Cervical Vertebral Body Chordoma in a Cat.

A 9-year-old, neutered female Maine Coon cat with a 6-week history of progressive ataxia was diagnosed with a cervical vertebral body mass using magnetic resonance imaging. The mass displaced and compressed the cervical spinal cord. The cat was humanely destroyed and necropsy examination confirmed a mass within the second cervical vertebral body. Microscopically, the mass was composed of large, clear, vacuolated ('physaliferous') cells. Immunohistochemically, the neoplastic cells expressed both cytokeratin and vimentin and the final diagnosis was a cervical, vertebral body chordoma. This is only the third report of a chordoma in this species and the first in this location. Chordoma should be considered as a potential differential diagnosis for tumours arising from the cervical vertebrae in the cat.

Video-otoscopy-guided tympanostomy tube placement for treatment of middle ear effusion.

OBJECTIVE: To describe video-otoscopy-guided tympanostomy tube placement in 12 cavalier King Charles spaniels with middle ear effusion and assess the clinical outcome. METHODS: A retrospective review of medical records of cavalier King Charles spaniels diagnosed with middle ear effusion and treated with tympanostomy tubes placement between 2012 and 2014 was performed. Outcome was assessed based on a telephone questionnaire. RESULTS: Twenty-two tympanostomy tubes were successfully placed in the tympanic membrane in 12 cavalier King Charles spaniels under video-otoscopic guidance using a rigid endoscope and grasping forceps. Follow-up based on an owner questionnaire was available for 11/12 dogs. Subjective improvement in hearing was observed in 9/11 dogs with three dogs achieving normal hearing, according to the owners, and six demonstrating partial improvements. Out of 11 dogs, 10 dogs were reported with improved quality of life. Pruritus of the ears resolved in 3/9 dogs. Clinical signs recurred in four dogs because of tube dislodgement. CLINICAL SIGNIFICANCE: Video-otoscopic tympanostomy tube placement appeared to be indicated as a treatment for middle ear effusion in cavalier King Charles spaniels. It subjectively improved hearing, pruritus and quality of life in most dogs. The tympanostomy tubes dislodged in some cases, leading to recurrence of clinical signs, which were effectively eliminated by replacement of a fresh tube.

[Recurrent hypoglycemia and a large intraabdominal tumor in a 61-year-old woman]. / Rezidivierende Hypoglykämien und ein großer intraabdominaler Tumor bei einer 61-jährigen Patientin.

HISTORY AND ADMISSION FINDINGS: A 61-year-old woman was found unconscious by her husband. The emergency doctor detected hypoglycemia (blood glucose 1.7 mmol/l). This was the first such event, the patient had not been known to have diabetes mellitus. At admission the physical examination and the laboratory findings revealed no abnormalities. INVESTIGATIONS: A fasting test was aborted shortly after the start because of the onset of neurological symptoms. An insulinoma was excluded by detecting suppressed levels of insulin and C-peptide. Computed tomography of the abdomen revealed a mesenteric tumour of 9 cm in diameter, which was identified immunhistologically as a grade 1 follicular lymphoma (FL).  After exclusion of endocrinological causes the recurrent hypoglycaemia was diagnozed as part of a paraneoplastic syndrome associated with a non-islet cell tumour hypoglycaemia (NICTH) with a newly diagnosed FL. TREATMENT AND COURSE: Specific medication with the CD20 antibody rituximab (375 mg/m2, once per week for a total of four cycles) was initiated. There were no further episodes of hypoglycaemia. After one year the patient remains free of any symptoms. CONCLUSIONS: After exclusion of any endocrinological reasons for hypoglycemia, differential diagnosis should include NICTH as paraneoplastic syndrome. In rare cases a hematological malignancy may be the underlying disease. The specific treatment of this disease likewise represents the causal treatment of NICTH.

Urinary iodide excretion in adults in germany 2005 meets WHO target.

