Biomedical subjects
C Reiners
Publications and source records attributed to C Reiners.
[Radioiodine therapy of Graves' disease--quality assurance and radiation protection].
Radioiodine (I-131) is used successfully since more than 50 years for treatment of hyperthyroidism in Graves' disease. In the USA, more than half of the patients with a Graves' hyperthyroidism are treated primarily with radioiodine, whereas in Europe the frequency is less than a quarter of the patients. In Germany consensus could be achieved, the antithyroid drugs are indicated in patients with manifest hyperthyroidism to induce euthyroidism before radioiodine treatment. Typical indications for radioiodine treatment are: Treatment with antithyroid drugs without success for more than one year, drug-incompatibility and increased risk for surgery. In relation to the radiation dose applied, hyperthyroidism is eliminated after radioiodine treatment; in 80-100% of the patients the incidence of hypothyroidism ranges between 50 and 100%. In Germany, for reasons of quality assurance and radiation protection, radioiodine treatment is carried out in hospitals with wards equipped with radiation protection facilities; fractionated treatment with radioiodine is not allowed. Due to recent changes in radiation protection regulations, patients can be dismissed earlier from the wards than before; the mean duration of stay could be decreased from 10-12 to 3-4 days. Radioiodine treatment is safe and has only few side effects. However, patients have to be followed-up for life. Considering the cost-benefit-relation, radioiodine treatment has advantages especially in patients with small goiters as compared to surgery.
[Procedures for thyroid scintigraphy].
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[Procedures for the radioiodine test].
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[Procedures for iodine-131 whole body scintigraphy in the differential diagnosis of thyroid cancer].
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[Guidelines in thyroid diagnosis].
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[Guidelines for radioiodine therapy (RIT) in benign thyroid diseases].
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[Guidelines for radioiodine therapy (RIT) in differentiated thyroid cancer].
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[Guidelines for radiosynorviorthesis].
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Is the UICC/AJCC classification of primary tumor in childhood thyroid carcinoma valid?
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Clinical experience with recombinant human thyroid-stimulating hormone (rhTSH): whole-body scanning with iodine-131.
Whole-body scanning (WBS) with iodine-131 (I-131) is currently used together with serum thyroglobulin (Tg) measurement in the diagnostic follow-up of well-differentiated thyroid carcinoma. One of the main disadvantages of I-131 WBS is its requirement of repeated weeks-long withdrawal of thyroid hormone suppression therapy (THST) to raise endogenous thyroid-stimulating hormone (TSH) production. This results in hypothyroidism and associated abnormalities, discomfort and morbidity. Recently, however, a series of multicentre clinical studies established the efficacy, safety, non-antigenicity, and quality of life benefits of recombinant human TSH (rhTSH, Thyrogen, thyrotropin alfa, Genzyme Corporation, Cambridge, MA, USA) in promoting radioiodine uptake and permitting sensitive I-131 WBS in patients on THST after initial therapy of well-differentiated thyroid cancer. Thus in everyday practice, rhTSH administration may in many cases supersede THST withdrawal as a preparative method for I-131 imaging. With the use of rhTSH, as whenever I-131 WBS is performed, useful and accurate imaging requires meticulous attention to good scanning practices. These include use of appropriate equipment, proper timing, sufficient scanning time, vigilance against artifacts and iodine contamination, and consideration of additional imaging in the case of ambiguous 48-hour scans. Whole-body retention of I-131 is approximately 50% greater during hypothyroidism after THST withdrawal than during euthyroidism on THST and rhTSH. Therefore, it is important to use an adequate diagnostic activity of > or =4 mCi (148 MBq) to compensate for the faster radioiodine clearance in the euthyroid state permitted by rhTSH administration. Ongoing dosimetric research eventually may provide more specific guidance regarding radioiodine activities for diagnostic, and, particularly, therapeutic purposes, with the use of rhTSH.
The role of recombinant thyroid-stimulating hormone (rhTSH) in the detection and management of well-differentiated thyroid carcinoma: a roundtable discussion.
