Influence of short-term interruption of antithyroid drugs on the outcome of radioiodine therapy of Graves' disease: results of a prospective study.

AIM: The factors influencing success of treating Graves' disease with radioiodine ( (131)I) are discussed controversially. This study analyses prospectively the influence of discontinuing antithyroid drugs (ATD) immediately prior to treatment with radioiodine on the therapeutic outcome. METHODS: We studied 141 patients with Graves' disease. In 73 of them (group A) treatment was performed under medication with ATD, in 68 patients (group B) ATD were discontinued for 3 - 7 days starting at the time of therapy. We performed a statistical analysis of the influence of ATD and other factors potentially influencing treatment results. RESULTS: In group A 49/73 patients were treated successfully (67 %) vs. 58/68 (85 %) in group B (p < 0.01). Characteristic changes in the kinetics of radioiodine were observed: after discontinuing ATD specific uptake was higher (2.0 %/ml in group A vs. 2.6 %/ml in group B, p = 0.004), and the effective half life was longer (5.1 +/- 1.3 d in group A vs. 5.5 +/- 1.1 d in group B, p = 0.076) resulting in a significantly higher radiation dose in group B (200 +/- 61 Gy in group A vs. 236 +/- 72 Gy in group B, p = 0.002). CONCLUSION: We conclude that short-term interruption of ATD improves the success rate of treating Graves' disease with radioiodine significantly.

Correlation of imaging techniques to histopathology in patients with diabetic foot syndrome and clinical suspicion of chronic osteomyelitis. The role of high-resolution ultrasound.

OBJECTIVE: To investigate the role of ultrasound in the diagnosis of osteomyelitis in the diabetic foot compared with magnetic resonance imaging (MRI), bone scintigraphy (BS), and plain film radiography (PFR). RESEARCH DESIGN AND METHODS: We investigated 19 consecutive diabetic patients (2 women, 17 men, age 60.7 +/- 9.8 years, BMI 27.0 +/- 3.8 kg/m2) with clinical suspicion of bone infection of the foot. A high-resolution ultrasound system (Esaote/Biosound, Munich) with a linear array transducer up to 13.0 MHz was used. The prospective and blinded results of each method were compared with histopathology as the reference method after metatarsal resection. RESULTS: In 14 of 19 patients, histopathology confirmed osteomyelitis. Ultrasound showed a sensitivity of 79% (PFR, 69%; BS, 83%; MRI, 100%), a specificity of 80% (PFR, 80%; BS, 75%; MRI, 75%), a positive predictive value of 92% (PFR, 90%; BS, 91%; MRI, 93%), and a negative predictive value of 57% (PFR, 50%; BS, 60%; MRI, 100%). CONCLUSIONS: Our data indicate that ultrasound might have a better diagnostic power for detecting chronic osteomyelitis in the diabetic foot than PFR and has similar sensitivity and specificity as BS. MRI is superior to the other three methods. We conclude that the use of ultrasound in the management of the diabetic foot is worthy of further investigation.

It takes acid, rather than ice, to freeze glucose.

Plasma glucose levels provide the cornerstone of diabetes evaluation. Unfortunately, glucose levels drop in vitro due to glycolysis. Guidelines provide suitable conditions which minimize glycolysis, such as immediate centrifugation or the use of ice/water slurry storage containers. For obvious practical reasons, most laboratories use blood collection tubes containing glycolysis inhibitors. We describe the effect of a variety of commonly used blood collection tubes on in vitro stability of glucose. Furthermore, we looked at the validity of the assumption that glycolytic activity is minimal when blood is kept in an ice/water slurry. Sodium fluoride alone does not reduce in vitro glycolysis in the first 120 minutes after phlebotomy. Addition of citrate almost completely prevented in vitro glycolysis, but showed a positive bias (0.2 mmol/l) compared to control. This is partly due to a small drop in glucose level in control blood, drawn according to the current guidelines. This drop occurs within 15 minutes, in which glycolysis has been described to be minimal and acceptable. NaF-EDTA-citrate based test tubes provide the best pre-analytical condition available. Furthermore, glucose levels are not stable in heparinized blood placed in an ice/water slurry. We strongly advise the use of NaF-EDTA-citrate based test tubes in diabetes research.

Examination of regional lymph nodes by sentinel node biopsy and molecular analysis provides new staging facilities in primary cutaneous melanoma.

