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Biomedical subjects

C Reiners

Publications and source records attributed to C Reiners.

At least 145 records · Page 8Linked to original sources
PubMed1990

Survival rates in patients with differentiated thyroid carcinoma. Influence of postoperative external radiotherapy.

Nine hundred thirty-two patients with papillary and follicular thyroid carcinomas were seen at the Departments of Medicine, Surgery, and Radiology of the University of Essen, Essen, Germany, between 1970 and 1986. In addition to standard treatment by surgery, radioactive iodine and medical thyroid stimulating hormone (TSH) suppression, 346 patients had received conventional external irradiation to the neck (mostly 40-60 Gy) before referral to our institutions, whereas 586 patients had not received radiotherapy. From the follow-up data of these patients, survival rates were calculated separately for tumor Stages T1 (n = 203), T2 (n = 552), and T3/T4 (n = 277) using life-table analysis. Distribution of risk factors (histologic type of tumor, grading of malignancy, presence of distant metastases, age and sex) was similar in all groups with the one exception, that the radiotherapy patients with Stage T3/T4 were older. There was no significant difference in the life expectancy of irradiated and not irradiated patients by Breslow and Mantel-Cox tests. In Stages T1, T2, and T3/T4, 75% of the radiotherapy patients survived for 10.6 +/- 0.32, 11.5 +/- 0.61, and 6.71 +/- 0.85 years, respectively; the figures for the nonirradiated patients were 9.4 +/- 0.17, 10.8 +/- 0.37, and 6.26 +/- 0.51 years, respectively. When survival rates were calculated separately for patients with Stage T3/T4 older and younger than 40 years, there was no obvious effect of radiotherapy in the younger group, whereas in the older patients, improvement of survival by radiation just failed to reach statistical significance (P less than 0.09). In conclusion, this retrospective analysis failed to prove that survival is prolonged in patients with differentiated carcinoma by administration of conventional external radiotherapy after surgery. A benefit to older patients with locally advanced tumors has still to be demonstrated.

Adenocarcinoma↗
PubMed1990

Incidence of hypothyroidism after irradiation of the neck with special reference to lymphoma patients. A retrospective and prospective analysis.

Twenty-eight patients were studied prospectively in order to determine the incidence of hypothyroidism after mantle irradiation for malignant lymphoma. This group was compared with a historical group of 65 patients, among them 36 patients with malignant lymphoma. The mean follow-up was 30 months for the prospective group and 46 months for the retrospective group. The mean thyroid dose for irradiated malignant lymphomas in the prospective and the retrospective group was 45 Gy and 43 Gy respectively. For other tumors with neck irradiation (retrospective group) the mean thyroid dose was 53 Gy. There were no cases of clinical hypothyroidism in our study. As for subclinical hypothyroidism which is characterised by elevated TSH, the incidence was 22% in the prospective group and 3% in the retrospective group, i.e. 8/93 patients showed a hypothyroid dysfunction. Three of the 8 patients with subclinical hypothyroidism had undergone lymphangiography before radiotherapy. Due to the elevated iodine pool a lymphangiogram is considered as a risk factor for hypothyroidism as well as for hyperthyroidism, which we observed twice in the prospective group. Evaluation of the thyroid function before lymphangiography and irradiation as well as regular thyroid function studies during the follow-up are recommended in order to detect hypothyroidism in time.

Adolescent↗
PubMed1990

[Operative standards in endocrine surgery: preoperative thyroid gland diagnosis].

Even in the era of efficient methods for diagnosis of disturbances of thyroidal function and morphology, the diagnostic program starts with inquiry of history and physical examination. Today, high resolution sonography is the basic method for assessment of thyroidal morphology whereas scintigraphy exclusively gives informations on topography of function. In-vitro determinations of TSH with sensitive assays are the most sensitive and efficient procedures for the clinically most relevant question, namely the exclusion of disturbances of global thyroidal function.