BACKGROUND: Recent regional and germanwide investigations have shown that the abolition of the requirement to declare iodine in foodstuffs and the greater emphasis on information about goitre prevention led to an increase in urinary iodine excretion in German schoolchildren. There was also a decrease in thyroid size and goitre prevalence in children. No up to date results in adults for the whole of Germany are available. METHODS: In 2005 we examined the urinary iodine excretion in the spontaneous morning urine of 1 538 healthy adults in 357 places from all over Germany. The iodine was measured by the Cer- arsenit method. RESULTS: The median iodine excretion amounted to 132 microg/l. There were no significant differences between age groups, sexes or regions. 64% had no iodine deficiency (>100 microg/l). In 23% the deficiency was slight (50-99 microg/l), in 10% moderate (20-49 microg/l) and in 3% there was severe iodine deficiency (<20 microg/l). 29% excreted >200 microg iodide per litre urine. CONCLUSION: According to the WHO guidelines, there is no longer an iodine deficiency in German adults.

[Thyroid gland ultrasound screening (Papillon Initiative). Report of 15 incidentally detected thyroid cancers]. / Schilddrüsenultraschallscreening (Initiative Papillon). Bericht über 15 zufällig entdeckte Schilddrüsenkarzinome.

In the framework of the Thyroid initiative Papillon 2001 - 2002 thyroid nodules and sonographically detectable focal lesions with a diameter more than 5 mm were verified in 23.1% of 64.123 persons without a history of thyroid disease. The frequency of such findings was with 33.0% in 46-65 years old persons three times higher then in persons aged 18-30 years (9.6%). In the diagnostic workup thyroid cancer was detected in 15 patients operated on up to now (6 women and 9 men; papillary cancers in 12 cases, follicular cancers in 3 cases) The smallest tumor had a diameter of 1.3 cm, the mean diameter was 2.3 +/- 91 cm. In 3 patients the tumor had invaded the tissue beyond the thyroid capsule, in 4 cases multicentric growth was detected. Lymph node metastases were found in 7/15 cases and distant metastases in 2/15 cases. These result reveal, that thyroid cancer detected by chance may be relatively aggressive. In daily routine, sonographically detectable lesions with poor echogenicity, irregular margins or internal calcifications with a diameter of more than 1 cm should be clarified by fine needle aspiration biopsy.

[Urinary iodine levels within normal range in German school-age children]. / Jodidurie bei Schulkindern in Deutschland 1999 im Normbereich.

BACKGROUND: Recent regional investigations have shown that the abolition of the requirement to declare iodine in foodstuffs and the greater emphasis on information about goitre prevention led to an increase in urinary iodine excretion in Germany. There was also a decrease in thyroid size and goitre prevalence in children. No up to date results for the whole of Germany are available. PROBANDS AND METHODS: In 1999 we examined the urinary iodine excretion in the spontaneous morning urine of 3,065 healthy 6- to 12-year-old school children in 128 places from all over Germany. The iodine was measured by the Cer-arsenit method. RESULTS: The median iodine excretion amounted to 148 micrograms/l. There were no significant differences between age groups, sexes or regions. 73% had no iodine deficiency (> 100 micrograms/l). In 20% the deficiency was slight (50-99 micrograms/l), in 6% moderate (20-49 micrograms/l) and in 1% there was a severe iodine deficiency (< 20 micrograms/l). 8% excreted > 300 micrograms iodide per liter urine. CONCLUSION: According to the WHO guidelines, there is no longer a iodine deficiency in Germany--at least among children prior to puberty.

Continuous rise of urinary iodine excretion and drop in thyroid gland size among adolescents in Mecklenburg-West-Pomerania from 1993 to 1997.

Improved legislation (1989, 1993), as well as education of the public, are likely to improve the iodine supply for the German population. Children and adolescents will be the first to profit. We investigated thyroid size and urinary iodine excretion in a total of 2906 students aged 10 to 18 in Mecklenburg-West-Pomerania in 1993, 1995, and 1997. The median urinary iodine excretion rose from 73 microg/g creatinine in 1993 to 133 microg/g in 1997. The prevalence of goiter, according to the reference range of Gutekunst, dropped from 33% to 10% over the same interval, and the median thyroid size declined from 11 ml to 6 ml. While only 6% of the test subjects excreted more than 150 microg iodine per g creatinine in 1993, this figure rose to 33% in 1997. The improved alimentary iodine supply is due to the increased use of iodine enriched salt by the food industry, food factories and in common food supply services.

