Search PubMed⌕ Search

Biomedical subjects

N B Watts

Publications and source records attributed to N B Watts.

70 records · Page 4Linked to original sources
PubMed1989

Sialadenitis mimicking metastatic thyroid carcinoma.

In the post-thyroidectomy patient who has received I-131 ablation for thyroid carcinoma, focal uptake on repeat total body images is usually interpreted as being indicative of functioning thyroid metastases. The differential of focal I-131 activity in such a patient has been described. This report adds to the differential by presenting a case of benign sialadenitis that caused focal neck uptake a year after ablation therapy with I-131.

Carcinoma, Papillary↗
PubMed1989

Reversible impairment of gonadotropin secretion in critical illness. Observations in postmenopausal women.

Gonadotropin levels were measured in 65 postmenopausal women admitted to the intensive care unit. Sixteen patients (25%) were hypogonadotropic as measured by luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels of 5 IU/L or less, and only 20 patients (31%) were found to have gonadotropin levels within the expected postmenopausal range (greater than or equal to 30 IU/L). No significant differences in prolactin or free thyroxine levels were found, but the cortisol level was higher and the total thyroxine level lower in the hypogonadotropic group. The patients in the hypogonadotropic group also seemed more seriously ill, with a longer duration of hospitalization, an increased total number of days in the intensive care unit, an increased number of days in the intensive care unit before gonadotropin sampling, a higher incidence of parenteral hyperalimentation, lower serum albumin levels, and higher mortality. Stimulation of the gonadotropin-releasing hormone performed on 10 patients showed a blunted response in patients with baseline LH and FSH levels of 10 IU/L or less. Of 10 patients followed up sequentially, 6 showed a rise in gonadotropin levels that paralleled recovery, 1 died with low gonadotropin levels, and 3 continued to have low gonadotropin levels 17, 34, and 82 days, respectively, after initial screening. Critically ill postmenopausal women may exhibit a marked fall in gonadotropin, LH, and FSH levels. This disease in gonadotropin levels in response to illness is reversible and results from pituitary unresponsiveness to gonadorelin hydrochloride.

Aged↗
PubMed1989

Use of a sensitive thyrotropin assay for monitoring treatment with levothyroxine.

To determine if a sensitive assay for thyrotropin (thyroid-stimulating hormone [TSH] ) would be useful as a primary test to determine optimal doses of levothyroxine, an enzyme immunoassay for TSH that discriminated hyperthyroid from euthyroid subjects with no overlap was compared with radioimmunoassays for TSH and thyroxine (T4) and the calculated free thyroxine index (FTI) in 100 patients receiving stable doses of levothyroxine. The basal TSH level, determined with the sensitive assay, predicted the TSH response to thyrotropin-releasing hormone (TRH); all patients whose basal TSH level was less than 0.35 mU/L had absent or subnormal responses, and all patients with TSH levels of 0.35 mU/L or greater had normal responses. In patients with normal TSH levels, the T4 level and FTI were superfluous (normal) or misleadingly high; conversely, 65% of patients with low TSH levels had normal T4 levels or FTIs, or both. An assay for TSH with sufficient sensitivity to discriminate between abnormally low values and the low range of normal can be used as the primary test for monitoring levothyroxine treatment. The T4 or FTI measurements are not needed if the TSH level is normal, but they should be done in patients with low TSH levels.

Dose-Response Relationship, Drug↗
PubMed1988

Rapid assessment of corticotropin reserve after pituitary surgery.

Corticotropin deficiency may occur after pituitary surgery, and, if unrecognized and untreated, it can be fatal. In this study the insulin tolerance test was used to assess hypothalamic-pituitary-adrenal reserve five to seven days after pituitary surgery, and postoperative morning serum cortisol concentration was compared with the insulin tolerance test for predicting corticotropin deficiency. In 35 patients with pituitary tumors studied prospectively, 27 had normal insulin tolerance test results five to seven days after pituitary surgery; in these patients, the morning serum cortisol concentration two to three days after surgery was 250 nmol/L (9 micrograms/dL) or greater. Eight patients had subnormal insulin tolerance test results or clinical evidence of adrenal insufficiency; the morning serum cortisol concentration in these patients was 80 nmol/L (3 micrograms/dL) or less. Postoperative adrenal insufficiency was transient (one to three months) in five of these eight patients. We retrospectively identified 45 patients whose postoperative morning serum cortisol values were 200 nmol/L (7 micrograms/dL) or greater; none of these patients had clinical evidence of adrenal insufficiency. We conclude that a morning serum cortisol level obtained two to three days after surgery and 24 hours after the discontinuation of hydrocortisone accurately predicts postoperative corticotropin reserve.

