Biomedical subjects

S Tibblin

Publications and source records attributed to S Tibblin.

94 records · Page 6Linked to original sources

PubMedDate not supplied

Neuroendocrine metastases of the liver.

Neuroendocrine liver metastases are rare, yet they represent an entity that has attracted much attention lately. The protracted course of neuroendocrine tumors and the hormone origin of their typical incapacitating symptoms constitute a logical basis for well founded and bespoke treatment. Demonstration of the liver secondaries is best done by ultrasonography (US) and contrast-enhanced computed tomography (CT), which on the whole have replaced the invasive angiography techniques. By use of histochemical and molecular biologic methods the exact nature of the tumor can be typified in tissue samples obtained percutaneously, laparoscopically, or surgically. Localization of nonpalpable metastases of the liver is best done by intraoperative US. Surgical removal of liver metastases is curative in some cases and is usually effective in relieving the symptoms. Also, palliative debulking or cytoreductive surgery is often worthwhile as it offers a chance of prolonged survival and symptom relief. Similar benefits are achieved by ischemic therapy preferably by temporary dearterialization, which in our department is done on an outpatient basis using a specially designed (externally controlled) occluder applied during a single laparotomy that includes debulking when appropriate as well as cholecystectomy. Hormonal therapy with somatostatin analogs may be used as a single treatment or in combination with ischemic therapy. It has an ensured symptom-reducing effect, whereas its influence on tumor growth is unsettled. Lately similar effects have been ascribed to human leukocyte interferon. In conclusion the specific characteristics of neuroendocrine tumors and the available treatment arsenal favor an active treatment approach in patients who have developed liver metastases.

Biopsy↗

PubMedDate not supplied

Side localization of parathyroid adenomas by simplified intraoperative venous sampling for parathyroid hormone.

Side localization of parathyroid adenomas was performed by venous sampling for intact parathyroid hormone (PTH) in 20 consecutive patients with primary hyperparathyroidism (pHPT) after induction of anesthesia. The results were thus available during surgery. Nineteen of the patients had solitary parathyroid adenoma, and one had hyperplasia. There was no complication to the procedure. A lateralizing PTH gradient for a parathyroid adenoma was obtained in 13 patients. At surgery 12 of them (92%) were proved correct; that is, the adenoma was localized on the same side. Thus the technique correctly lateralized the adenoma in 12 of 19 patients (63%). We therefore conclude that the method of intraoperative venous sampling for intact PTH is safe, and the predictive value of a lateralizing gradient is high. It could therefore be used as an adjunct to surgical skill and noninvasive localization procedures in selected cases, for instance in patients with prior neck surgery and hypercalcemic crisis.

Adenoma↗

PubMedDate not supplied

Indications for thyroxine therapy after surgery for nontoxic benign goitre.

Of 287 consecutive patients, surgically treated at our department for benign, nontoxic goitre during a six-year period, 261 could be followed up, on average, 8.0 years postoperatively. Unilateral surgical procedures had been used in 199 patients, subtotal thyroidectomy in 62. 29 patients were treated with thyroxine (T4) immediately postoperatively ("recurrence prophylaxis"); in the other patients thyroxine was only given in cases of hypothyroidism (significant increase of s-TSH). 26 patients had a goitre recurrence 0.5-10 years after surgery; of these 3 had got T4 as "recurrence prophylaxis" and 23 had not. There was no significant difference between patients with and without T4 postoperatively regarding the rate of recurrence. Of 55 patients treated with subtotal thyroidectomy, 33 had postoperative latent (n = 26) or manifest (n = 7) hypothyroidism. Only 13 of 177 patients operated on unilaterally developed hypothyroidism; two of these had Hashimoto's thyroiditis. All cases of hypothyreosis except 4 were detected within the first 12 months of follow-up. This study indicates that routine use of thyroxine as prophylaxis against recurrence after surgery for benign nontoxic goitre can be strongly questioned and that the risk of hypothyroidism is high after subtotal thyroidectomy.

Female↗

PubMedDate not supplied

Morphometric studies on nuclei in smears of fine needle aspirates from oxyphilic tumors of the thyroid.

Morphometry was applied to smears of fine needle aspirates from 26 oxyphilic thyroid neoplasms. Thirteen tumors were considered benign as judged from histologic findings and clinical follow-up for 2 to 20 years after the operation. Thirteen tumors were considered malignant histologically; four of these had proven metastases. In each case the mean and standard deviation of the projected nuclear area were calculated from 200 nuclei in the smear. Our results indicate that morphometric estimation of mean nuclear size and/or degree of anisokaryosis is of no practical value in distinguishing between benign and malignant thyroid neoplasms of the oxyphilic type.

Biopsy, Needle↗