Prophylactic thyroidectomy in 75 children and adolescents with hereditary medullary thyroid carcinoma: German and Austrian experience.

When mutations of the RETproto-oncogene were found in 1993 to account for hereditary medullary thyroid carcinoma (MTC), surgeons obtained the opportunity to operate on patients prophylactically (i. e., at a clinically asymptomatic stage). Whether this approach is justified, and, if so, when and to which extent surgery should be performed remained to be clarified. A questionnaire was sent to all surgical departments in Germany and Austria. All of the patients who fulfilled the following criteria were enrolled: (1) preoperatively proved RET mutation; (2) age

[Increased dietary intake of iodine in young people in Mecklenburg-Vorpommern 1993 and 1996]. / Alimentäre Jodaufnahme bei Jugendlichen in Mecklenburg-Vorpommern zwischen 1993 und 1996 gestiegen.

We investigated the goiter prevalence and the urinary iodine excretion of 2,109 young people between 10 and 18 years in the district of Mecklenburg-Vorpommern, Germany in 1995/96. The thyroid volume was determined by ultrasound (7.5 MHz), the iodine excretion by a modified cer-arsenit method. The daily iodine excretion as related to the body surface area and the age related creatinine excretion per 24 h were measured. The results were compared with those of a similar study from 1993 in the same region and the same range of age. The goiter prevalence in 1997 amounted to 18.5%. Among the studied persons 3.6% showed one or more nodules within their thyroid gland. The iodine excretion increased from 70 micrograms in 1993 to 95 micrograms in 1997. There were no changes in the individual nutritional habits (especially iodine-containing foods, using iodized salt etc.). We believe that the raised iodine intake is the result of a higher iodine supply in the commercially produced foodstuffs and animal products due to an increased incorporation of iodine in manufacture of food products.

Serum zinc levels and goitre epidemiology in Germany.

Zinc is an essential element involved in many basic biochemical reactions. Animal experiments and clinical data support the hypothesis that in the presence of inadequate iodine supply zinc deficiency may be a stimulus for the development of goitre. Within the framework of a study to record goitre prevalence and iodine supply of Germany we determined the serum zinc levels in 5932 clinically healthy persons. The mean value was 13.1 +/- 1.75 mumol/l. There were no differences neither in age, in sex nor in regional distribution. Furthermore there were no correlations between serum zinc level, thyroid volume and urinary iodide excretion. Only 1% of all cases had low zinc levels (< 10 mumol/l). Older people (> 40 years) with lowered serum zinc levels showed significantly larger thyroids. We conclude that there is no relevant undersupply of zinc and therefore the trace element is not involved in the goitre endemy of Germany.

Mutations of the ret protooncogene in German multiple endocrine neoplasia families: relation between genotype and phenotype. German Medullary Thyroid Carcinoma Study Group.

It has been suggested that not only the position but also the nature of the mutations of the ret protooncogene strongly correlate with the clinical manifestation of the multiple endocrine neoplasm type 2 (MEN 2) syndrome. In particular, individuals with a Cys634-Arg substitution should have a greater risk of developing parathyroid disease. We, therefore, analyzed 94 unrelated families from Germany with inherited medullary thyroid carcinoma (MTC) for mutation of the ret protooncogene. In all but 1 of 59 families with MEN 2A, germline mutations in the extracellular domain of the ret protein were found. Some 81% of the MEN 2A mutations affected codon 634. Phenotype-genotype correlations suggested that the prevalence of pheochromocytoma and hyperparathyroidism is significantly higher in families with codon 634 mutations, but there was no correlation with the nature of the mutation. In all but 1 of 27 familial MTC (FMTC) families, mutations were detected in 1 of 4 cysteines in the extracellular domain of the ret protooncogene. Half of the FMTC mutations affected codon 634. Mutations outside of codon 634 occurred more often in FMTC families than in MEN 2A families. In all but 1 of 8 MEN 2B patients, de novo mutations in codon 918 were found. These data confirm the preferential localization of MEN 2-associated mutations and the correlation between disease phenotype and the position of the ret mutation, but there was no correlation between the occurrence of hyperparathyroidism or pheochromocytoma and the nature of the mutation.

