We established a highly sensitive method to determine triazolam and its major metabolites, alpha-hydroxytriazolam and 4-hydroxytriazolam, in human plasma and urine with a liquid chromatography-mass spectrometry system which incorporates an atmospheric chemical ionization interface. A plasma sample and a urine sample after solvent extraction were injected into an ODS column of reversed phase with a mobile phase in a linear solvent gradient of initially 50 mM ammonium acetate (pH 4.0) 50%:methanol 50% and 15 min later methanol 100%; quantification limits of as low as 20 pg/mL at an SNR of 3 were obtained for each compound. With diazepam as an internal standard, recovery yields of 84, 81, and 77% were obtained for triazolam, alpha-hydroxytriazolam and 4-hydroxytriazolam, respectively.

Adult↗

PubMedDate not supplied

Early recurrence of hyperthyroidism in patients with Graves' disease treated by subtotal thyroidectomy.

Prerequisites for surgical treatment of Graves' disease are that it can be done safely and that it is associated with a low incidence of recurrent hyperthyroidism. Early recurrence is especially undesirable. We studied 728 patients with Graves' disease treated by subtotal thyroidectomy using multivariate analysis in order to determine the factors related to early recurrence. The following factors were analyzed: age, sex, duration of medical treatment, weight of resected thyroid tissue, thyroid remnant size, preoperative level of thyroid-stimulating hormone (TSH) binding inhibitory immunoglobulin (TBII), and antimicrosomal hemagglutination antibody (MCHA). "Early recurrence" was defined as TSH suppression observed within the first year after surgery and continuing for at least 6 months. A total of 106 patients (14.6%) had early recurrence. Statistical analyses were performed by the chi-square test for univariate analysis and a logistic model for multivariate analysis. Significant factors were thyroid remnant size, MCHA, and TBII. These results indicated that TBII and MCHA are related to early recurrence of hyperthyroidism, and smaller remnant size is recommended for patients with a high MCHA titer or a high TBII level (or both) in order to avoid early recurrence.

Adolescent↗

PubMedDate not supplied

Thyroid carcinoma after radioactive iodine therapy for Graves' disease.

Although the causal relation between radioactive iodine therapy (RIT) for Graves' disease and the subsequent occurrence of thyroid carcinoma is not definite, surgeons may be faced with the treatment of such patients. We studied the clinicopathologic features of patients with thyroid carcinoma following RIT for Graves' disease. From January 1983 to December 1991, 11 patients with thyroid carcinoma occurring 1 year or more after RIT for Graves' disease underwent surgery at Ito Hospital. These 11 patients accounted for 0.51% of 2146 surgical cases of thyroid carcinoma and 0.17% of 6419 RIT cases of Graves' disease during the period. They were all women, and their mean ages at RIT and surgery were 44.3 and 51.4 years, respectively. The administered dose of RI was 222.1 MBq and the absorbed dose 45.3 Gy on average. Total thyroidectomy was performed in two patients, subtotal thyroidectomy in three, and lobectomy in six. Bilateral modified neck dissection (MND) was added in two patients, and ipsilateral MND in seven. Histology revealed 10 papillary and 1 follicular carcinoma. The mean diameter of the tumor was 18.5 mm. Intraglandular dissemination of the tumor was noted in only one case and solid growth pattern in two. Nodal metastasis was disclosed in six cases, but in five of them only one node was involved. The present study indicated that thyroid carcinoma occurring after RIT for Graves' disease is not an aggressive variety, and thyroid lobectomy with ipsilateral MND would be sufficient as surgical treatment for such patients.

Adenocarcinoma, Follicular↗