Octreotide and Graves' ophthalmopathy and pretibial myxoedema.
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Biomedical subjects
Publications and source records attributed to K M Huang.
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We have demonstrated that there is an antibody related to extraocular muscle enlargement in autoimmune ophthalmopathy (Graves' ophthalmopathy, thyroid-associated correlated with orbital computed tomography (CT). This study was designed to identify the autoantigen and to determine whether there are common antigens among the extraocular muscle, the lacrimal gland, and the thyroid. We prepared a 100,000g sediment fraction of porcine extraocular muscle, lacrimal gland, thyroid, and human thyroid, followed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and immunoblotting with sera from patients with Graves' disease, with or without ophthalmopathy, classified by symptoms and signs combined with orbital CT and normal controls. The results showed there was an approximately 55-kDa protein band which was recognized by the sera in 32.1% (9/28) of patients with autoimmune ophthalmopathy and in 47.3% (9/19) of patients with extraocular muscle enlargement demonstrated by orbital CT. It was significantly higher than the positive rates in patients without autoimmune ophthalmopathy and normal controls (15.8 and 11.1%, respectively, P < 0.025). However, there was no common antigen among the extraocular muscles, the lacrimal gland, and the thyroid. To further confirm this eye muscle-specific antigen, the approximately 55-kDa protein band was cut and solubilized from the nitrocellulose paper after SDS-PAGE, and electrophoretically transferred and used as an antigen in enzyme-linked immunosorbent assay. The absorbance was significantly higher in patients with autoimmune ophthalmopathy than patients without ophthalmopathy (P < 0.005), and normal controls (P < 0.01). Our findings suggest that an approximately 55-kDa protein may be a possible antigen in the eye muscle related to autoimmune ophthalmopathy.
In a general population-based geriatric disease survey in Taipei City, the bone mineral density (BMD) of 58 women over 65 years of age was measured for the whole body, lumbar spine (L2-L4), and proximal femurs using a 153Gd based dual photon absorptiometer. These women were found to have at least one vertebral fracture. The results showed that the BMD readings of both the lumbar spine (L2-L4) (mean Z score +/- SEM = 0.05 +/- 0.12) and the femoral neck (mean Z score +/- SEM = -0.20 +/- 0.10) were not statistically different from those of age-matched controls. However, the total body BMD in these 58 patients was significantly lower than in the normal controls (mean Z score +/- SEM = -1.07 +/- 0.10, p < 0.0001). In the normal control group (N = 69, age 50-85), there was a significant linear correlation between the total body and lumbar BMD (r = 0.81, p < 0.0001). This correlation was not found in the 58 women with vertebral fractures (r = 0.14, NS). Our results suggest that geriatric women with vertebral fractures are more osteoporotic than normal aged women, even though they have a relatively mild degree of spinal osteoporosis. But, because of age-associated degenerative changes or other factors, conventional anteroposterior lumbar BMD measurements cannot detect the difference. The total body BMD readings, but not the lumbar or femoral neck BMD readings, seem to be less affected by these local changes and may provide a better discriminative or predictive value for vertebral fracture in this particular age group.
To investigate the effects of prolonged thyrotoxicosis, we measured the bone mineral densities (BMD) of 24 untreated patients who had suffered from symptoms of thyrotoxicosis for at least 1 year. We also recruited 116 healthy Chinese women residing in the Taipei area as normal controls. The BMDs of these 24 patients for the whole body skeleton, lumbar spine, femoral neck, greater trochanter and Ward's triangle were all significantly lower than those of normal controls (one sample t-test, two-tailed alternative). Older patients had lower absolute values and a trend towards more severe bone loss, which was most significant at the femoral trochanter and Ward's triangle (p less than or equal to 0.05). The decrease in BMD was more pronounced in the vertebral bodies than in the proximal femur for all patients, implying predominantly trabecular bone loss in this disease. The BMDs of 10 patients were reevaluated 1 year after successful medical treatment. These 10 patients had remained euthyroid for 1 year with antithyroid drugs and showed a small, but significant, improvement in their BMDs at the lumbar spine and the proximal femur on reevaluation. However, the recovery was far from complete. Our findings suggest that thyrotoxicosis causes a remarkable loss of bone mineral, which cannot be compensated for after 1 year of successful treatment. Thus, early diagnosis and therapeutic intervention are important for preventing osteoporotic fractures, especially in elderly patients.
