PubMed Health⌕ Search

Biomedical subjects

L Hegedüs

Publications and source records attributed to L Hegedüs.

At least 37 records · Page 2Linked to original sources
PubMed2001

Ultrasound guided laser ablation of a parathyroid adenoma.

We present a case of primary hyperparathyroidism with severe hypercalcaemia, treated successfully with ultrasound (US) guided percutaneous interstitial laser photocoagulation (ILP) of a single parathyroid tumour. To our knowledge, this is the first reported case of ILP applied in primary hyperparathyroidism. US guided thermic tissue coagulation with ILP may be a non-surgical alternative in patients with symptomatic hypercalcaemia due to a parathyroid tumour when surgery is contraindicated.

Adenoma↗
PubMed2001

[New surgical method in the treatment of severe hemorrhoidal bleeding caused by decompensated liver cirrhosis].

Authors used a new technique for haemorrhoid surgery performed with PPH (Procedure for Prolapse and Haemorrhoids) instrument to cure bleeding haemorrhoids caused by vascularly decompensated liver cirrhosis. Longo developed the special circular stapler in 1993. The 69 years old female patient underwent continuous medical treatment during the last 10 years due to liver cirrhosis developed as a result of chronic alcoholism. There were two haemorrhoidectomies in her previous history. Haemorrhoidal bleed was in the background of severe haematochesia in July 1999. She was transfused with 38 units of blood at Department of internal medicine. Because no result was expected by further conventional surgery, this new procedure was performed. After uneventful postoperative period the patient was discharged without any complaints. During six months follow-up there was no further bleeding and her quality of life is better.

Aged↗
PubMed2000

Cigarette smoking and risk of clinically overt thyroid disease: a population-based twin case-control study.

BACKGROUND: The effects of cigarette smoking on the thyroid gland have been studied for years. However, the effect of smoking on thyroid function and size is still controversial. OBJECTIVE: To determine the impact of cigarette smoking on the development of clinically overt thyroid disease. METHODS: Matched case-control study of 132 same-sex twin pairs (264 individuals) discordant for clinically overt thyroid disease, ascertained from a population-based nationwide twin register. Information on thyroid disease and smoking habits was gathered by questionnaire, and the patients' endocrinologist or general practitioner verified the diagnosis. RESULTS: Overall, smoking was associated with an increased risk of developing clinically overt thyroid disease (odds ratio, 3.0; 95% confidence interval, 1.4-6.6; P = .003). This association remained statistically significant in monozygotic and dizygotic disease-discordant pairs. The effect of smoking was more pronounced in monozygotic vs dizygotic pairs (odds ratio, 5.0 vs 2.5; P= .04 for both). Essentially similar results were obtained after subdividing the twin pairs into groups discordant for clinically overt autoimmune (49 pairs) and nonautoimmune (83 pairs) thyroid disease. Among twin pairs concordant for smoking, probands with clinically overt autoimmune thyroid disease smoked significantly more than did their healthy co-twins (17 pairs; P= .03), whereas no difference was found between probands with nonautoimmune thyroid disease and their healthy co-twins (34 pairs; P= .20). CONCLUSIONS: Smoking is associated with an increased risk of developing clinically overt thyroid disease. Furthermore, our data suggest that cumulative cigarette consumption is a risk factor, most pronounced in autoimmune thyroid disease.

Autoimmunity↗
PubMed2000

Low birth weight is not associated with clinically overt thyroid disease: a population based twin case-control study.

OBJECTIVE: In recent years low birth weight has been proposed as a risk factor for the development of several chronic diseases in adult life, including diabetes and subclinical autoimmune thyroid disease. The association could, however, also be due to genetic or environmental factors affecting both birth weight and adverse health outcomes in adult life. Moreover, it is at present unknown whether or not low birth weight is associated with an increased risk of developing clinically overt thyroid disease. The aim of the present study was to investigate the impact of birth weight and several other birth characteristics on the development of clinically overt thyroid disease. DESIGN: A twin case-control study of same sex twin pairs. PATIENTS: One hundred and thirty-one same sex twin pairs (262 twin individuals) discordant for clinically overt thyroid disease, ascertained from a population based nation-wide twin register. MEASUREMENTS: Information about birth weight, birth length, birth order (first vs. second born), and prematurity was obtained from the original midwife records. RESULTS: Forty-nine twin pairs were discordant for clinically overt autoimmune thyroid disease (Graves' disease = 35 and Hashimoto's thyroiditis = 14) and 82 pairs were discordant for overt nonautoimmune thyroid disease (Simple goitre = 79 and toxic nodular goitre = 3). Overall, there was no difference in birth weights between probands and the healthy co-twins in monozygotic (MZ, n = 39) or in dizygotic (DZ, n = 92) pairs (MZ: mean +/- SE: 2619 +/- 93 g vs. 2553 +/- 89 g, P = 0.40; DZ: 2576 +/- 45 g vs. 2585 +/- 49, P = 0.86). By means of logistic regression, the impact of other birth characteristics such as birth length, birth order (first vs. second born), and prematurity was tested. None of the variables reached statistical significance. Subdividing the twin pairs into those discordant for clinically overt Graves' disease, Hashimoto's thyroiditis, and nonautoimmune thyroid disease did not change the results. CONCLUSIONS: This is the first study of the effect of birth weight and other birth characteristics on the subsequent development of clinically overt thyroid disease in which maternal, socioeconomic, and to a high degree, genetic factors have been controlled for. Our study did not show any effect of birth weight or any of the other birth characteristics on the risk of developing clinically overt autoimmune or nonautoimmune thyroid disease.