Histopathologic parameters of the primary tumor, such as Breslow's tumor thickness and Clark's level of invasion are the current basis for prognostic classifications of primary cutaneous melanoma. Once patients develop regional node metastasis, histopathologic features of the primary melanoma no longer contribute significantly to survival prediction. In this tumor stage, the extent of lymph node involvement is the main prognostic factor. This study addresses the question whether application of a highly sensitive molecular biology assay for detection of submicroscopic melanoma cells in sentinel lymph nodes may be suitable to improve melanoma staging. One hundred and sixteen patients with primary cutaneous melanoma with a total of 214 sentinel lymph nodes were enrolled. Sentinel lymph nodes were analyzed by histopathology including immunohistochemistry and by reverse transcription-polymerase chain reaction for tyrosinase. Patients were examined for tumor recurrences during a follow-up period of 19 mo (median). Disease-free survival probabilities were calculated and independent prognostic factors were determined by multivariate analysis. Using histopathology, micrometastatic nodal involvement was detected in 15 patients (13%). Of the 101 patients with histopathologically negative sentinel lymph nodes, 36 were reclassified by positive tyrosinase reverse transcription-polymerase chain reaction and 65 patients were still negative by reverse transcription-polymerase chain reaction. Recurrences were observed in 23 (20%) of 116 patients. These tumor recurrences were demonstrated in 10 patients (67%) with histopathologically positive sentinel lymph nodes, in nine patients (25%) with submicroscopic tumor cells detected by reverse transcription-polymerase chain reaction, and in four patients (6%) negative by both methods. The differences in recurrence rates were statistically significant (p = 0.01). In a multivariate analysis, histopathologic and reverse transcription-polymerase chain reaction status of the sentinel lymph node were demonstrated to be the only significant prognostic factors for predicting disease-free survival. Tyrosinase reverse transcription-polymerase chain reaction for the detection of minimal residual melanoma in sentinel lymph nodes is a powerful tool to determine patients who are at increased risk for subsequent metastasis. Moreover, a group of patients with high tumor thickness was identified by negative reverse transcription-polymerase chain reaction to be at low risk for recurrent disease. These data may have an impact on future tumor classifications of primary cutaneous melanoma.

Detection of melanoma micrometastasis in sentinel nodes by reverse transcription-polymerase chain reaction correlates with tumor thickness and is predictive of micrometastatic disease in the lymph node basin.

The sentinel node has been reported to be representative for the presence or absence of metastatic melanoma in the draining lymph node basin. In this study, for the first time sentinel nodes and adjoining nonsentinel nodes were analyzed for micrometastatic disease using tyrosinase reverse transcription-polymerase chain reaction (RT-PCR) in comparison with standard immunohistochemistry. Successful identification of the sentinel nodes using a gamma probe-guided surgery was achieved in 73 (92%) of 79 patients with cutaneous stage I and II melanoma (tumor thickness > or =0.75 mm). A total of 794 regional lymph nodes, 148 sentinel nodes, and 646 adjoining nonsentinel nodes were evaluated. Tyrosinase RT-PCR was shown to increase the sensitivity for melanoma cell detection in sentinel nodes significantly (49% positivity) as compared with immunohistochemistry using antibodies against HMB-45 antigen and S-100 protein (18% positivity). Examination of sentinel nodes was highly predictive in determining the presence of regional lymph node micrometastasis by immunohistochemistry (99%) and RT-PCR (89%). Interestingly, detection of nodal micrometastasis by RT-PCR showed a strong positive correlation with tumor thickness of primary cutaneous melanoma. These results suggest the clinical significance and emphasize the importance of tyrosinase RT-PCR for detection of melanoma micrometastasis in sentinel nodes.

Bone marrow scintigraphy with technetium-99m anti-NCA-95 to monitor therapy in malignant osteopetrosis.

We report a case of a 2-mo-old girl with malignant osteopetrosis. Conventional radiological investigations of the skull and left hand showed the characteristic pattern of generalized sclerosis. Bone marrow immunoscintigraphy with 99mTc-labeled antibodies against nonspecific cross-reactive antigen (NCA) 95 was performed before and after bone marrow transplantation. Before transplantation, whole-body images showed bone marrow stores exclusively in the base of the skull. The rest of the skeleton did not reveal any hematopoietic activity. The liver and spleen showed increased antibody uptake as expected in extramedullary hematopoiesis. Repeat scintigraphy after bone marrow transplantation from her haploidentical father demonstrated an almost completely normalized tracer distribution corresponding to her clinical and hematological improvement. Bone marrow immunoscintigraphy appears to be an ideal complement to radiograph diagnostics in malignant osteopetrosis. In primary diagnosis, scintigraphy demonstrates the quantitative extent of bone marrow displacement. It also proves an ideal tool in monitoring the effectiveness of therapy after bone marrow transplantation.

Emotions and cognitions associated with bingeing and weight control behavior in bulimia.

