An 88-year-old woman with tetraparesis after a fall.
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Biomedical subjects
Publications and source records attributed to B Klemenz.
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AIM: Of this study was to investigate the extent of thyrotropin (TSH) suppression and volume reduction in combination therapy of endemic goitre. We compared an individually adapted dose of thyroxine with a fixed dose. METHODS: 105 patients of a multicenter study (randomised, single blinded, controlled) received daily a weight-adjusted LT4-dose in combination with 150 micrograms iodide (group A) or a fixed combination of 100 micrograms LT4 plus 100 micrograms iodide (group B), respectively. At the beginning and after 12 weeks TSH-levels and goitre volume were examined. RESULTS: Although the amount of thyrotropin suppression showed no differences in both groups, there were more patients in the weight-adjusted treatment group with completely suppressed thyrotropin serum concentrations (p < 0.05). Both groups showed a reduction of goitre volume of 24% CONCLUSION: A weight-adjusted LT4-dose of 1.4 micrograms/kg body weight often leads to subclinical hyperthyroidism. To obtain low TSH-levels without complete suppression LT4-doses of 1.0 microgram/kg body weight plus 150 micrograms iodide are probably sufficient.
Plan Analysis, a method introduced by CASPAR (1989, 1996) to develop individual case conceptualizations for adult therapy, is an important diagnostical approach for the planning of child therapies, as well. Compared with the procedure for adults, the inferring of child plans requires partially modified strategies which are presented, discussed, and demonstrated by a concrete example of case conceptualization. Plananalytic developed case conceptualizations allow the derivation of general therapeutic change goals and modification strategies which are finally presented.
AIM: The incidence of functional autonomous adenomas, detected in every second nodular goiter by scintigraphic methods is very high in an area of iodine deficiency. The color-coded Doppler sonography (CCDS) as a diagnostic tool in differentiating thyroid nodules is discussed controversially. METHODS: In this prospective study we investigated the value of CCDS in 200 patients with nodular thyroid alterations compared with 99m-Technetium (Tc) scintigraphy. RESULTS: Focal maximas of Tc-uptake were detected in 22.5% of all patients, and 44.5% of the thyroid nodules showed increased vascularity. There was no correlation between nodular vascularity and thyroid 99m-Tc uptake (TcTU). In contrast to this we could demonstrate a significant relation between vascularity and the diameter of the nodule (p < 0.0001). The results are discussed in the context of method specific limitations of ultrasound examinations. CONCLUSION: Our results confirm that CCDS has no great importance in the differentiation of thyroid nodules. Scintigraphy remains the diagnostic method of choice to assess the topographic thyroid function.
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Computer access to the medical literature has become more convenient than ever with MEDLINE and other bibliographical databases available on CD-ROM. The benefits of literature searching by computer include improvements in the quality of medical decision making and cost effectiveness of patient care. However, the results obtained by physicians with amateur searching skills are often inferior to those obtained through the traditional service mediated by a skilled librarian. To ensure that future physicians develop the skills necessary for effective use of the medical literature, it is essential to provide training in literature searching by computer at medical school.
The Internet is rapidly expanding as an environment for electronic communication and resource sharing. The World Wide Web, a relatively new service on the Internet, provides access to a wealth of information resources through a simple point-and-click interface. Available resources of interest to physicians include bibliographical and statistical databases, literature reviews, discussion groups, press releases, newsletters, drug information, self-assessment questionnaires, multimedia textbooks, patient simulations, clinical decision aids, educational software, and much more. Access to the Internet is widely available in universities and medical libraries; physicians working at home can gain access from a personal computer linked by a modem to a telephone line, by subscribing to an Internet service provider.