We reviewed the computed tomographic (CT) findings of the sella turcica in 26 patients with a serum prolactin level of over 200 ng/ml. The interval between the dates of CT examination and checking of the serum prolactin level were within 2 months. There were 24 nonpregnant women with a mean age of 30 years and 2 men with a mean age of 28.5 years. None of them were taking medication known to cause an elevation in serum prolactin levels. Surgery was performed on 8 patients with chromophobe adenomas of the pituitary gland: 6 of them were proven to have prolactin-secreting tumors (prolactinomas) after performing a special stain, and the remaining 2 patients, clinically diagnosed as prolactinomas, showed extremely high serum prolactin levels (3,200 and 2,251 ng/ml, respectively). CT studies showed that the height of the pituitary gland in the coronal sections were more than 7 mm in 15 cases (58%) and more than 10 mm in 13 cases (50%); focal bulging of the diaphragma sellae in 16 cases (62%); erosion of the sellar floor in 20 cases (77%); deviation of the pituitary stalk in 19 cases (73%); and abnormal attenuation or enhancement of the pituitary gland in 18 cases (69%). Three patients (12%) showed no evidence of any abnormal CT finding despite a hyperprolactinemic state of over 200 ng/ml. Six histologically proven cases (23%) of prolactinomas and chromophobe adenomas showed radiologic evidence of cavernous sinus invasion. We conclude that patients with a serum prolactin level higher than 200 ng/ml generally show significant changes in the sella turcica in CT.
We reviewed the myelograms and computed tomographic myelograms of 12 cases of intraspinal tumor with a "cupping sign" on the myelogram in the region of the conus medullaris from 1986 to 1988. There were 5 intramedullary tumors, 4 of them having an exophytic component, and 7 intradural-extramedullary tumors. The myelograms revealed that 4 of the 5 intramedullary tumors showed expansion and the outline of the conus medullaris was irregular, whereas 1 of the tumors showed smooth compression (crescent-shaped) and displacement of the conus medullaris. Six of the 7 intradural-extramedullary tumors showed smooth compression and displacement of the conus medullaris, while 1 of the tumors had caused expansion of the conus medullaris. Complete blockage of the passage of the contrast medium was noted in 3 of the 5 intramedullary tumors, while a partial block was noted in 3 of the 7 intradural-extramedullary tumors. Two of the 7 intradural-extramedulllary tumors showed an extradural tumor component, such as a dumb-bell tumor and a enlarged intervertebral neural foramen. Tumor calcification was noted in 1 of the 7 intradural-extramedullary tumors. Dural ectasia was noted in 2 of the 7 intradural-extramedullary tumors which were later proven to be neurofibromatosis. We conclude that smooth compression (crescent-shaped) and displacement of the conus medullaris, existence of an extradural tumor component, and eroded intervertebral neural foramina favor intradural-extramedullary tumors, while expansion and a conus medullaris with an irregular outline favors intramedullary tumors.