The examination of cognitions and emotions during the bulimic cycle is critical in understanding possible maintenance factors involved in bulimia. In this study, 22 bulimics and 22 nonbulimics recorded their thoughts and feelings every 2 waking hours over a 6-day period. Bulimics additionally recorded their moods and thoughts during their binges and compensatory behaviors (e.g., purging, exercise). Higher levels of negative affect were reported at all stages of the cycle compared to baseline, although negative affect decreased after the compensatory behavior stage. Subjects also reported stronger distorted cognitions before and after the binge compared to baseline. One of the distorted cognitions (feeling fat) decreased in strength after subjects engaged in compensatory behavior. Additional analyses revealed that most levels of negative affect and distorted cognitions were elevated prior to binges as compared to meals. Finally, negative affect and distorted cognitions were stronger after binges than after meals.

Bulimia: prevalence and component factors in college women.

Using a measure of bulimia (BULIT) that has demonstrated validity and reliability, the prevalence of bulimia among three samples of college females was found to range from 2.0 to 3.8%. These percentages are substantially lower than most previous reports would suggest. Factor analysis of the BULIT data revealed that the binging factor accounted for 63% of the variance. Other factors identified include vomiting, negative feelings about overeating, menstruation problems, preference for high caloric/easily ingested food, and weight fluctuations. The intercorrelations among the factors were examined and the implications of these data for the proposed revised DSM-III criteria for bulimia are discussed.

Mechanism of thyroid-hormone regulated expression of the SERCA genes in skeletal muscle: implications for thermogenesis.

Thyroid hormone increases the Ca2+-ATPase activity of the sarcoplasmic reticulum (SR) in skeletal muscle, thereby increasing the energy-turnover associated with Ca2+-cycling during contraction and rest. The fast-muscle isoform of the Ca2+-ATPase (SERCA1) and the slow-muscle isoform (SERCA2a), are encoded by two genes that are transcriptionally regulated by T3. The SERCA1 isoform can be expressed to considerably higher levels than the SERCA2a isoform. The stimulation of transcription of the SERCA1 gene by T3 is mediated by two thyroid hormone response elements, located in the promoter of this gene. The intracellular [Ca2+] can modulate the effect of T3. The increase in SR Ca2+-ATPase activity seen when T3-levels rise above normal, results from the induction of SERCA1 expression in slow muscle fibers. Concomitant high levels of Ca2+-ATPase activity are associated with down-regulation of SERCA2a expression in these fibers. The observed T3-dependent increase in SERCAI expression and associated Ca2+ATPase activity will increase the overall metabolic rate of the organism significantly under normal conditions, because of the high average level of contractile activity of slow fibers. Given the rise in serum T3-levels during prolonged cold exposure, these data suggest that fiber-specific stimulation of SERCA1 expression contributes to the thermogenic response in non-shivering thermogenesis. This mechanism may be particularly relevant in larger mammals, which have a relatively high percentage of slow fibers in skeletal muscle, and which need to rely on tissues other than brown fat for the generation of extra heat.

[Osteitis diagnosis in a group of angiology patients: a comparison of X-ray and nuclear medicine studies]. / Osteitisdiagnostik in einem angiologischen Patientengut: Vergleich von röntgen- und nuklearmedizinischen Untersuchungen.

PURPOSE: Of the study was to examine the ranking of radiographs and bone scans in the diagnosis of osteitis. PATIENTS AND METHODS: 115 patients with arterial occlusive disease in stage Fontaine i.v. were referred for examination of the peripheral skeletal parts of the lower extremity. 126 radiographs and bone scans were taken. The time between the two examinations was 10 days maximum to enable direct comparison. Leukocyte scintigraphy was employed as gold standard. RESULTS: The sensitivity of radiographs was 47% with a specificity of 91%. Sensitivity and specificity of bone scans was 78% for both values. The positive predictive values for radiographs and bone scans were 88% and 85%, the negative predictive values were between 80% and 97%. CONCLUSION: In the majority of cases osteitis can be diagnosed with relatively inexpensive methods such as conventional x-rays and bone scans. Only in unclear cases further examinations such as leukocyte scintigraphy or magnetic resonance imaging should supplement the diagnosis.

[Reduction of thyroid volume following radioiodine therapy for functional autonomy]. / Reduktion des Schilddrüsen-volumens nach Radiojodtherapie wegen funktioneller Autonomie.

In a retrospective study we evaluated the data of 112 patients who underwent radioiodine treatment for functional autonomy of the thyroid at Essen University Hospital from 1988 to 1993. Therapeutic activities of radioiodine were administered after individual determination of activity for intended radiation doses (150-300 Gy) taking into consideration autonomously functioning volume, maximum uptake, and effective half-life. The achieved dose was calculated by means of measurement of the radioiodine kinetics during therapy. Depending on the type of autonomous function of the thyroid (solitary autonomously functioning nodule, multiple autonomously functioning nodules, autonomously functioning thyroid tissue) volume reductions between 39 and 46% were found approximately 6 months after treatment.