Adult↗
PubMed2000

Management of the nontoxic multinodular goitre: a European questionnaire study.

BACKGROUND AND OBJECTIVE: The optimum management strategy for the patient with a multinodular nontoxic goitre is still a matter of debate. Our aim was to assess the attitudes towards management of such patients throughout Europe by means of a questionnaire. DESIGN: The questionnaire was circulated to all clinician members of the European Thyroid Association (ETA). A case report was followed by diagnostic investigations and choice of therapy in the index case (a 42-year-old woman with an irregular nontender bilaterally enlarged thyroid of 50-80 g and no clinical suspicion of malignancy). Eleven variations of the basic case report were proposed in order to evaluate the impact on management of each alteration. SUBJECTS AND METHODS: One hundred and sixty-seven members replied to the letter, and 120 individuals from 22 countries completed the questionnaire (corresponding to approximately two-thirds of the clinical members of the ETA). RESULTS: Based on the index case, serum TSH was the routine choice of 100%, and serum free T4/T4-index was included by 74%. Serum TPO autoantibodies, Tg autoantibodies and calcitonin were measured by 65%, 49% and 32%, respectively. The median number of blood tests used was four (range 1-11). Considerable intercountry variations were seen in the preferred imaging methods. Ninety-one percent of the clinicians would use at least one imaging modality. Ultrasound (US) was used by 84%, thyroid scintigraphy by 76%, and both methods by 69%. US had first priority (53% vs. 19% for scintigraphy). If scintigraphy was performed, fine-needle aspiration cytology was routinely used by 17% (inhomogeneous uptake) and 95% (dominant 'cold' area), and 63% used US-guidance. L-T4 treatment was supported by 52% of the clinicians, iodine supplementation by 4%, radioiodine by 6% and surgery by 10%. In the case of a suppressed serum TSH, radioiodine treatment was preferred by 44%, while surgery was the favoured recommendation in four clinical variations with a large goitre or suspicion of malignancy. Marked differences between the countries were suggested by L-T4 therapy being the dominant treatment in Italy, France and Germany in contrast to the prevailing use of radioiodine in Denmark and a wait and see policy in the UK. CONCLUSIONS: Fundamental differences between European countries exist as regards diagnosis and treatment of the multinodular nontoxic goitre suggesting difficulties in reaching a consensus.

Biomarkers↗
PubMed2000

A population-based study of chronic autoimmune hypothyroidism in Danish twins.

Hashimoto's thyroiditis (HT), atrophic thyroiditis (AT), and Graves' disease are autoimmune thyroid diseases in which genetic factors are suspected to play an important role in disease susceptibility. In a recent population-based twin study we rendered it probable that a substantial part of the susceptibility to Graves' disease is attributable to genetic factors. At present there are no population-based twin studies supporting such a genetic influence in the etiology of HT/AT. To elucidate whether there is a genetic influence in the etiology of HT/AT, we studied the distribution of HT/AT in a population-based sample of 2945 Danish female-female twin pairs (5890 individuals) born between 1953 and 1972. Information on hypothyroidism was obtained from a nationwide questionnaire survey in 1994. Information from hospitals, out-patient clinics, general practitioners, and specialists was sought to verify the diagnosis. The overall prevalence of autoimmune hypothyroidism was 0.41% (24 of 5890). The prevalence did not differ between monozygotic and dizygotic twins (0.42% and 0.40%, respectively). The crude proband-wise concordance rates were significantly higher for monozygotic compared to dizygotic twin pairs: 0.55 (95% confidence interval, 0.23-0.83) vs. 0.0 (95% confidence interval, 0.0-0.25; P = 0.01). All of the healthy cotwins (n = 15) of twins with clinically overt autoimmune hypothyroidism were biochemically euthyroid. Overall, regardless of zygosity 53% (8 of 15) of the healthy cotwins were positive for antithyroid antibodies. The prevalence of autoantibodies among the monozygotic cotwins was 80% (4 of 5) and 40% (4 of 10) among dizygotic cotwins (P = 0.36). In conclusion, the higher concordance rate in monozygotic compared to dizygotic pairs indicates that genetic factors play a role in the etiology of HT/AT among Caucasian women living in areas with borderline iodine deficiency. However, the fact that the concordance rate among MZ twins was below 1 suggests that environmental factors also are of etiological importance.