[Current state of alimentary iodine deficiency in Germany]. / Aktueller Stand der alimentären lodversorgung in Deutschland.

Germany finds itself among the most iodine deficient countries of Europe. Voluntary use of iodized salt constitutes the only goiter prophylaxis. In the last few years, measures such as the opening up of European internal markets, abolition of lac pertaining to the alimentary iodine consumption. Random samples of urine collected from 5932 persons without thyroid ailment, distributed over 32 regions of Germany, were measured for iodine excretion. The median value of iodine excretion was 72.4 micrograms I/g creatinine. Children under 10 years (76.9) and persons over 70 years (80.7) showed a slightly higher iodine elimination than those between 11-70 years (71.9). No differences between the former East Germany and West Germany as well as North, South and middle regions of unified Germany were observed. 55% of the study population presented with iodine values between 50 and 100 micrograms, 19% with lower than 50 micrograms. Only 9% showed sufficient iodine state. The results expose the inadequacy of the voluntary measures to tackle the problem of alimentary iodine deficiency.

[Goiter incidence in Germany is greater than previously suspected]. / Strumaprävalenz in Deutschland grösser als bisher angenommen.

BACKGROUND: The data regarding goitre prevalence in Germany is based on calculation arising out of dissimilar studies conducted among inhomogeneous study groups. The aim of our study was to collect data towards prevalence of goitre, thyroid size and structure through a prospective nationwide survey conducted using identical examination methods and study protocol. PATIENTS AND METHOD: A total number of 6815 subjects belonging to various age groups and spread over 32 regions in Germany participated in our thyroid ultrasound study conducted with a 7.5 MHz transducer. Information regarding nutrition, use of iodised table salt and iodine containing medicine and/or substances were collected through a questionnaire. The volumetry and age related normal values were followed as per the guidelines set by Deutsche Gesellschaft für Endokrinologie. RESULTS: Enlarged thyroid was seen in 50% of 18 to 70 year age group, 52% of 11 to 17 year age group and in 21% of children up to 10 years. Focal lesions were detected in 2.5% of subjects below 18 years and in 30% of women and 21% of men over 18 years. A positive correlation between age, thyroid volume and number of thyroid nodules was seen. Up to 83% of the examined subjects admitted to using iodised table salt. Children consuming iodised salt were found to have smaller thyroid glands. No correlation was found between the consumption of iodised salt and thyroid size in the adolescent age group and young adults. CONCLUSION: The prevalence of goitre in Germany is higher than it has been reported. The study underlines the insufficiency of the present goitre prophylaxis. Only an iodine prophylaxis (table salt, food products, fodder) backed by legislative measures can bring about a real breakthrough.

Tissue regenerates of adrenal cortex with a physiological function twelve years after bilateral total adrenalectomy for Cushing's syndrome.

We report about a male patient, who underwent bilateral total adrenalectomy due to ACTH-dependent Cushing's syndrome without pituitary adenoma in his 11th year of life. Symptoms of Cushing's disease were absent during the follow-up period. Height and body weight followed the percentiles 25 and 50 respectively. An endogenous cortisol production was not detected and steroid substitution became necessary. Five years after the surgery, he showed normal cortisol levels, but there was no cortisol increase under ACTH-loading. Nine and 12 years (1993) after surgery, we found normal, physiological levels of cortisol suggestive of normal functioning adrenal glands (day profile of cortisol, Liddle-Test, ACTH-Test, CRH-Test, cortisol excretion in 24-h-urine). Moreover, baseline ACTH and its rise under CRH stimulation were normal. Scintigraphy revealed normal-sized adrenal tissue in orthotopic position on both sides. Steroid supplementation was discontinued. Presently the patient is healthy, active and under no steroid therapy. No evidence of residual or relapsing Cushing's disease or Nelson's syndrome has been found up to this point.

