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Biomedical subjects

H Döge

Publications and source records attributed to H Döge.

At least 19 recordsLinked to original sources

[Where does subclinical hypothyroidism start? Implications for the definition of the upper reference limit for thyroid stimulating hormone].

UNLABELLED: The upper limit of the TSH reference range is currently under discussion. In its recent guidelines, the National Academy of Clinical Biochemistry (NACB) recommended the use of approximately 2.5 mIU/L, rather than approximately 4 mIU/L, due to the fact that reference populations, on which the definition of the reference range is based, contain persons undergoing an initial phase of autoimmune thyroid disease. This will skew the upper reference limit of TSH. Ultrasonography, in addition to measurement of thyroid autoantibodies, should be used to exclude these persons. OBJECTIVE: The present study investigates whether the NACB recommendation also applies for a region of mild iodine deficiency. METHODS: According to NACB criteria, a reference population (713 persons) was defined out of a total study population of 1442. The TSH reference range was calculated in this reference group and in further subgroups by percentiles. The results were compared with the total study population and the NACB recommendation. All assays used were provided by BRAHMS Diagnostica AG, Hennigsdorf, Germany. RESULTS: As expected, all median TSH values, excluding the median of the group with a hypoechogenic thyroid were close to 1.2 mIU/L. The 97.5th percentile in the reference population was 3.35 mIU/L. However, there was no difference compared to the total study population. CONCLUSION: The upper reference limit for TSH based on a reference population according to NACB criteria came down to 3.35 mIU/L, but not to approximately 2.5 mIU/L. Interestingly, there is no difference compared to the total study population.

Diagnosis, Differential↗

[Follow-up studies of patients with negative TRH test and normal thyroid hormone levels].

The aim of the study was to assess the clinical significance of the association of a negative TRH-test with normal thyroid hormone levels. Therefore, we repeated the investigation in 63 patients one year after the first examination. In 6 patients (10%) hyperthyroidism had developed. Euthyroid autonomy was diagnosed in 11 patients (17%). A prolonged normalisation period of the pituitary-thyroid regulation after having discontinued the thyroid hormone drugs was found in 7 patients (11%). In 40% of the patients the TRH-test remained negative and in 22% of the patients the TSH-response became positive without any known reason. The findings show that a negative TRH-test and normal thyroid hormone levels do not necessarily imply subclinical hyperthyroidism.

Adult↗

[Value of sonography in assessing nodular changes of the thyroid in an endemic goiter area].

In an area of endemic goiter 304 patients with an increased thyroid gland were examined by palpation, sonographically and partly scintigraphically. The average age was 37 (12-78) years, the average age of the patients with nodular changes of the thyroid gland 38-44 years. Patients with a diffuse struma were significantly younger with an average age of 33 years. A false-positive enlargement of the thyroid gland established by palpation occurred in 16.1% (n = 49/304). In the sonographic examination 148 out of 304 patients revealed a diffuse enlargement of the thyroid gland without provable nodular change. However, in about one third already more or less clearly characterized regressive changes could be observed. In 156 of the 304 patients 109 times solitary nodes and 47 times multinodular changes were established sonographically. In more than one third of all nodular goiters or one fifth of all patients examined a cyst was demonstrated sonographically. Two thirds of the sonographically established nodular changes were, however, solid. In 53 of all 304 examined patients could sonographically be established additional, unexpected nodes which had escaped the palpation and partly also the scintigraphic investigation. In 14% the node suspected by palpation could not be ascertained sonographically. According to the echo structure echo-poor and echo-equal solid nodes dominated. The frequency of carcinomata of the solid nodes was 6.7%. Apart from 4 echo-poorly and 2 complexly structured nodes a carcinoma of the thyroid gland demonstrated itself sonographically to the same echo. Finally conclusions are drawn for the diagnostics of the thyroid gland in the endemic area of goiter.

Adult↗

[Bone scintigraphy following cryodevitalization of the mandible].

A tumor of the mandible can be destroyed successfully by cryogenic devitalisation. The revitalisation process was observed in 6 miniature swines by means of nuclear medical bone exploration. The bone metabolism decreased clearly postoperatively, and indeed laterally more than lingually. An increased blood flow and bone metabolism was recognized as an expression of the repair process at the border to the healthy bone after 7 days, later also lingually whereas no reaction was found laterally. The extent of the devitalised bone was 0.5-1.0 cm bigger than the cryosurgical part.

Animals↗

Intrathecal therapy with 198Au-colloid for meningosis prophylaxis.

Telecobalt irradiation in combination with intrathecal (IT) methotrexate has been replaced by IT 198Au-colloid and methotrexate for meningosis prophylaxis in leukemia. Seventy-seven children received 56-200 MBq 198Au-colloid. The distribution was measured with a scintillation camera having a data processing facility. The radiopharmaceutical is adsorbed at the surface of the spaces with cerebrospinal fluid (CSF) 10-20 h after application. The normal retention of the administered radioactivity in the intracranial subarachnoid space (ISS) and in the spinal subarachnoid space (SSS) were 52 +/- 10% and 26 +/- 9%, respectively. An impairment of the normal distribution was observed after IT methotrexate and also postinjection CSF leakage. The calculated radiation absorbed doses in the cerebral and spinal meninges at a depth of 0.01 cm, i.e. the thickness of the pia, were 45 +/- 17 mGy and 189 +/- 91 mGy, respectively, for 1 MBq administered 198Au-colloid. The dosimetry shows that an effective radiation absorbed dose of 18 Gy can be delivered to the cerebral meninges by the application of 400 MBq 198Au-colloid.

Acute Disease↗

[Primary malignant lymphoma of the central nervous system].

Clinical and morphological observation of 56-year-old man with a primary isolated malignant non-Hodgkin's lymphoma of the central nervous system in the hypothalamus, with the formation of metastases in the space of the cerebrospinal fluid and a solitary extraneural metastasis in the epicardium. No generalised lymphoma. The histological classification is discussed. The importance of the cytology of the cerebrospinal fluid to a climical diagnosis is pointed out.

Brain Neoplasms↗