Adenoma↗
PubMed1988

Carcinomatous involvement of the thyroid presenting as subacute thyroiditis.

Carcinomatous involvement of the thyroid is a most unusual cause of hyperthyroidism and thyroiditis, with only a few cases reported in the literature. The authors present a 35-year-old woman with signs, symptoms, and laboratory findings of hyperthyroidism, and subacute thyroiditis that was due to extensive replacement of the thyroid gland by adenocarcinoma (shown by fine needle aspiration). After chemotherapy with vincristine and cisplatin, the swelling of the thyroid resolved, thyroidal uptake of radioactive iodine increased, and mild hypothyroidism developed. Despite the improvement in her thyroid status, she died from progressive malignancy. This case illustrates the value of fine needle aspiration cytology where doubt exists in the diagnosis of thyroid disorders.

Adenocarcinoma↗
PubMed1988

Osteoporosis.

Although powerful tools are available for the measurement of bone density, the diagnosis of osteoporosis is still made largely on clinical grounds. Bone density measurement is not recommended for routine screening, but it may be useful in deciding whether to treat high-risk patients and in following the effects of treatment. Estrogen therapy is used for the prevention of osteoporosis in women with early menopause and as treatment within five to seven years of menopause. Several agents currently being tested offer promise in restoring normal strength to osteoporotic bone.

Aged↗
PubMed1988

Medical relevance of laboratory tests. A clinical perspective.

To address the role of proficiency testing in the medical usefulness of laboratory tests, nine steps involved in the generation and application of a laboratory test result are identified and discussed: test ordering, patient preparation, specimen, sample, analysis, result, reporting, recognition, and action. Clinical uses of test results are enumerated. Good clinical skills are necessary for optimal test efficiency. Clinicians should improve their selection of tests, pay attention to proper patient preparation, and refine the process of interpretation of test results using disease-based reference ranges and more formal analysis of predictive value. By better definition of the clinical uses of laboratory tests, appropriate attention can be directed to steps in the laboratory domain such as medically relevant goals for accuracy and precision. With clearer understanding of the testing process, proficiency testing for monitoring laboratory performance can be more fully utilized. Audit models should be developed that include assessment of the outcome of the laboratory testing process.

Clinical Competence↗
PubMed1987

Carcinoma metastatic to the thyroid: prevalence and diagnosis by fine-needle aspiration cytology.

Although metastatic involvement of the thyroid is not commonly considered in the differential diagnosis of a patient with a thyroid mass, such involvement may be more frequent than has been previously appreciated. To evaluate the prevalence of this disorder, all patients with thyroid nodules referred in a 12-month period underwent fine-needle aspiration, regardless of history or scan results. Seventy patients were studied, six of whom had a previous history of malignant disease. Two of the latter had coincidental thyroid disease, but four (5.7% of the total series) had carcinoma metastatic to the thyroid gland. Two of these patients had had no evidence of malignancy for years prior to the appearance of the thyroid metastases. In one case, the metastasis was a functioning nodule. Fine-needle aspiration cytology provided prompt and accurate diagnosis in all patients. We conclude that metastatic carcinoma to the thyroid is not rare, its presentation may be confused with primary thyroid disease, and fine-needle aspiration cytology is the procedure of choice in such cases, and should be done early in the evaluation of all patients with thyroid nodules, regardless of the presumed etiology or function by scan.

Adenocarcinoma↗
PubMed1986

Nonmetastatic bladder cancer associated with hypercalcemia, thrombocytosis and leukemoid reaction.

