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Biomedical subjects

D E Hellman

Publications and source records attributed to D E Hellman.

8 recordsLinked to original sources
PubMed1980

Hyperaldosteronism, hyperparathyroidism, medullary sponge kidneys, and hypertension.

Hyperparathyroidism and hyperaldosteronism coexisted in association with medullary sponge kidneys in a 27-year-old woman with severe hypertension. A modest fall in systolic and diastolic pressure followed removal of a parathyroid adenoma. Blood pressure was controlled with spironolactone therapy and restored to normal after removal of an aldosterone-secreting adrenal tumor. Elevated levels of aldosterone may have been responsible for the severe hypertension, while hypercalcemia may have had a synergistic effect on the arteriolar response to circulating vasoactive peptides.

Adenoma↗
PubMed1980

The thyroid gland.

Disorders of the thyroid gland are frequently unrecognized and untreated by the attending physician and present the anesthesiologist with a diagnostic and therapeutic challenge. Very large goiters distort and compress the larynx and require an experienced anesthesiologist for safe intubation. If surgery is elective and can be postponed in patients suspected of being hypo- or hyperthyroid, there is sufficient time to permit the anesthesiologist and the attending physician to obtain appropriate tests of thyroid function and institute appropriate therapeutic measures to restore the metabolic rate to normal. When there is insufficient time to confirm a clinical diagnosis of thyroid disease, the anesthesiologist is faced with important therapeutic decisions. It is the author's opinion that therapeutic intervention is, in most instances, preferable to therapeutic nihilism. In the case of a patient suspected of hypothyroidism, it is usually safe to administer a physiologic replacement dose of thyroxine to support the patient intraoperatively or postoperatively. If hypothyroidism is associated with cardiovascular disease, other debilitating illness, or advanced age, thyroxine must be given with extreme caution in order to avoid dangerous tachyarrhythmias or too rapid acceleration of the metabolic rate. The hyperthyroid patient facing nonelective surgery represents a very serious challenge to the anesthesiologist, since marked accentuation of clinical hyperthyroidism (thyroid storm) is a major risk of such surgery. In such a situation, intravenous propranolol and intravenous iodine are the optimal drugs for a safe and uncomplicated clinical course during and following surgery. In both instances, the anesthesiologist must use skillful clinical judgment in making the appropriate diagnosis and selecting appropriate therapy. Careful and continuous supervision of the patient is necessary during and following surgery and appropriate treatment and support of the patient should be provided until it is safe to discontinue therapy, if necessary, to confirm the diagnosis of thyroid disease. Careful clinical judgment and judicious use of appropriate medication should provide the patient with a smooth and safe intraoperative course and a rapid and uncomplicated postoperative recovery.

Adolescent↗
PubMed1979

Radioiodine in the treatment of medullary carcinoma of the thyroid.

Medullary carcinoma (MC) of the thyroid, in contrast to papillary-follicular carcinoma, fails to concentrate iodine and thus has not been treated with radioactive iodine. We have successfully treated a 16-yr-old Mexican-American girl with residual MC after maximal thyroidectomy (Tx), utilizing radioiodine (131I) to deliver radiation to residual follicular cells in the tumor bed. Immediately after Tx, plasma thyrocalcitonin levels before and during calcium infusion were all elevated (640--1200 pg/ml). 131I (150 mCi) was administered 12 days after Tx after four daily im injections of bovine TSH. Three months after 131I therapy, thyrocalcitonin levels before and during calcium infusion were all normal (less than 50 pg/ml). Ten months after 131I therapy, thyrocalcitonin levels before and after iv pentagastrin were all normal (less than 60 pg/ml). These results suggest that parafollicular cells are radiosensitive, and that therapeutic levels of radiation can be delivered to these cells after Tx if iodine trapping by the remaining follicular cells is enhanced by high levels of circulating TSH. 131I may be the therapy of choice for MC after Tx, if disease has not spread beyond the area proximate to the thyroid gland.

Adolescent↗