A series of 23 patients with intractible gastrointestinal (GI) bleeding were managed by the transcatheter method. The series included 5 with hemobilia, 8 with upper GI (UGI) bleeding, 5 with lower GI (LGI) bleeding and 5 with variceal bleeding. The etiology of the hemobilia was surgery, or percutaneous transhepatic cholangiography and drainage (PTCD) complicated by various degrees of biliary tract infection. The causes of UGI bleeding included erosive gastritis, gastric and duodenal ulcers, and traumatic duodenal laceration. All 5 LGI bleedings were due to ischemic colitis and all 5 variceal bleedings were due to hyperdynamic portal hypertension from arterio-portal (A-P) shunting for hepatocellular carcinomas (HCC). Intra-arterial vasopressin infusion was performed on 17 (4, hemobilia; 8, UGI; and 5 LGI bleeding) of these 23 cases as initial management. The success rate for vasopressin in hemobilia, UGI and LGI bleeding was 75% (3/4), 38% (3/8), and 60% (3/5), respectively. The overall initial success rate of vasopressin was 52% (9/17). The relatively poor success rate of vasopressin infusion for UGI bleeding was due to ulcers and laceration. The incidence of rebleeding for vasopressin infusion was 22% (2/9) including one case each of UGI and LGI bleeding. Three patients (1 hemobilia and 2 UGI bleeding) among these 17 cases underwent transarterial embolization (TAE) after failure of intra-arterial vasopressin infusion. One of these 23 cases with hemobilia underwent TAE for initial transcatheter control of the GI bleeding. Five cases of active esophageal variceal bleeding, caused by A-P shunting in HCC, were all successfully controlled by TAE.(ABSTRACT TRUNCATED AT 250 WORDS)
Nine cases of Burkitt's type and 5 case of non-Burkitt's type small, non-cleaved cell lymphoma were retrospectively studied to evaluate their clinical and radiological manifestations. In the Burkitt's group, the median age of onset was 9 years old; the male to female ratio was 2:1; and the most frequent presentation was abdominal mass. These features conformed to those of non-endemic (or American) type Burkitt's lymphoma. In comparison with the Burkitt's group, less male-predominance (M:F = 2:3) and cervical mass as the most frequent initial symptom were found in the non-Burkitt's group. Plain films and computed tomographies were collected to evaluate the encroachment of the disease into various organs or compartments. There was a statistically significant correlation in site of the main mass between these two types; the Burkitt's type prefers extranodal, whereas the non-Burkitt's type prefers nodal, involvement. Computed tomographic appearance of Burkitt's lymphoma was also analyzed and summarized by the following five aspects: (1) tumor location-predominantly in the abdomen or head/neck region; (2) tumor density-rather homogeneous and slightly less than that of muscle; (3) tumor margin-often well-localized with distinct contrast to adjacent normal tissue; (4) extranodal predilection- the most frequent pattern of involvement; and (5) bony chang-often mild, despite the size of the mass.
The magnetic resonance imaging (MRI) in 4 cases of subchondral cyst at the knee joint region, were acquired from a 1.5 Tesla imager. We found a high incidence of concomitant occurrence of subchondral cysts with a ruptured anterior cruciate ligament (ACL) in all of these cases. The 2 men and 2 women, had an average age of 35. Clinically, they complained of dull knee pain and mild instability. Conventional radiography detected subchondral cysts in 3 of them, while MRI disclosed that all of the subchondral cysts were at the tibial plateau, close to the intercondyloid eminence. To date, MRI is the only imaging modality which can depict the concomitant occurrence of a subchondral cyst and a ruptured anterior cruciate ligament at the knee joint. Whether these subchondral cysts were the consequences of the ruptured anterior cruciate ligaments as one of the causes in addition to synovial fluid intrusion and bony contusion, need further clinical observation and investigation.
