is associated with atrophic but not with goitrous variant of Hashimoto's thyroiditis.

BACKGROUND: Dermatitis herpetiformis (DH) is a gluten-sensitive skin disease that is associated with a variety of autoimmune disorders. Several investigations demonstrated an association between DH and autoimmune thyroid disease. However, it has not been shown if DH is associated with atrophic or goitrous variant of Hashimoto's thyroiditis. MATERIALS AND METHODS: We investigated a cohort of 41 DH patients (18 male, 23 female) and a control group (11 male, 19 female; sex and age matched healthy volunteers) to find out which variant of Hashimoto's thyroiditis is associated with DH. All patients had thyroid hormones and antibodies measured. In addition to that, thyroid sonography as well as detailed history-taking of previous thyroid disease were performed. RESULTS: In the control group no individual with elevated levels of thyroid antibodies nor abnormal thyroid hormones nor thyroid atrophy was found. Median thyroid volume in the control group was 11 mL (range 4.8-24.7 mL). However, in nine DH patients (22%) elevated levels of antithyroid microsomal (TM) antibodies were seen (P < 0.01). Three of them had abnormal thyroid hormones (7%). In the group of DH patients a significantly smaller thyroid volume was found (median 8 mL, range 1. 6-25.2 mL; P < 0001). Thyroid atrophy (volume < 4.4 mL) was found in 10 DH patients (24%) of whom 9 were females. All patients with elevated levels of TM antibodies or abnormal thyroid hormones and all patients with a history of previous hypothyroidism had a thyroid volume < 7 mL. Goitrous variant of Hashimoto's thyroiditis was not seen in any of the DH patients. CONCLUSIONS: Our findings demonstrate that DH is associated with atrophic but not with goitrous variant of Hashimoto's thyroiditis.

Adult↗
PubMed2000

Advanced insular thyroid carcinoma in a fourteen-year-old girl: twenty-four years of follow-up.

Insular thyroid carcinoma has become a separate entity among thyroid malignancies. It is regarded as intermediate in aggressiveness between well-differentiated and anaplastic thyroid carcinomas. Reports on the clinical course of children with insular thyroid carcinoma are rare. We report the case of a 14-year-old girl who was admitted to our thyroid outpatient ward in 1975 with a scintigraphic cold thyroid nodule and multiple enlarged cervical lymph nodes. Chest radiography showed metastases in both lungs. After total thyroidectomy and, central and modified unilateral radical neck dissection, the girl was given a dose of 80 mCi 131I. Posttherapeutic scan demonstrated diffuse tracer uptake in both lungs. A second dose of 200 mCi 131I was administered 4 months later and another dose of 150 mCi 131I in July 1976. Subsequently, whole-body scans showed inconspicuous tracer distribution and chest x-rays were normal. The patient was treated with levothyroxine and followed until 1982, when she left Vienna. In 1999, the patient was contacted for reexamination. She has been well and had had two healthy children. The patient was taking 150 microg levothyroxine daily; she had a normal TSH value and her thyroglubulin was 0.3 ng/mL. Chest radiography and sonography of the neck showed no pathological findings. The paraffin sections of the patient's tumor were reexamined in 1999 and demonstrated the histologic characteristics of a poorly differentiated insular thyroid carcinoma (pT4a, pN1a, M1). These findings demonstrate that even in advanced stages, insular thyroid carcinoma treatment can be successful.

Adolescent↗
PubMed2000

Radioactive contamination of contact lenses during radioiodine therapy.

Although the secretion of radioiodine in tears is not unexpected, there are only few investigations in that field. We report the measurement of 131I in disposable contact lenses for daily use during radioiodine treatment. After administration of 740 MBq 131I, all contact lenses of a 59-year-old female used the day before and 5 days after radioiodine therapy were collected and measured in a gamma counter. Activities of 124 Bq (right) and 139 Bq (left) were measured in the contact lenses used during the first day after administration of radioiodine. The activity in the contact lenses of the following days was significantly lower. An initial dose rate of approximately 0.31 microSv x h(-1) was caused by the radioactivity resulting in a total dose of 13 microSv to the patient's eye lens. That dose is negligible compared to the dose caused by the incorporated radioactivity.

Contact Lenses, Hydrophilic↗
PubMed1997

[Survival after poisoning due to intake of ten-times lethal dose of acetone].

HISTORY AND ADMISSION FINDINGS: A 42-year-old man was found unconscious, having swallowed 800 ml of an unknown liquid with suicidal intent. On admission, when his breath smelled strongly of acetone, he was intubated and ventilated, and several gastric lavages were performed. INVESTIGATION: The serum acetone concentration was 2000 mg/l, that in urine 2300 mg/l. The residue of the liquid in the bottle from which he had drunk was pure acetone. DIAGNOSIS, TREATMENT AND COURSE: Acetone poisoning having been established he was carefully hyperventilated, haemofiltration was performed over 16 hours and forced diuresis with high fluid intake was undertaken. His condition quickly improved and he was extubated after 14 hours. There was no subsequent evidence of organ damage. Repeated measurements of acetone in blood and urine indicated its elimination with a half-life of 11 hours. Literature search revealed that this was the second highest concentration of acetone in blood and urine followed by survival. CONCLUSION: This case demonstrates that, after acute acetone poisoning with an amount ten times the lethal dose, intensive care and rapid elimination of acetone can achieve sequelae-free survival.

Acetone↗