[Despite use of iodized salt in individual food preparation there remains a 1st degree iodine deficiency in Germany]. / Trotz Verwendung von Jodsalz zur individuellen Speisenzubereitung bleibt ein Jodmangel I. Grades in Deutschland bestehen.

Due to the fact that the use of iodated table salt is not compulsory in Germany and entirely at the discretion of the individual consumer, there is hardly any effective prevention of endemic iodine deficiency struma in this country. The good results achieved in the former GDR with iodine prophylaxis dropped to the FRG level after the unification. Using iodated salt when preparing individual food dishes is not enough to counteract iodine deficiency. We proved this in our study which is communicated below. An iodine deficiency of the first degree remains. Effective compensation of iodine deficiency can be achieved only if iodine is added on a large scale in all branches of food preparation (including the serving and catering of food), of the food industry (on both a major and a small scale) and in meat production, i.e. in producing food of animal origin.

[Bone alkaline phosphatase as an activity parameter of acromegaly]. / Alkalische Knochenphosphatase als Aktivitätsparameter der Akromegalie.

Serum levels of growth hormone (GH: arithmetic mean of three measurements eight hours apart), somatomedin C (SmC), alkaline phosphatase activity and the bone isoenzyme of alkaline phosphatase (as the liver/bone isoenzyme ratio) were measured in 26 patients with acromegaly (11 men and 15 women; mean age 45.5 [24-66] years), 18 in the active and eight in the nonactive phase of the disease. Activity was characterized by a raised (660 [330-1149] ng/ml), inactivity by a normal (186 [40-300] ng/ml) SmC concentration. All 18 patients with active acromegaly had an abnormally low liver/bone isoenzyme ratio (mean of 0.66 [0.01-1.28]). In seven of the eight patients with inactive acromegaly it was within normal limits. Thus measurement of bone alkaline phosphatase, which is significantly cheaper than that of SmC, is suitable for assessing activity.

[TSH receptor antibody determination using the TSH radioreceptor antibody assay in clinical practice]. / TSH-Rezeptor-Antikörperbestimmung mit dem Radiorezeptor-Assay TRAK in der klinischen Praxis.

We tested the clinical valency of the TSH-receptor antibody (TBIAb) determination (TRAK assay, Fa. Henning) for the differential diagnostics of various diseases of the thyroid gland (n = 259), particularly of the hyperthyroidism. In 110 out of 114 basedowians TBAIAb could be proved (sensitivity 96%). The specifity to healthy persons (n = 20) was 100%, to the disseminated autonomy (n = 61) 92%. In 43 bland strumas and 22 cases of primary hypothyroidisms no circulating TBIAb were found. Of 40 cases of Basedow's hyperthyroidism the TBIAb titres were pursued during a 12-month methimazol therapy. In these cases was shown that negative antibody titres at the end of the treatment were connected with an essentially lower rate of early relapses than positive ones. Moreover, a highly dosed application of methimazol revealed a more favourable tendency than a low dosed one. From this we conclude that the TBIAb measurement with a commercial kit is a sensitive, sufficiently specific and practicable method for the differential diagnostics of hyperthyroidism and that to a certain degree it allows conclusions on the course of Basedow's disease after thyrostatic long-term therapy.

[Results of thyrostatic therapy of hyperthyroidism in patients with Basedow's disease and disseminated autonomy]. / Ergebnisse der thyreostatischen Therapie der Hyperthyreose bei Patienten mit Morbus Basedow bzw. disseminierter Autonomie.

Up to now the results of drug treatment are unsatisfying. Treatment of more than 1-2 years did not decrease the occurrence of relapses. Thyroid suppression test and TRH test give the same indications concerning the outcome in cases with Graves' disease and disseminated autonomy (short-time prognosis). The relapse rate is distinctly higher in Graves' disease than in cases with disseminated autonomy (goitre class 3 excluded).