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Biomedical subjects

M M Kaplan

Publications and source records attributed to M M Kaplan.

At least 91 records · Page 5Linked to original sources
PubMed1990

Thyroid nodularity after childhood irradiation for lymphoid hyperplasia: a comparison of questionnaire and clinical findings.

Ionizing radiation is a well-established cause of thyroid cancer and nodularity, however, important questions relating to the magnitude of the risk following low-dose medical exposures remain unresolved. To address these issues, we conducted a follow-up study of 1590 individuals treated between 1938 and 1969 with X-rays for childhood lymphoid hyperplasia (av. thyroid dose = 24 cGy) and 1499 individuals treated with surgery only. Thyroid nodularity was determined from self-administered questionnaires completed by 1195 irradiated and 1063 surgically-treated subjects and from clinical examinations of 602 irradiated and 457 non-irradiated subjects. A much higher relative risk (RR) for radiation-induced thyroid nodules was estimated from the questionnaire than from the clinical examination data, 15.8 and 2.7, respectively. (The corresponding estimates of excess RR per cGy were 64 and 7%). Analysis of the examination data revealed a strong dose-response relationship, similar excess RR/cGy for males and females, and an inverse relationship with age at exposure. Although the thyroid gland is one of the most sensitive organs to the neoplastic effects of radiation, the radiation-induced risk of thyroid nodularity reported from questionnaire studies may over-estimate the true risk.

Adult↗
PubMed1990

Progress in thyroid cancer.

The last decade has seen significant advances in our understanding of thyroid cancers, in the areas of the molecular genetics and biology of these tumors, in effective use of preoperative diagnostic tools, and in appropriate long-term follow-up care. Studies of the roles of oncogenes, growth factors, and familial susceptibility factors offer the potential for further improvement in making early, accurate diagnoses. Objective prognostic scoring systems, now under development, can accurately separate the minority of papillary and follicular thyroid cancer patients at high risk for recurrence and mortality from the majority who do not need aggressive treatment. These systems will permit effective design of future studies of the impact on disease outcome of radioactive iodine treatment and follow-up testing by new imaging methods on disease outcome.

Humans↗
PubMed1990

Ablative radioactive iodine therapy for apparently localized thyroid carcinoma. A decision analytic perspective.

Adjuvant therapy with ablative radioiodine after surgical resection of apparently localized thyroid carcinoma remains controversial because of the favorable prognosis of thyroid carcinoma and the risk of leukemia from the radioiodine. No controlled trials have been performed to examine this issue. We constructed a decision analytic model to examine whether patients with apparently localized thyroid carcinoma should receive radioiodine. Our analysis suggests that radioiodine modestly improves life expectancy by 2 to 15 months, depending on the patient's age and sex. This model predicts that the benefit of a reduction in the likelihood of recurrence outweighs the risk of leukemia from radioiodine.

Adult↗
PubMed1989

Management of biliary obstruction. A comparison of percutaneous, endoscopic, and operative techniques.

Surgery for obstructive jaundice is being challenged by endoscopic and percutaneous techniques. To compare their safety and efficacy, the courses of 157 patients treated for biliary obstruction were examined. Outcome was judged by mortality, complications, and need for further intervention. Forty-eight patients underwent endoscopic papillotomy (43 [90%] had stone disease) with two deaths and 11 cases of (23% incidence) of cholangitis. Pancreatitis developed in 9 (19%). Twenty-seven patients (56%) required further endoscopic, percutaneous, or surgical intervention. Sixty-five patients underwent transhepatic drainage (58 [89%] had malignant neoplasms) with a 28% (n = 18) mortality rate. Cholangitis developed in 26 (40%), and 50 (77%) required further transhepatic or surgical intervention. Forty-four patients underwent surgery (22 [50%] had stone disease and 12 [27%] had malignant neoplasms) with a 4.5% (n = 2) mortality rate. Cholangitis developed in 3 (7%), pancreatitis developed in 2 (4.5%), and bleeding developed in 1 (2%). Eight (18%) required further intervention. While endoscopic papillotomy provides efficacious treatment for stone disease, surgery provides a more expeditious, less morbid relief for malignant obstruction.

Adult↗
PubMed1989

Effect of age on tests of intestinal and hepatic function in healthy humans.

We studied intestinal function and hepatic microsomal phase I monooxygenase function in healthy, free-living subjects, aged 19-91 yr. In subjects (n = 114) given a diet including 100 g/day of fat, fecal fat in a 72-h collection did not increase with advancing age. D-Xylose excretion (n = 54) following a 25-g oral load significantly declined with increasing age, but a concomitant decline in creatinine clearance suggested a decrease in renal function rather than an absorptive defect. Furthermore, there was no evidence for an age-associated increase in bile salt deconjugation by intestinal bacteria as shown by the glycocholate breath test (n = 60). Finally, there was no evidence for a decrease in hepatic microsomal function with advancing age as measured by the aminopyrine breath test (n = 60). We conclude that digestive/absorptive and hepatic microsomal phase I monooxygenase function are well preserved in healthy humans throughout life.

