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Biomedical subjects

N W Thompson

Publications and source records attributed to N W Thompson.

At least 163 records · Page 9Linked to original sources
PubMed1984

Secretory diarrhea with islet cell hyperplasia and increased immunohistochemical reactivity to serotonin.

Two patients with secretory diarrhea and signs and symptoms consistent with the Verner-Morrison syndrome and islet cell hyperplasia are described. Both patients responded well to subtotal pancreatectomies. The morphologic changes in the pancreata were characterized by proliferation of islets associated with periductal and interstitial fibrosis. Immunohistochemical stains demonstrated increased staining for serotonin in islet cells. A few islet cells also stained for vasoactive intestinal polypeptide. The significance of these results is discussed.

Adenoma, Islet Cell↗
PubMed1984

An immunohistochemical study of pheochromocytomas.

Twenty -six adrenal pheochromocytomas and four normal adrenal medullae were studied immunohistochemically. These included four malignant tumors with proven metastases, six tumors in patients with neurofibromatosis, nine tumors in patients with multiple endocrine neoplasia type 2, and seven sporadic nonfamilial pheochromocytomas. Immunohistochemical localization of neuron-specific enolase (NSE) was seen in all tumors and in the four normal adrenals. Methionine enkephalin-like immunoreactivity was present in tumors from all four groups and in the normal adrenals. Corticotropinlike immunoreactivity was found focally in two normal adrenal medullae and in four benign pheochromocytomas. Our results indicated that NSE was present in all four major groups of pheochromocytomas, including benign and malignant tumors. This marker aided in distinguishing between adrenal cortical and medullary tumors in unusually difficult cases, since all normal adrenal cortex and adrenal cortical tumors had negative test results for NSE.

14-3-3 Proteins↗
PubMed1984

Follicular carcinoma of the thyroid gland: trends and treatment.

Pure follicular carcinoma of the thyroid gland has become a relatively uncommon type of primary thyroid neoplasm in the United States. During a 20-year period (1962 to 1982) 37 cases of pure follicular carcinoma were treated at the University of Michigan Medical Center. Cases of the follicular variant of papillary carcinoma and Hürthle cell carcinoma were excluded. There were 26 women and 11 men in the series. The mean ages were 46.9 +/- 17.5 and 45.3 +/- 11.5 years, respectively. The overall, mean age was 46.4 +/- 15.9 years. Surgical treatment included total thyroidectomy in 83.8% of the cases. Seventy-six percent of the patients were treated after operation with 131I irradiation. The mean total dose was 230.5 mCi. Three patients (8.1%) had regional lymph node involvement. Six patients (16.2%) had distant metastases to bone and/or lung at the time of diagnosis. Seven patients (18.9%) died after a mean survival of 7.7 years. Six patients (16.2%) died of their disease. Twenty-nine patients (78.4%) are alive and disease free after a mean follow-up interval of 11.8 years. Pure follicular carcinoma is decreasing in incidence and usually occurs at an older age than do other forms of differentiated thyroid cancers. It is frequently more aggressive than papillary carcinoma although lymph node metastases are less common. Total thyroidectomy and 131I therapy are the recommended treatments since metastases to bone and/or lung are the usual locations of distant spread. Bone metastases are rarely if ever cured. However, excellent long-term palliation may be achieved.

Adenocarcinoma↗
PubMed1983

Total thyroidectomy for Hürthle cell neoplasm of the thyroid.

The treatment of Hürthle cell neoplasms of the thyroid is controversial because of a lack of information about their clinical behavior and long-term follow-up. We reevaluated our experience of the past 33 years and compared our early experience with the more aggressive surgical approach used during the past ten years. We treated 62 patients with Hürthle cell neoplasm from 1949 through 1982. Twenty-six patients had benign neoplasms and 35 had malignant neoplasms proven by capsular or vascular invasion or nodal metastasis. Fourteen deaths were directly attributable to recurrent or metastatic disease, three among those with benign lesions. An aggressive surgical approach, involving total thyroidectomy or early-completion total thyroidectomy following lobectomy for all tumors histologically malignant or larger than 2 cm, resulted in a lower recurrence rate (21% v 59%) and fewer operations per patient (1.7 v 2.9) than in patients having other operations.

Adolescent↗
PubMed1983

Cervical metastases from small bowel carcinoid tumors.