Adult↗
PubMed2000

Management of the solitary thyroid nodule: results of a North American survey.

The present survey evaluated current trends in the management of the nontoxic solitary thyroid nodule by expert endocrinologists in North America and compared their results with a similar European Thyroid Association survey. A questionnaire was circulated to all clinical members of the American Thyroid Association. An index case (a 42-yr-old woman with a solitary 2 x 3-cm thyroid nodule and no clinical suspicion of malignancy) and 11 variations were provided to evaluate how each alteration would affect management. One hundred and seventy-eight members replied and 142 responses were retained for analysis, corresponding to a response rate of 43% of clinically active members. Based on the index case, basal serum TSH was the routine choice of 99%, and serum T4 and/or free T4 were included by 61% of the respondents. Thyroid peroxidase antibodies and serum calcitonin were included by 30% and 5%, respectively. Thyroid scintigraphy was used by 23% ((123)I, 63%; (99m)Tc, 31%; (131)I, 6%), and ultrasonography was used by 34%. Fine needle aspiration biopsy was routinely used by all and was guided by palpation in 87%. Based on the individually chosen diagnostic tests indicating a benign solitary thyroid nodule in a euthyroid subject, L-T4 treatment was advocated by 47%, no specific treatment and follow-up was advocated by 52%, and surgery was advocated by 1%. Clinical factors suggesting thyroid malignancy (e.g. rapid nodule growth and a large nodule of 5 cm) lead a significant number of clinicians (40 - 50%; P < 0.00001) to disregard biopsy results and to choose a surgical strategy. Nevertheless, North American endocrinologists heavily rely on fine needle aspiration biopsy results. Compared to the European Thyroid Association survey, North American endocrinologists use imaging [scintigraphy, 23% vs. 66% (P < 0.0001); ultrasonography, 34% vs. 80% (P < 0.0001)] and serum calcitonin (5% vs. 43%; P < 0.0001) less frequently. A nonsurgical strategy prevails in North America, and despite controversies on the effect of L-T4, this treatment is supported by more than 40% in both Europe and North America.

Adult↗
PubMed2000

Genetic and environmental factors in the aetiology of simple goitre.

The aetiology of simple goitre, affecting up to 5% of a population in iodine-sufficient areas and over 10% in endemic areas, is incompletely understood. It is generally believed that the development of simple goitre, whether endemic or sporadic, depends on complex interactions between genetic, environmental and endogenous factors. The importance of genetic factors is evident from the clustering of simple goitre within families and from a higher concordance rate for goitre in monozygotic than in dizygotic twins. Recently, studies assessing the role of specific candidate genes or genetic markers in the aetiology of simple goitre have given conflicting data in various families. However, there may well be single genes playing a major role within certain families, eg the thyroglobulin (Tg) gene, the thyroid-stimulating hormone receptor (TSHR) gene, the Na+/I- symporter (NIS) gene, and the multinodular goitre marker 1 (MNG1) on chromosome 14, but the genes will vary from family to family. In addition, family and twin studies also indicate a modest to major role for environmental factors in the aetiology of simple goitre. Clearly, iodine deficiency and cigarette smoking are the most important environmental risk factors associated with the genesis of simple goitre. Other suggested risk factors include naturally occurring goitrogens, emotional stress and certain drugs and infections. Ongoing studies focus on whole-genome screening in multiplex families as well as on large population-based case-control studies. However, the possibility that simple goitre is a heterogeneous disease without a single well-defined genotype and phenotype should be left open.

Genetic Linkage↗
PubMed2000

[Inguinal hernia repair with mesh plug technique (initial experiences with a new, tension-free surgical method)].

Majority of inguinal hernia repair are performed in Hungary by traditional surgical techniques, reconstruction under tension (Bassini, Kirschner, Shouldice). Hernia surgery underwent a revolutionary change from the 80's. Set out from the United States, tension-free methodologies (Lichtenstein, laparoscopy, mesh plug) have spread worldwide, of which early and late results--especially recurrence rate--are significantly better than the formerly used techniques. Authors introduce the surgical technique of mesh plug hernioplasty and their promising experiences after the first 80 operations.