Diagnostic Imaging↗
PubMed1990

[Coincidence of hyperparathyroidism and thyroid gland cancer].

127 patients, operated for hyperparathyroidism in a 4-years period (1986-1989) were analyzed retrospectively, regarding concurrent thyroid disease. In 42 patients (33%) thyroid resection was performed simultaneously. Of these, in five cases (4%), thyroid malignancy was discovered: there was one follicular carcinoma, one multilocular papillary tumor and three well differentiated small papillary carcinomas (less than 1.5 cm diameter). This prevalence of thyroid tumors is comparable to the results of different authors (2.5-8.5% in the literature). We conclude that preoperative examination should include the thyroid gland before parathyreotoid exploration.

Adenoma↗
PubMed1990

[The diagnostic value of captopril radionuclide nephrography for renovascular hypertension in childhood].

In four children the role of captopril-radionuclide nephrography in the diagnosis of renovascular hypertension was studied. Captopril (0.5-1.0 mg/kg orally) did not affect Iodine-123 Hippuran nephrography in two children with mild renal artery stenosis, but induced an accumulation of the tracer within the kidneys in two children with hemodynamically significant renal artery stenosis. As in adults Iodine 123 Hippuran nephrography appears to be a useful tool to identify patients with significant renal artery stenosis.

Adolescent↗
PubMed1989

[Initial symptoms of malignant thyroid tumors: the effect of age and sex in an iodine-deficient region. Experiences with 1116 patients].

Initial symptoms of thyroid cancer were collected and analysed for 1116 patients with thyroid cancer in an iodine-deficient region, retrospectively for the period 1960-80 (604 patients), prospectively for 1981-87 (512). Using the WHO classification, 56.1% of patients had papillary, 32.7% follicular, 4.8% C-cell, 3.7% anaplastic and 2.7% various other malignant tumours. In 40% of all patients the initial sign had been a solitary intrathyroid nodule. Cervical lymph node swelling as initial sign had been significantly more frequent in men (21.1%) than in women (10.3%; P less than 0.003). In patients aged under 40 years the cervical lymph node signs were three times as common as among those over 50 years. Distant metastases as initial sign of papillary carcinoma were seen only in those over 60 years. Tumour stages T3 and T4 were seen significantly more frequently in over 60-year-old (42.2%) than under 40-year-old (25.1%; P less than 0.001), independent of histological type. Composition and initial signs of this patient cohort in an iodine-deficient region differed only slightly from those in an iodine-rich region.

Age Factors↗
PubMed1989

[Side effects of antithyroid therapy of hyperthyroidism. A study of 1256 continuously treated patients].

Side effects of antithyroid treatment were retrospectively analysed in 1256 patients with hyperthyroidism. Overall rate of side effects was 14.3%. Skin reactions were the most frequent ones (5.6%), followed by arthropathies (1.6%). The incidence of agranulocytosis was 0.14%. Median duration of all side effects was 1.5 months. In half the cases the side effects were controllable so that treatment was continued, although at a changed dosage. The rate of cross-reaction between carbimazole and thiamazole, on the one hand, and propylthiouracil, on the other, was 13.8% and 15.2%, respectively. The side effects became apparent after a mean of one month's treatment, almost always (in 97.1%) within the first year of treatment. There was a significant dose dependence for an initial thiamazole dose of over 20 mg (relative side effect risk of 2.3), and for an initial dose of over 30 mg for carbimazole (relative side effect risk of 1.6). Although most side effects were not dangerous, in normal instances the lowest possible dosage should be administered to control hyperthyroid metabolism. Long-term treatment with low doses seem to be without problems.

Adult↗
PubMed1989

Tc-99m-(V)-DMSA: the new sensitive and specific radiopharmaceutical for imaging metastases of medullary thyroid carcinomas?