Adult↗
PubMed1989

Phenolic and tyrosyl ring iodothyronine deiodination by the Caco-2 human colon carcinoma cell line.

Thyroid hormone metabolism was studied in the human Caco-2 colon carcinoma cell line, which at confluence exhibits several functions of differentiated enterocytes. Cells were harvested two to 17 days after reaching confluence. Intact cells and homogenates were tested for deiodination of [125I]-labeled substrates. Small amounts of thyroxine (T4) were converted by homogenates to 3,3',5'-triiodothyronine (rT3), 3,3'-diiodothyronine (3,3'-T2), and 1-, with no detectable production of 3,5,3'-triiodothyronine (T3) by homogenates or cells. rT3 was converted to 3,3'-T2 and 1- with an apparent Michaelis constant (Km) for rT3 of 24 nmol/L; 6-n-propyl-2-thiouracil (PTU) had a 50% inhibitory concentration of 30 nmol/L and abolished rT3 5'-deiodination at 1 mmol/L in the presence of 20 mmol/L dithiothreitol (DTT). T3 was deiodinated to 3,3'-T2 and 3'-monoiodothyronine (3'-T1) with an apparent Michaelis constant (Km) for T3 of 5.7 nmol/L; this reaction was not inhibited by 1 mmol/L PTU. Phenolic and tyrosyl ring deiodinating activities were maximal four and six days, respectively, after the cells reached confluence. Homogenates of cells grown in standard medium containing fetal calf serum had fivefold higher rT3 5'-deiodinating activity than cells grown in a serum-free defined culture medium, reflecting a fivefold difference in the apparent Vmax with no difference in the apparent Km for rT3. There was no difference in T3 5-deiodination rates in homogenates of Caco-2 cells grown in the two media until 12 days postconfluence, when cells grown in standard medium had higher activity.(ABSTRACT TRUNCATED AT 250 WORDS)

Carcinoma↗
PubMed1989

Hypothyroidism. Don't treat patients who don't have it.

An erroneous diagnosis of hypothyroidism causes unnecessary expense and inconvenience for patients, may result in needless and possibly unsafe treatment, and could delay the correct diagnosis. The erroneous diagnosis is often reversed by a second opinion, thereby causing loss of patient confidence and damage to pride and self-esteem in the initial physician. To avoid these problems, the physician should look for the cause of the hypothyroidism, which is easily and reliably established in about 95% of patients. In the rare instance that one is not evident, it may be prudent for the primary care physician to seek consultation before prescribing lifelong thyroid hormone replacement therapy.

Diagnostic Errors↗
PubMed1989

Lymphadenopathy in primary biliary cirrhosis: CT observations.

The authors retrospectively evaluated computed tomographic (CT) scans obtained in 21 patients with primary biliary cirrhosis, 13 of whom subsequently underwent liver transplantation. Evidence of enlarged lymph nodes, primarily in the gastrohepatic ligament and porta hepatis, was seen on CT scans in 17 patients (81%). Lymphadenopathy also occurred in unusual sites for benign adenopathy, including the paracardiac (24%) and mesenteric (19%) lymph nodes. Surgical or autopsy confirmation of enlarged lymph nodes was made in 13 patients, and histologic analysis of the specimens revealed reactive hyperplasia, sinus hyperplasia, sinus histiocytosis, fibrosis, or normal architecture in these enlarged nodes. The authors conclude that lymphadenopathy is a frequent CT finding in primary biliary cirrhosis and that recognition can help prevent misdiagnosis of lymphoma or metastatic disease.

Adult↗
PubMed1989

Arthralgias as a presenting manifestation of primary biliary cirrhosis.

Two patients presenting with arthralgias had associated minor elevations in liver enzymes. Each patient's serum had a cytoplasmic pattern of fluorescence on HEp-2 cells which led to the detection of antimitochondrial antibodies. Liver biopsy in both patients revealed primary biliary cirrhosis. Awareness of this limited, articular presentation of primary biliary cirrhosis may result in early treatment and the potential to arrest liver damage in some patients.

Adult↗
PubMed1989

Treatment of recurrent thyroid cysts by injection of tetracycline or minocycline.

We analyzed the effects of tetracycline hydrochloride or minocycline hydrochloride sclerotherapy on 66 recurrent thyroid cysts. All were hemorrhagic lesions except one serous cyst; cytologic study showed all were benign. On average, three treatments were given until resolution or the patient became unavailable for follow-up. The cumulative frequency of cyst disappearance was 33%, 45%, 52%, and 59% after 1, 2, 3, and 4 treatments. Five additional patients had cyst resolution after six to 19 treatments, and the serous lesion did not resolve. Cysts requiring more than two treatments were larger at presentation than those resolving after one or two treatments. Side effects in 179 treatments were local pain lasting ten to 20 minutes in 4.5%, radiated pain lasting one to two hours in 4.5%, fatigue lasting one to two days in 3.9%, and a febrile sensation lasting one to two days in 2.8%. Hemorrhagic thyroid cysts can usually be cured by repeated tetracycline or minocycline sclerotherapy with tolerable side effects.

Cysts↗