Adult↗
PubMed1999

[Thyrotoxic periodic paralysis].

Thyrotoxic periodic paralysis (TPP) is a rare complication of hyperthyroidism mainly seen in patients of Oriental origin and is rarely encountered in Western countries. TPP clinically resembles familial periodic paralysis with recurrent episodes of weakness or flaccid paralysis of especially the legs. Transient hypokalaemia is regularly observed during attacks and remission can be achieved by administration of potassium salts. The definitive treatment of TPP is to restore euthyroidism. This case describes a thyrotoxic patient who initially presented with periodic paralysis.

Adult↗
PubMed1999

Radioiodine therapy for multinodular toxic goiter.

BACKGROUND: Radiolabeled iodine 131 therapy is used for treatment of multinodular toxic goiter, but long-term follow-up studies are lacking. METHODS: A prospective study of 130 consecutive patients (115 women) treated with 131I for multinodular toxic goiter and followed by evaluation of thyroid volume (determined using ultrasound) and thyroid function variables. RESULTS: The patients were observed for a median of 72 months (range, 12-180 months). Sixty-six patients received antithyroid drug pretreatment; 64 did not. Iodine 131 treatment (3.7 MBq/g thyroid tissue corrected to a 100% 24-hour 131I uptake) was given as a single dose in 81 patients, 2 doses in 38, and 3 to 5 doses in 11. One or 2 treatments cured 119 patients (92%), and 68 (52%) became euthyroid within 3 months after 131I treatment. The median 131I dose was 370 MBq (range, 93-1850 MBq). Forty-nine patients needing more than 131I dose had a reduction in median thyroid volume from 56 mL (range, 21-430 mL) to 44 mL (range, 15-108 mL), representing a 24% reduction related to the insufficient 131I dose. In all patients, the initial median thyroid volume of 44 mL (range, 16-430 mL) decreased to 25 mL (range, 8-120 mL) (P<.005), representing a median reduction of 43%, 24 months after the last 131I dose. Hypothyroidism evaluated using life-table analysis developed in 6% of patients who did not receive antithyroid pretreatment and 20% who did (P<.005) after a median of 42 months (range, 3-60 months), the total hypothyroidism frequency being 14% within 5 years of treatment. CONCLUSIONS: Ninety-two percent of patients with multinodular toxic goiter were cured with 1 or 2 treatments. The thyroid volume was reduced by 43%, with few side effects. Iodine 131 should be the choice of treatment in patients with multinodular toxic goiter.

Adult↗
PubMed1999

[Serum thyroglobulin compared with ultrasonically detected recurrent goiter].

Thirty-nine patients were studied for 13 years following resection of non-toxic goitre in order to correlate changes in serum thyroglobulin (Tg) to relapse. Preoperative serum Tg was elevated. After operation, mean serum Tg declined to 43 micrograms/L at one year and increased to 90 micrograms/L at 10 years. Thyroid hormones showed evidence of compensated hypothyroidism at one month which normalised within one year. 13 years after resection thyroid volume was determined by ultrasonography in 30 patients. In 10 patients the thyroid volume was enlarged (> or = 28 ml). In this group delta Tg after resection was 133 micrograms/L, compared to 26 micrograms/L in the 20 patients without relapse (volume < 28 ml). Thus, repeated serum Tg determinations may provide biochemical evidence of increased growth of thyroid remnants following goitre resection.

Adult↗
PubMed1999

[Investigation and treatment of solitary thyroid gland nodules by Danish endocrinologists. A questionnaire study].

In order to evaluate the attitude among Danish specialists in endocrinology towards the management of the solitary thyroid nodule a questionnaire study, based on a case report of a 42-year old woman with a solitary 2 x 3 cm thyroid nodule and absence of clinical suspicion of malignancy, was performed. Routine in vitro tests included serum TSH in all and FT4 and total T4 in more than half of the respondents. 99mTc scintigraphy and ultrasonography (US) were included by nearly 100% of the clinicians and additional fine-needle aspiration (FNA) was suggested by 90%. Regardless of a benign cytology, surgery was preferred by 66% and follow-up by the most of the remaining, while L-T4 therapy was suggested by only 2%. In case of clinical suspicion cytology was disregarded by most and surgery was preferred by 90% of the clinicians. The survey illustrates that both scintigraphy and US as well as FNA are used routinely, and that surgery is regarded as first choice of treatment by most Danish clinicians.

Adult↗