In the follow-up of five patients with histologic proven medullary thyroid carcinoma (MTC) and raised serum calcitonin and CEA levels the pentavalent Tc-99m-(V)-DMSA and the Tc-99m-MDP bone scan had the highest sensitivity in the localisation of metastases. Both methods are not tumor specific. A false positive Tc-99m-(V)-DMSA uptake in an old osteomyelitis of one vertebra could be demonstrated. The J-123-MIBG and In-111-F(ab2)' antibody scan did not allow to localise one of the above described metastases. In conclusion in the follow-up of patients with MTC and elevated tumor marker concentrations the Tc-99m-(V)-DMSA and the Tc-99m-MDP bone scan should be the second diagnostic procedures after sonography has been performed.

Adult↗
PubMed1988

[Radiological diagnosis of late effects on thoracic organs after chemotherapy and/or radiation therapy as well as after radionuclide therapy].

With respect to the considerable risk involved in oncologic therapy methods, especially when bleomycin is administered, a specific observation of the possibly fatal side effects is necessary. As, for example, a regression of pulmonary alterations caused by bleomycin is possible when they are detected early, the call for early recognition of developing lesions is becoming more and more urgent. Conventional radiologic diagnosis is scarcely important in early recognition, but X-ray computed tomography is a suitable imaging method because it is able to visualize tiny intrapulmonary and pleural alterations. The CT image of bleomycin pneumopathy is variable. There are irregular, partly sharply defined nodular structures. They are generally found in peripheric sites near to the pleura with the exception of the pleura mediastinalis. Contrary to functional investigations such as the determination of the CO diffusion capacity which are equipment- and cost-consuming, X-ray computed tomography does not only offer a qualitative information on an existing pneumopathy, but provides also a precise localization of these pulmonary alterations. Computed tomography is a method for the quantitative assessment of the peripheral lung density with the same amount of information as the measurement of the gas transfer per pulmonary volume unity. However, it offers the advantage of a simultaneous qualitative visual judgement of the organ, i.e. not only the types and dimensions of pulmonary lesions can be assessed, but the physiologic effect of these lesions, i.e. the pulmonary function, can be determined by quantitative density measurement, too. Thus quantitative computed tomography represents an alternative in the assessment of the pulmonary function. According to the recommendations of Bellamy et al., it should be combined to routine computed tomography of the thorax. The method of choice for the diagnosis of anthracycline cardiotoxicity is radionuclide ventriculography. A decrease of the left ventricle expulsion to less than 45% is considered as a critical value. However, cardiac side effects of cytostatic drugs can be detected early in the individual course, so that late effects in the sense of irreversible cardiomyopathy are prevented.

Adult↗
PubMed1988

Changes of serum angiotensin-I-converting enzyme in patients with thyroid disorders.

In 149 subjects (63 euthyroid, 21 hyperthyroid, 26 with autonomous nodules, subdivided into 20 euthyroid and 6 hyperthyroid, 17 hypothyroid subjects and 22 women taking estrogens) the serum angiotensin-I-converting enzyme (SACE) was spectrophotometrically measured and correlated with age, systolic and diastolic blood pressure, free thyroid hormones (FT4, FT3) and delta TSH level. In patients with diffuse hyperthyroidism and with regional autonomy, systolic blood pressure was elevated. The highest values for FT4 and FT3 were found in patients with hyperthyroidism and hyperthyroid autonomous nodules. SACE correlated with age for the euthyroid control group (p less than 0.05). In this group, SACE levels were higher in men than in women (p less than 0.02). Regarding all 149 subjects together, significant linear correlations between SACE and systolic blood pressure as well as with FT4 and FT3 concentrations could be demonstrated (p less than 0.01-0.001). Among the individual groups the mean SACE activities were significantly elevated in hyperthyroid patients (p less than 0.01). No significant differences could be observed between controls and euthyroid subjects with autonomous nodules as well as in hypothyroid cases. In comparison to euthyroid patients the mean SACE levels of hyperthyroid patients with autonomy were significantly (p less than 0.05) elevated. The SACE activities of women taking estrogens for contraception did not differ significantly from SACE in age-matched female controls.

Adult↗