Small bowel carcinoid tumors usually metastasize to regional lymph nodes and the liver but metastases to the neck are extremely rare. Over a ten-year period 48 cases of small bowel carcinoid were diagnosed at our institution and of these, three cases (6%) were associated with neck metastases--one to the thyroid gland and two to cervical lymph nodes. The former patient and one of the latter patients had symptoms of the carcinoid syndrome. The other patient was asymptomatic and presented with a solitary neck mass. Urine levels of 5-hydroxyindolacetic acid (5-HIAA) were elevated in the two symptomatic patients but were undetectable in the asymptomatic patient. Extirpation of the involved cervical nodes and the primary small bowel lesion was performed in two patients. In addition, both patients have received chemotherapy with 5-fluorouracil. One patient remains asymptomatic four years after diagnosis but the other patient continues to have five to six bowel movements per day nine months after operation. Small bowel resection was performed in the patient with a metastasis to the thyroid. This patient died of sepsis after a second operation for an intraabdominal abscess. The histological patterns of the primary tumor and the metastatic lesions were similar and the cells of the metastases contained argentaffin-positive granules. We conclude that 1) an intraabdominal carcinoid tumor should be considered as the location of the primary tumor in patients who present with a neck mass containing metastatic carcinoid and 2) the prognosis for patients with extraabdominal metastases is similar to that for patients with intraabdominal disease only.

Adult↗
PubMed1983

Angiographic detection of unsuspected carcinoma of the thyroid gland.

Angiography is seldom used to detect carcinoma of the thyroid. We have recently encountered four patients with hypervascular lesions of the neck demonstrated by angiography for evaluation of an unrelated medical problem. In each, carcinoma of the thyroid was detected and total thyroidectomy performed. Because of the possibility of carcinoma of the thyroid in patients with hypervascular lesions of the neck, we recommend exploration of the neck, regardless of symptoms, physical findings or scintiscan results.

Adenocarcinoma↗
PubMed1983

Rationale for the operative management of substernal goiters.

During the course of 872 thyroidectomies performed at the University of Michigan Medical Center between 1972 and 1982, 50 patients (5.7%) were found to have substernal goiters, 42 of which were benign and eight malignant (16%). Symptoms included airway compression (22 patients), dysphagia (13 patients), hoarseness (four patients), weight loss (three patients), and thyrotoxicosis (10 patients). Five patients with compression symptoms, four of whom had benign disease, had superior vena cava syndrome. Most patients were elderly (mean age 66 years), were women (3.2 women:1 man), and had long-standing goiters (mean duration 16 years). All but one operation was performed through a cervical incision. There were no intraoperative deaths. Complications were: pneumonia (one patient), wound hematoma (one patient), transient hypocalcemia (two patients), and atrial fibrillation (two patients). This series illustrates five reasons to support operative management. (1) There is no other treatment for long-standing large multinodular goiters. (2) Iodine 131, the alternative to operation for patients with large thyrotoxic goiters, can precipitate acute reactions in the elderly that can result in respiratory distress. (3) A long history of having a large multinodular goiter precluded neither malignancy, hyperfunction, nor complications such as tracheal or esophageal compression. (4) Malignancy occurs in a significant number of these lesions, which are inaccessible to needle biopsy. (5) Nearly all substernal goiters can be removed through a cervical incision. Presence of a substernal goiter is in itself an indication for operation.

Adult↗
PubMed1982

Treatment of adrenal carcinomas.

Twenty-three patients with adrenal carcinoma were treated between 1953 and 1981. Six patients underwent resection of the primary tumor and/or local radiation therapy but received no chemotherapy. Their mean survival (+/- SD) was 10.3 +/- 8.7 months. In contrast, 17 patients who were treated with mitotane had a mean survival of 46.6 +/- 42.7 months. Response to therapy depended on when in the course of the disease chemotherapy was instituted, and on the combination of surgical excision and drug treatment of recurrent disease. Longest survival was observed in patients who received mitotane as adjuvant therapy before clinical evidence of metastases was noted and in those who were treated with mitotane and underwent subsequent surgery for recurrent tumor. Mean survival for this group was significantly longer, 74 +/- 33 months, than for the other patients. Patients treated in this series received low-dose long-term therapy. Adverse effects of mitotane were found to be dose dependent.

Adrenal Gland Neoplasms↗
PubMed1982

Simultaneous presentation of untreated hyperparathyroidism and obstructing ureteral calculi: surgical considerations.

Simultaneous presentation of obstructing ureteral calculi and untreated primary hyperparathyroidism offers an interesting therapeutic dilemma. We herein review 8 cases, with 6 occurring in the last 3 years. When both conditions require surgical intervention the parathyroid adenoma should be excised first. The adenoma and offending stone can be removed at the same operation, with resultant prompt relief of pain and decrease in hospitalization.

Adult↗
PubMed1982

Localization of the source of hyperinsulinism: percutaneous transhepatic portal and pancreatic vein catheterization with hormone assay.

