Biomedical subjects

R H Caplan

Publications and source records attributed to R H Caplan.

58 records · Page 4Linked to original sources

PubMedDate not supplied

Thyroxine toxicosis. A common variant of hyperthyroidism.

To determine the frequency of thyroxine (T4) toxicosis, we calculated a free triiodothyronine index (FT3I) on 124 patients who displayed elevations of the free T4 index (FT4I) on initial screening. If the clinical presentation was not characteristic of hyperthyroidism or if the FT3I was not elevated, a thyrotropin-releasing hormone (TRH) test was performed. Of 83 hyperthryoid patients, 70 displayed elevations of both the FT4 and FT3 indices. Thirteen patients, however, had elevations of the FT4I alone. This frequency of T4 toxicosis is higher than generally appreciated. Forty-one patients, most of whom were ill with nonthyroidal diseases, had normal TRH test results and were classified euthyroid. We conclude that FT4I elevations owing to T4 toxicosis and nonthyroidal illnesses are common and that the laboratory differentiation between the syndromes may be difficult.

Adolescent↗

PubMedDate not supplied

Elevation of the free thyroxine index in psychiatric patients.

We calculated a free triiodothyronine (FT3) index on 124 patients who exhibited symptoms and signs of hyperthyroidism and elevations of the free thyroxine (FT4) index on initial screening. A thyrotropin-releasing hormone (TRH) test served as the final arbiter of thyroid function if the clinical presentation was not characteristic of hyperthyroidism or if the FT3 index was not elevated. Forty-one of the 124 patients had normal TRH tests and were thus classified as euthyroid. Of these patients with the so-called euthyroid sick syndrome, 23 had psychiatric disorders. In a separate study, we measured a FT4 index on 100 unselected admissions to the psychiatric ward. Of six patients with elevated FT4 values, only one had hyperthyroidism. We conclude that false positive FT4 index elevations occur commonly in psychiatric patients. The mechanism(s) for the FT4 index elevations remain obscure. Despite some limitations, the TRH test is a valuable diagnostic adjunct for diagnosing hyperthyroidism in the mentally ill patient when other tests and serial observations are inconclusive.

Adolescent↗

PubMedDate not supplied

Constant intravenous insulin infusion during labor and delivery in diabetes mellitus.

We treated 30 diabetic women (31 pregnancies) during the peripartum period with a continuous insulin infusion. A mean infusion rate of 1.0 micron/h maintained the mean plasma glucose concentration below 100 mg/dl in 84% of the patients; the plasma glucose concentration was below 100 mg/dl within an hour of delivery in 71% of the women. Mild hypoglycemia developed during the infusion in three women and after delivery in another patient. Only two infants of the diabetic mothers developed transient and asymptomatic hypoglycemia. We conclude that continuous insulin infusion is a practical, safe, and effective method for treating diabetic mothers during the peripartum period and suggest that this technique may decrease the frequency and severity of neonatal hypoglycemia.

Blood Glucose↗

PubMedDate not supplied

Diffuse sclerosing variant of papillary thyroid carcinoma: case report and review of the literature.

OBJECTIVE: To describe a patient with a diffuse sclerosing variant of papillary (DSVP) thyroid cancer and to summarize the reported clinical manifestations and treatment of other patients with this malignant tumor. METHODS: We reviewed the pathologic findings in a 14-year-old girl, who had survived for 19 years after treatment of a presumed undifferentiated thyroid cancer. When reassessment revealed histologic features of DSVP cancer, we reviewed the case reports of this type of malignant lesion identified from a MEDLINE search of articles published between 1985 and 1995. RESULTS: Review of the pathologic features showed a diffuse tumor in the thyroid gland without an identifiable mass and extensive bilateral lymph node metastatic lesions. Histologic examination disclosed pronounced fibrosis, numerous psammoma bodies, primarily a solid growth pattern, lymphocytic infiltration, and extensive invasion of lymphatic spaces. The nuclear features were characteristic of papillary carcinoma. Review of 63 cases of DSVP cancer indicated that this variant accounted for 0.2 to 5.7% of papillary cancer, affected primarily young women, and usually manifested with diffuse involvement of one or both thyroid lobes. Thyroid antibodies were frequently detected in the serum. Cervical lymph node metastatic lesions, local invasion, and distant metastatic involvement were described in 75, 35, and 16% of patients, respectively. Although the cancer recurred in 37% of patients, only two died of this malignant tumor. CONCLUSION: DSVP cancer can be confused with nontoxic goiter, chronic thyroiditis, nonthyroidal malignant tumors, or undifferentiated thyroid cancer. We suggest that the same therapy used for young patients with conventional papillary thyroid cancer is also appropriate for most patients with the diffuse sclerosing variant.

Journal Article↗