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Biomedical subjects

A Diethelm

Publications and source records attributed to A Diethelm.

7 recordsLinked to original sources
PubMed2000

Extent of surgery for intermediate-risk well-differentiated thyroid cancer.

BACKGROUND: Methods of assigning patients with papillary or follicular thyroid cancer (well-differentiated thyroid cancer) to risk groups for the purpose of determining appropriate therapy have been developed. Despite these efforts, the optimal extent of surgery for intermediate-risk patients remains controversial. METHODS: A retrospective study was conducted of 208 patients with well-differentiated thyroid cancer (DTC) from two institutions. Univariate and multivariate analysis of patient- and tumor-related variables was performed. A regression model was obtained, three risk groups (low, intermediate, and high) were defined, and survival curves were generated. RESULTS: Prognostic variables were age (P <0.001), distant metastases (P <0.001), tumor size (P <0.001) and an aggressive growth pattern (P = 0.03) by univariate analysis and age (P <0.001) and distant metastases (P <0.001) by multivariate analysis. Tumor size (P = 0.07) was included in the regression model. Total thyroidectomy appeared to provide a survival advantage for intermediate risk patients. High-risk patients treated by lobectomy had a poorer prognosis. CONCLUSIONS: Total thyroidectomy may provide a survival advantage for intermediate-risk patients with DTC. A prospective randomized trial with 200 such patients is required to confirm this finding.

Adenocarcinoma, Follicular↗
PubMed1994

[Cholesterol crystal embolisms due to systemic thrombolysis of an acute myocardial infarct].

A 63-year-old male patient admitted with acute inferior myocardial infarction was treated with tissue plasminogen activator (rt-PA) and heparin. 4 hours after the initiation of the rt-PA infusion he showed painful cutaneous alterations on the lower trunk, mistaken as drug-induced rash and later correctly identified as livedo reticularis. Simultaneously, renal function deteriorated. Assuming hypersensitivity vasculitis, we instituted immunosuppressive treatment which proved to be ineffective. Skin biopsy including the deeper layers showed multiple cholesterol emboli. Anticoagulants were stopped and we noticed no further cholesterol embolism or further decline of renal function. 10 previous publications have mentioned a causal relationship between systemic fibrinolytic treatment and the cholesterol crystal embolism syndrome. In 7 cases, however, angiographic procedures were used or the interval between fibrinolysis and the occurrence of cholesterol crystal embolism was too long to exclude spontaneous or heparin-induced cholesterol crystal embolism. The short interval in our own case points clearly to the systemic fibrinolytic therapy as the culprit. We would like to draw attention to the possibility that in individuals with advanced atherosclerotic lesions of the aorta or major arteries, systemic fibrinolytic treatment of myocardial infarction may give rise to the cholesterol crystal embolism syndrome.

Embolism, Cholesterol↗
PubMed1987

Early graft function.

1. Most of the first rejections occurred between the first and third weeks after transplantation, with the peak at 7 days. 2. Average serum creatinine values of 2 mg/dl were achieved in 2 days for living-related donor transplants. Cadaver donor grafts reached an average of 4 mg/dl by the tenth day, but in patients without rejection serum creatinine values of almost 2 mg/dl were achieved. 3. Cadaver donor grafts with cold ischemia times less than 12 hours led to the best early serum creatinine values. Cold ischemia times up to 48 hours and possibly beyond led to slightly higher creatinine levels but did not produce damage in proportion to the cold ischemia time. 4. Patients who were sensitized to more than 50% of the panel showed evidence of sensitization by having higher serum creatinine levels from one week to 3 weeks. 5. Even in the first few days after transplantation with a cadaver donor, black recipients had a higher serum creatinine than white recipients. The donor's race did not have a marked effect. 6. CsA doses given to cadaver donor recipients were about 2-4 mg/kg higher than living-related donor transplants. Patients experiencing a rejection episode were found to have been treated with about 1 mg/kg more than those without rejections. The corresponding blood levels of CsA were higher in the cadaver donor grafts and those with rejections. 7. Early serum creatinine levels were very strongly correlated with the one-year graft survival rate. Even one day after transplantation, the difference between patients with the best and worst one-day serum creatinine levels was as much as 30% in the one-year graft survival rate. At 2 weeks, the group with the best serum creatinine had a one-year survival rate that was 50 percentage points higher than the worst creatinine group. At one month, the best serum creatinine group had a one-year survival rate that was about 80 percentage points higher than the worst serum creatinine group. 8. Patients with high CsA levels of over 400 ng/ml in the early one-month posttransplant period, had poorer one-year graft survival than those with lower levels. The optimum level appeared to be less than 100 ng/ml by the tenth day and about 100-200 ng/ml to the third week posttransplant.(ABSTRACT TRUNCATED AT 400 WORDS)

Creatinine↗