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Biomedical subjects

D Zimmerman

Publications and source records attributed to D Zimmerman.

140 records · Page 8Linked to original sources
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Pediatric transseptal transsphenoidal pituitary surgery.

The use of the transseptal transsphenoidal approach to the pituitary gland has gained acceptance as a safe, relatively atraumatic means of removing pituitary tumors. The outcome in adult patients has been successful; however, the outcome in pediatric patients whose noses may still be developing is not well described. We reviewed the outcomes in 41 patients younger than age 18 years who underwent transseptal transsphenoidal pituitary surgery at our institution between 1986 and 1997 (20 boys and 21 girls; age, 3 to 17 years; mean age, 13.4 years). The most common diagnosis was prolactin-secreting adenoma (14 patients), followed by craniopharyngioma (7 patients). Presenting symptoms included headache (20 patients), galactorrhea (13 patients), and menstrual irregularities (11 patients). The most common early complication was transient diabetes insipidus (20 patients). No patient experienced serious bleeding at pack removal and no patient developed a cerebrospinal fluid leak postoperatively. Follow-up ranged from 3 months to 12.7 years, with 7 patients experiencing recurrent or residual disease between 6 days and 2 years after their original transseptal procedure. The most common long-term surgical complication was nasal obstruction in 5 patients, 3 of whom also complained of seasonal allergies. Four patients complained of recurrent sinus infections, and 4 patients noted an external nasal deformity as a result of the surgery.

Adolescent↗
PubMedDate not supplied

Allergy and pulmonary impairment in Iowa veterinarians.

If small animal practice exposure, including the laboratory animal situations encountered in academic and other research pursuits, is more detrimental to veterinarians than large animal practice exposure for induction of allergic respiratory disease, then preventive measures such as increased ventilation, use of high efficiency particulate filters, and wearing of masks should be encouraged to reduce allergen exposures. Migration from large animal practice, likewise, should be discouraged. Failure to migrate to low occupational allergy risk situations early enough in a veterinary career can have severe and even fatal results. If the observed respiratory disease in veterinarians is in fact due to exposure, then unfortunately, it may in some cases be progressive and not just chronic. Data which could provide criteria for predicting occupational allergy and possible related respiratory disease outcome is scant at this time and career counselling is difficult. If the veterinary occupational animal allergy data should be proven correct such results can be used to help others.

Humans↗
PubMedDate not supplied

Fine-needle aspiration biopsy: use in diagnosis and management of pediatric thyroid diseases.

Fine-needle aspiration (FNA) biopsy of the thyroid is a reliable, safe, cost-effective, and widely used test. Its introduction and application have had a significant impact in the management of nodular thyroid diseases in adults. However, its utility in pediatric practice is not recognized or emphasized. During the last 12 years we performed 10,971 FNAs; 57 (0.5%) were in patients younger than age 17 years. Among 47 of these biopsies, 66% were benign, 15% were malignant, 6% were suspicious for malignancy and 13% were nondiagnostic. Biopsy was most often (96%) performed for the evaluation of diffuse or nodular goiter. The most common benign cytologic diagnosis was colloid goiter in 17 of 31 patients (55%) and Hashimoto's thyroiditis in 9 of 31 patients (29%). There were no false-positive results and there was one false-negative cytologic result. Among patients who had malignancy proved histologically, nine patients (75%) had papillary thyroid cancer. In this study, FNA biopsy was crucial in deferring surgery in 28 of 47 patients (60%). It is clear that the application of FNA biopsy prevents unnecessary surgery and improves surgical selection of patients with thyroid malignancy. On the basis of our extensive experience, we recommend FNA biopsy as the first diagnostic test for pediatric patients with nodular thyroid lesions.

Journal Article↗
PubMedDate not supplied

Somatomedin C/insulin-like growth factor I levels after treatment of acromegaly.

An in-house method was used, including dissociation of Somatomedin C/insulin-like Growth Factor I (Sm-C/IGF-I) binding proteins with acid and extraction of Sm-C/IGF-I by C-2 cartridge before radioimmunoassay, to measure plasma Sm-C/IGF-I levels in three groups of patients--total of 19--with acromegaly who underwent transsphenoidal removal of pituitary tumors. In group A (n = 7), the Sm-C/IGF-I levels did not decrease to normal on postoperative day 1 even though the growth hormone concentration had decreased to normal. In group B (n = 4), the Sm-C/IGF-I level decreased to normal in three of the four patients on postoperative day 4, but it remained elevated in one. At two months postoperatively, all four patients had normal values. Group C patients (n = 8) had had an operation two to 23 years previously, and all remained in remission with normal Sm-C/IGF-I levels. Our findings indicate that the Sm-C/IGF-I assay is useful for monitoring acromegaly after transsphenoidal removal of pituitary tumors, but it should be ordered at least four days postoperatively.

Acromegaly↗
PubMedDate not supplied

Assay of somatomedin C by cartridge extraction prior to radioimmunoassay with antiserum developed against synthetic somatomedin C.

The whole molecule of human somatomedin C (SM-C) prepared by the total synthesis method was used as an antigen to produce an antiserum for a radioimmunoassay. Since plasma proteins that bind SM-C interfere with the assay, a method was developed that uses acid dissociation followed by C-2 cartridge extraction to strip SM-C from its binding proteins before assay. This assay has no cross-reactivity with human proinsulin or insulin-like growth factor II (IGF-II). The SM-C values in 339 normal subjects showed age-dependence, increasing from childhood to a peak at age 14 to 16 years and decreasing sharply before adulthood. In adults, the SM-C values decreased gradually with age. All 13 patients with acromegaly who were tested had an increased SM-C value, with no overlap with the normal range. The 12 patients with prolactinoma but non-growth-hormone-producing pituitary tumor had no increase in SM-C. Two children with pituitary deficiency had low SM-C values; one of these children received growth hormone therapy, and his SM-C value increased from undetectable to normal. By three weeks after discontinuation of the therapy, his SM-C value was again undetectable. Of 20 children with short stature and constitutional delay of growth and development, SM-C was below normal in 70 percent and normal in 30 percent. Two patients with malnutrition had below-normal SM-C values.

Adolescent↗