A Roundtable meeting of European endocrinologists and nuclear medicine physicians recently examined the role of recombinant human thyroid-stimulating hormone (rhTSH, Thyrogen, thyrotropin alfa, Genzyme Corporation, Cambridge, MA, USA) in the detection and management of well-differentiated thyroid carcinoma. The meeting sought to review clinical work to date and to provide guidance and perspective on the agent's application in everyday practice. The Roundtable included a panel discussion centering on three major topics: 1) rationale for use of exogenous versus endogenous TSH stimulation of radioiodine uptake and thyroglobulin (Tg) production; 2) impact and use of rhTSH in diagnostic follow-up; and 3) role of rhTSH in radioablation. The panel concluded that obtaining TSH stimulation of radioiodine uptake and Tg production exogenously with rhTSH obviates the weeks-long withdrawal from thyroid hormone suppression therapy (THST) needed to obtain such stimulation endogenously. rhTSH administration thereby eliminates morbidity, discomfort and uncertainties of compliance and timing associated with THST withdrawal. Thus compared to withdrawal, rhTSH administration offers important advantages in safety, quality of life, reliability, predictability and convenience to patients and care providers. rhTSH therefore represents a major advance in the diagnostic follow-up of well-differentiated thyroid cancer. By increasing the sensitivity of serum Tg testing during THST, rhTSH administration also improves the sensitivity of diagnostic follow-up. In addition, heightening the sensitivity of Tg testing may permit more selective application of iodine-131 whole body scanning, decreasing the invasiveness of diagnostic follow-up. Clinical studies are underway to confirm the preliminary promise of rhTSH as an adjunct to radioablation of normal or neoplastic thyroid tissue, with emphasis on the therapeutic setting.
131I therapy of thyroid cancer patients.
Thyroid cancer is a rare malignancy with wide interethnic and geographic variations. In Germany thyroid carcinoma is the 13th most frequent malignancy (2.7 new cases yearly per 100,000 inhabitants). The overall temporal incidence is increasing slightly in recent years. The most common types of cancer are papillary (60-80%) and follicular cancers (10-20%). The relevant prognostic indicators are tumor stage and distant metastases. The mean survival rates in papillary thyroid cancer usually exceed 90%, whereas in follicular thyroid cancer they amount to approximately 80%. The standard treatment procedure in differentiated papillary and follicular thyroid cancer consists of total thyroidectomy followed by adjuvant ablative therapy with radioiodine. Only in papillary thyroid cancer stage pT1N0M0 lobectomy alone is considered to be appropriate. In patients with locally invasive differentiated thyroid cancers stage pT4 adjuvant percutaneous radiation therapy is a treatment option. Radioiodine therapy has to be performed under the stimulative influence of TSH. Usually TSH suppressive medication with Levothyroxine has to be withdrawn approximately 4 weeks prior to radioiodine therapy. In the future, exogenous stimulation by recombinant TSH may be used instead of thyroid hormone withdrawal. It has been proven by different studies that ablative radioiodine therapy reduces the frequency of recurrences and tumor spread in patients with thyroid cancer significantly. In patients with distant metastases, up to 50% of complete responses may be achieved with radioiodine treatment.
Comparison of total and regional body composition in adolescent patients with anorexia nervosa and pair-matched controls.
Body composition in 31 adolescent girls suffering from anorexia nervosa (AN) was measured at the time of hospitalization in order to assess the muscle/bone relationship as a potential source of the development of osteopenia. Differences in lean tissue, fat and bone mass in total body, weight bearing and non weight bearing limbs were estimated in AN and pair-matched controls aged 14.2 +/- 1.8 years (range: 9-17 years). Further, it was investigated if bone mineral density (BMD) better reflects the muscle/bone relationship than bone mineral content (BMC). At the distal radius parameters measured by peripheral quantitative computed tomography (pQCT) were used to estimate the association of volumetric bone density to bone strength and lean body mass. The correspondence to the same and different body regions was assessed. Total lean mass in the controls was closely related to total body bone mineral content (TBBMC), as was lean tissue and bone mass of the limb subregions (r = 0.82 to 0.93). In contrast, the correlation was significantly lower in AN (r = 0.33 to 0.77). In the controls, the pQCT-derived bone strength was correlated with muscle mass of the forearm (r = 0.78, p < 0.001), but only moderately in AN (r = 0.47, n.s.). Regional lean tissue was 11-20% and fat mass was 56-66% lower in AN (p < 0.01). After adjustment for height, TBBMC was different at p = 0.01. Within the limbs subregions, BMC (but not BMD) was different in both groups only in the upper arm and the thigh. BMC reflected the bone/muscle relationship better than BMD. Intra- and between group regressions gave no significant differences between weight bearing and non weight bearing limbs. In conclusion, the assessment of musculoskeletal factors may be a useful tool to develop individual preventive measures for therapy after recovery of our patients.