Insulin concentrations were measured in the portal venous system through the percutaneous transhepatic approach in 12 patients with organic hyperinsulinism. Single insulinomas were found in 10, an adenoma and islet cell hyperplasia in one, and nesidioblastosis in one patient. Angiography localized adenomas in two. Local step-ups of insulin levels in the portal venous system, found in all patients with insulinomas, corresponded to tumor sites at surgery. Multiple step-ups were found in the portal venous system of the patient with nesidioblastosis and the patient with an adenoma with islet cell hyperplasia. Three tumors were localized in the head of the pancreas which would indicate the primary surgical approach rather than blind resection of the body and tail. Three of the 10 adenomas were not identifiable by palpation after pancreatic mobilization during surgery. In all patients, organic hyperinsulinism was cured after surgery. Percutaneous transhepatic portal and pancreatic vein catheterization with measurement of radioimmunoactive insulin concentrations is a safe and reliable method and may play an important role in the localization of adenomas in patients with normal angiographic studies and previous negative surgical explorations.

Adenoma↗
PubMed1982

Radioimmunoassay of serum parathyrin: comparison of five commercial kits.

We compared serum parathyrin radioimmunoassay data obtained with five commercially available kits for normal subjects, patients on dialysis, and patients with hyperparathyroidism. The Cambridge Nuclear kit gave low results, did not distinguish the dialysis-group sera from the normal sera, and had the greatest CV (56%) both inter- and intra-assay. The Immuno Nuclear PTH-II kit gave more satisfactory clinical data than their PTH-C-terminal kit; however, as with most procedures involving a substantial and variable nonspecific binding correction for each serum, parallelism between samples and the standard curve was poor, turnaround time slow, and inter-assay CV high (39%). Unlike the other kits, the Nichols and the Iso-Tex products depend on a direct methodology; they displayed good parallelism and distinguished among our three populations. A Scatchard plot of results with the Nichols kit was closest to the ideal linear model; the Iso-Tex kit had the shortest turnaround time.

Dialysis↗
PubMed1982

Survival time and "cure" in papillary and follicular thyroid carcinoma with distant metastases: statistics following University of Michigan therapy.

Between 1947 and 1980, 103 patients with well-differentiated thyroid carcinoma with metastases outside the neck were treated with sodium iodide (I-131) after surgical treatment. Forty-one patients had distant metastases first detected an average of 7.44 yr after the initial operation establishing the diagnosis of thyroid carcinoma. Follicular and papillary carcinomas gave the same survival time in patients, matched for age and sex, who had metastases outside the neck. Those considered to be free of their metastatic disease after I-131 therapy survived three times as long as those with persistent disease. Patients freed of their metastases had a higher conformity rate with half of our ten procedures of "ideal" treatment, compared with patients not freed of their metastases.

Adenocarcinoma↗
PubMed1982

Familial hyperparathyroidism caused by solitary adenomas.

Most cases of familial hyperparathyroidism are due to diffuse chief cell hyperplasia. No documented cases of familial disease associated with single adenomas in which multiple glands have been biopsied have been reported. The family described here had solitary adenomas proven in four members. Biopsy of other glands showed normal parathyroid tissue. Despite careful evaluation, additional endocrinopathies have not been found during a 24-year follow-up.

Adenoma↗
PubMed1982

The anatomy of primary hyperparathyroidism.

Although several classic anatomic studies describing the number, location, size, and weight of normal parathyroid glands have been reported, as detailed description of the parathyroid glands in a large series of patients with primary hyperparathyroidism has not been available. Drawings were made of the exact locations of each of the normal and enlarged parathyroid glands identified, immediately following neck explorations in all patients with primary hyperparathyroidism during a 4-year period (1977 to 1981). The enlarged glands were also measured and weighed after excision. The records of 273 patients were reviewed. Single gland enlargement (adenoma) was found in 218 patients (80%). Hyperplasia of all identified parathyroid glands was found in 42 patients (15%). Two adenomas (at least two other glands grossly and microscopically normal) were found in seven patients (2.6%). Seven patients (2.6%) with biochemical evidence of the disease had only normal glands at neck exploration. Adenomas in ectopic locations were frequent. However, their locations, with few exceptions, were predictable. The larger an adenoma, the more likely it was to be ectopic. Right superior gland adenomas (mean size 2.6 cm) were ectopic in 39%. Left superior glands (mean size 2.62 cm) were ectopic in 36%. No superior parathyroid adenomas were intrathyroidal. five of 223 (2%) adenomas were entirely surrounded by thyroid parenchyma in the lower pole. Nearly all inferior gland adenomas within the thymus could be readily excised through the cervical incision. In the seven cases in which only normal parathyroids were identified, no fewer than three glands wer proven in each. Three patients have had subsequent mediastinal exploration and excision of an adenoma. This failure rate of cervical exploration (4%) is attributed to mediastinal adenomas, and a second adenoma, and incorrect diagnosis. An awareness of the frequency of ectopic adenomas and their usual locations is of considerable benefit to the surgeon. Identification of the normal glands is of great importance as the search for a specific missing gland (adenoma) can be conducted in a logical sequence based on anatomic and embryologic knowledge of the parathyroids.

Adenoma↗