The purpose of this study was to elucidate the incidence of orbital changes in computed tomography, and the relationships of orbital changes with eye-muscle antibody (EMAb), thyrotrophin-binding inhibitor immunoglobulin (TBII), antithyroglobulin antibody (TgAb) and anti-thyroid microsomal antibody (MsAb), in 55 consecutive patients with hyperthyroid Graves' disease. EMAb was demonstrated by an immunoperoxidase technique. The results showed that the prevalence of orbital fat increase, extraocular muscle enlargement, lacrimal gland enlargement and optic nerve swelling were 54.5, 41.8, 21.8 and 16.5% respectively. There were 32.7% of patients without any orbital changes. The patients with extraocular muscle enlargement, lacrimal gland enlargement and optic nerve swelling had higher titres of EMAb than the patients without these orbital changes. The patients with lacrimal gland enlargement had a lower TBII index than those without. There was no difference in TgAb or MsAb between the patients with extraocular muscle enlargement, lacrimal gland enlargement, optic nerve swelling or orbital fat increase and those patients without these orbital changes. The patients with extraocular muscle enlargement, optic nerve swelling and orbital fat increase had a higher degree of exophthalmos than the patients without these orbital changes. EMAb was negatively correlated with TBII. However, there was no correlation between EMAb and TgAb or MsAb. The degree of exophthalmos was positively correlated with EMAb and negatively correlated with age. There was no correlation between exophthalmos and TBII, TgAb or MsAb. In conclusion, although the pathogenesis of orbital changes and hyperthyroidism is different, a close link between these two entities is suggested by the high incidence of orbital changes in hyperthyroid Graves' disease.(ABSTRACT TRUNCATED AT 250 WORDS)
Five patients with underlying malignancy were detected antemortemly to have cardiac metastasis by post-enhanced CT scanning. The most common presentations were abnormal heart sounds, electrocardiographic changes and inexplicable heart failure; which lead us to suspect cardiac metastasis. One patient had an "engorged azygous knob" on his chest x-ray film, which provided a clue to possible cardiac metastasis. All of these patients had tumor thrombi in their large tributary veins in addition to the primary tumors. Thus, we advanced the CT scan to the cardiac region and cardiac metastases were, therefore, diagnosed. The tumor thrombi in the large tributary veins seemed to be the source for intracardiac spreading. Cardiac angiographies were performed in 3 patients and confirmed the diagnosis. We conclude that post-enhanced CT scanning is useful in the diagnosis of cardiac metastasis and the presence of tumor thrombi in the large tributary vein is an early sign of cardiac involvement.
The tissue from a patient with nasopharyngeal carcinoma has been transferred to nude mice (BALB/c), and has successfully been growing through twenty passages. The tumors in the nude mice and primary human tumor have been examined for the cellular DNA content by FCM and also conventional pathological examination, chromosome analysis, and EBV test. The tumor take rate varied markedly in different passages with a mean value of approximately 70%, and showing a tendency to increase. The tumor doubling time within 6-12 weeks after transplantation of six tumors in 18 and 20 passages were 14.8 and 9.3 days respectively. However, the tumor volume at 12 weeks varied significantly, ranging from 438 to 1998 mm3. By FCM, it has been found that the values of DNA index were about the same in both primary tumor and the tumors in nude mice. The distribution of various phase cells in cell cycle was also about the same in both. In conclusion, the application of FCM to examine the cellular DNA content of the tumor in nude mice is a rapid and sensitive method, useful in the investigation on the stability of biological characteristics of human NPC in nude mice and in further studies on the effects by various therapeutic methods.
Fifteen patients with acute cerebral infarct in the territory of the middle cerebral artery were examined with dynamic computed tomography (CT) to evaluate cerebral perfusion changes. Perfusion changes could be detected in 93% of the patients within a short period after the attack (the earliest instance was within 2 hours) and before any detectable morphologic change. The attenuation coefficient of the area of infarction showed a statistically significant difference in peak amplitude compared with that in the contralateral unaffected brain or with that in the control group (P less than .05). A delay in the time to peak in the affected side versus in the contralateral side was observed in six patients with stroke and ranged from 4.2 to 49.2 seconds with or without a change in peak amplitude. The clinical outcome in the patients correlated well with the initial perfusion change measured with dynamic CT scanning. The greater the difference in peak amplitude, the worse the residual neurologic defect. Patients with a prolonged time to peak (greater than 8 seconds) usually had poor clinical outcome. The whole dynamic study took 10-15 minutes more than a conventional CT study but provided more complete information as a basis for clinical treatment and an indication of clinical outcome.
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