We reviewed 4 patients with urothelial bladder cancer and hypercalcemia but without evidence of bony metastasis. Of the patients 2 presented with a leukemoid reaction (1 also had thrombocytosis). None of the patients had evidence of bone metastases or other causes of hypercalcemia, such as hyperparathyroidism, sarcoidosis or vitamin D intoxication. All 4 patients received aggressive therapy for the tumors. In each instance the serum calcium returned to normal following radiation therapy or tumor removal, lending support to the theory of humoral hypercalcemia of cancer. A diagnostic and therapeutic approach to such patients is outlined.

Aged↗
PubMed1984

Contractile function and rhythmicity of cardiac preparations from Escherichia coli endotoxin-shocked guinea pigs.

Isovolumic left ventricular (LV) preparations were isolated from guinea pigs 16-18 hr after IP injection of either saline (control groups) or 4 mg/kg of Escherichia coli endotoxin (shock groups). The tissues were then subjected to mechanical performance comparisons in a carefully regulated coronary perfusion system. Endotoxicosis consistently resulted in myocardial contractile dysfunction as evidenced by significantly low values for LV systolic pressure and maximal rates of LV pressure rise (+dP/dtmax) and fall (-dP/dtmax). There was a distinct tendency for spontaneous tachybradydysrhythmias in the shock groups, but the LV contractile deficit was not dependent upon beating frequency. Also, LV function curves (systolic pressure vs end-diastolic pressure) generated by shock hearts were shifted downward and to the right of control curves, in the direction of inotropic failure. Thus, cardiodynamic adjustments during endotoxin shock may reflect and be limited by underlying dysfunction intrinsic to the heart itself; by 16-18 hr, the resulting functional changes in LV myocardium are manifested in an isolated environment and do not depend on depressive constraints operative in the intact host.

Animals↗
PubMedDate not supplied

Esterified estrogen therapy in postmenopausal women. Relationships of bone marker changes and plasma estradiol to BMD changes: a two-year study.

OBJECTIVE: To determine the relationships among bone mineral density changes, bone marker changes, and plasma estrogens in postmenopausal women receiving estrogen replacement therapy. DESIGN: A total of 406 postmenopausal women received 1,000 mg calcium and continuous esterified estrogens (0.3 mg, 0.625 mg, or 1.25 mg) or placebo daily for up to 24 months. Bone mineral density and bone marker measurements were determined at 6-month intervals; plasma estrogens were measured in a subset after 12, 18, and 24 months. RESULTS: Esterified estrogens produced significant increases in bone mineral density (lumbar spine, hip) compared with baseline and placebo at 6, 12, 18, and 24 months. Bone markers decreased from baseline with all esterified estrogen doses relative to placebo. Bone marker changes at 6 months correlated negatively with bone mineral density changes at 24 months (correlation coefficient range = -0.122 to -0.439). The strongest correlation was noted for spine bone mineral density changes and serum osteocalcin. Mean plasma estrogen levels increased with esterified estrogen dose, and bone mineral density changes correlated positively with plasma estrogen levels. Positive bone mineral density changes were noted in treatment groups with plasma estradiol levels at and above 25 pg/mL. CONCLUSIONS: Esterified estrogens, at doses from 0.3 mg to 1.25 mg/day, unopposed by progestin, increase bone mineral density of the spine and hip in postmenopausal women. These bone mineral density changes correlated significantly with bone marker changes at 6 months and with plasma estrogens at 12, 18, or 24 months. Data variability minimizes the predictive value of the bone marker changes in monitoring individual therapy.

Absorptiometry, Photon↗
PubMedDate not supplied

Postoperative management of diabetes mellitus: steady-state glucose control with bedside algorithm for insulin adjustment.

An algorithm was developed to determine whether an individualized insulin infusion could maintain plasma glucose in a desirable steady state after surgery. In 24 patients, insulin was provided according to a "glucose-feedback" formula to maintain plasma glucose between 120 and 180 mg/dl (6.7-10.0 mM). Initial plasma glucose was elevated, 218 +/- 16 mg/dl (mean +/- SE 12.1 +/- 0.9 mM), but reached the target range after 8 h and remained steady for the rest of the study period. Insulin requirements varied considerably, 0.5-5.0 U/h. Infusion rates were correlated with initial plasma glucose but not with previous insulin dose, HbA1c, or percent ideal body weight. Although insulin needs cannot be predicted, plasma glucose can be maintained in a desirable range after surgery via a simple formula suitable for implementation by general ward nurses.

Adult↗