[Sequelae of Czernobyl].
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Redifferentiation therapy with retinoids: therapeutic option for advanced follicular and papillary thyroid carcinoma.
During the course of tumor progression the differentiated morphologic and functional characteristics of differentiated thyroid carcinomas (DTC) disappear. This corresponds to more aggressive growth, metastatic spread, and loss of iodine uptake. Experimental data give strong evidence that differentiated functions of iodine metabolism can be reinduced by retinoic acids. Results of a study performed in patients with advanced DTC are presented. Twenty patients with DTC (eight follicular, seven papillary, five oxyphilic) were selected for treatment with retinoic acid 1.5 mg/kg body weight/day over 5 weeks. All patients had advanced tumor stages with prior operative and radioiodine treatment. Extensive tumor invasion, distant metastatic spread, or insufficient or no radioiodine uptake precluded any conventional therapeutic option. The aim was to assess the changes under retinoid treatment. Iodine uptake increased in eight patients (three follicular, three papillary, two oxyphilic). Thyroglobulin (TG) as parameter for tumor mass and differentiation increased in 12 (63%) patients, decreased in 6 (32%), and did not change in 1 (5%). Retinoids do have an effect on differentiation status of DTC, reinducing iodine uptake in 50% of patients. TG levels do not always parallel a response in iodine uptake.
Differentiated thyroid cancer in children and adolescents.
INTRODUCTION: There have been only a few studies on differentiated childhood thyroid cancer (DTC) in children and adolescents. METHODS: We analyzed the characteristics of DTC with respect to age, gender and histology in 114 patients under 18 years of age. In a questionnaire-based survey, data of 114 patients, aged between 3 years and 18 years, was collected from 65 clinical institutions in Germany. Characteristics of 80 females and 34 males were evaluated, and the prognostic effect of age, gender, histology, multicentric growth, tumor stage and N-status on distant metastases was tested using multivariate discriminant analysis. Between-group comparison was performed using student t-test and chi-squared test. RESULTS: The incidence of DTC in females was higher than in males with a peak of female:male ratio at puberty, which was more pronounced in children with papillary thyroid cancer, but not with follicular thyroid cancer. Papillary thyroid cancer was associated with more advanced disease (P=0.009), more lymph-node involvement (P=0.007) and more distant metastases (P=0.02) compared with follicular thyroid cancer. Multivariate analysis showed advanced tumor stage as the only significant factor (P=0.02) associating with distant metastasis. CONCLUSION: It can be concluded that in children and adolescents: 1. The incidence of papillary thyroid cancer is higher in females than males, with a peak at puberty. 2. The only significant factor associated with distant metastases is the advanced tumor stage. 3. Childhood thyroid cancer is frequently associated with lymph-node involvement, distant metastases and advanced tumor stage. 4. Papillary childhood thyroid cancer is more aggressive than follicular type.
Five-year study of medical or surgical treatment in children with severe vesico-ureteral reflux dimercaptosuccinic acid findings. International Reflux Study Group in Europe.
UNLABELLED: The results of serial dimercaptosuccinic acid (DMSA) imaging over 5 years are reported in 287 children with severe vesico-ureteral reflux entered into the European Branch of the International Reflux Study in Children. The children were randomly allocated to medical (n=147) or surgical (n=140) management and DMSA studies were performed during the follow up period at least 6 months after any urinary tract infection. Abnormal images were classified into four types: (1) large polar hypodensity with normal renal outline; (2) peripheral photon deficient defect(s) in a non-deformed kidney; (3) small renal image with normal contour; and (4) peripheral defect(s) with resultant irregularity of the renal outline. The DMSA findings were abnormal at entry in 235 (82%) with no difference in incidence or severity between the two treatment groups. During follow up, deterioration was observed in 25 medically and 23 surgically treated patients and comprised image deterioration alone in 17, image deterioration with corresponding reduction in differential function in 16 and reduction in relative function without image change in 15, with similar distribution between the two treatment groups. Deterioration was more frequent in children entering the study under the age of 2 years and in those with grade IV rather than grade III reflux. These findings, showing no difference in outcome between children managed surgically or medically, are consistent with the radiological results already published. CONCLUSION: In the International Reflux Study the DMSA scintigraphic data showed no difference in outcome between children managed surgically or medically.