Parental factors related to bulimia nervosa.

The purpose of the present study was to examine the relationship between parental factors and bulimia nervosa. Subjects were female undergraduate students (classified as bulimic, subclinical bulimic, or normal) and their parents. Daughters and their parents were administered a questionnaire which assesses attitudes about being overweight, radical dieting, and parental pressure to lose weight. The bulimic group, and in some instances the subclinical group, were significantly different in that they reported perceiving themselves to be overweight, engaging in radical means of weight control, and perceiving more parental pressure to radically diet and exercise. The mothers of bulimic students, and in some instances subclinical bulimic students, were significantly different from the mothers of normal students in restricting their daughters' food intake, encouraging their daughters to diet and exercise in order to lose weight, and perceiving their daughters as being overweight. There were no significant differences among the three groups of fathers. Limitations of these findings were discussed as well as implications for further research.

Parental variables associated with bulimia nervosa.

The present study examined daughter and parent variables associated with bulimia nervosa, including attitudes about body image, eating and dieting histories, and self-esteem. Subjects were female undergraduates (bulimic, subclinical bulimic, and normal) their parents. Daughters differed in bodymass, with bulimics largest, followed by subclinicals, and finally controls. After daughter's bodymass was covaried, daughters differed in the expected direction on eating and body measures and perceived pressure from mothers to lose weight. Bulimic and subclinical daughters also perceived their mothers, more than their fathers, to pressure them to lose weight. After parents' bodymass was controlled, parents did not differ in eating behavior, dieting and weight history, self-esteem, body importance, or body image (self). Parents also did not differ in their perceptions of their daughters' bodies or the pressure exerted upon their daughters to lose weight after daughter's body-mass was covaried.

Attitudes toward bulimic behaviors in two generations: the role of knowledge, body mass, gender, and bulimic symptomatology.

The perceived commonality and acceptability of symptoms of bulimia, as well as associated variables including gender, generation, knowledge of bulimia, body mass index, and bulimic symptomatology, were assessed. These views were explored in a sample of college students (N = 155 male; N = 173 female) and their parents (N = 194 mothers; N = 163 fathers). Females perceived bulimic symptoms to be more common than males, and students perceived them to be more common than their parents. Students perceived bulimic symptoms to be more acceptable than their parents. Females had higher levels of bulimic symptomatology, particularly daughters. Stepwise simultaneous regression analyses revealed that one's own level of bulimic symptomatology was the primary predictor of one's attitudes toward the commonality and acceptability of bulimic symptoms. Bulimic symptomatology was primarily predicted from perceptions of the acceptability of bulimic symptoms and body mass index. Results suggest that college-age students may be at greater risk for the development of bulimia nervosa because of their greater tolerance of these symptoms; alternatively, people endorsing higher levels of bulimic symptomatology may adjust their attitudes, perceiving bulimic symptoms to be more tolerable, in order to alleviate the dissonance between their attitudes and behaviors.

Eating and body image concerns among obese and average-weight children.

Research compared obese and average-weight children with regard to concerns about being or becoming overweight, history of dieting, concerns about the effects of eating food, and perceived discrepancy between real and ideal body image. Participants included 526 obese and average-weight elementary-age school children to whom questionnaires were administered. Gender (male/female), obesity status (obese/average-weight), and grade level (lower elementary/upper elementary) were considered. Obese children were significantly more likely to engage in dieting behaviors, to express concern about their weight, to restrain their eating, and to exhibit more dissatisfaction with their body image than average-weight children. Girls were more likely to exhibit these behaviors than were boys. These findings suggest the importance of studying the emergence of disordered eating habits in childhood.

Bulimia and interpersonal relationships: an extension of a longitudinal study.

We examined changes in bulimia in female college students and changes in the relationship between bulimia and satisfaction with interpersonal relationships. We extended data collected from a 19-month time period in a previous study to a 31-month time period. Bulimics, subclinical bulimics, and normals showed a leveling off of the previous decline in bulimic symptoms assessed at the 19-month testing. There were strong negative correlations between the Bulimia Test and ratings of satisfaction with male interpersonal relationships, but the correlations were not significant for satisfaction with female relationships.

Fear of intimacy and attachment among rape survivors.

The purpose of the present study was to investigate attachment and fear of intimacy among rape survivors. As previous research has documented that several domains of functioning are affected by the experience of rape, it was hypothesized that the survivors may have difficulties with attachment and intimacy. Subjects were selected from an undergraduate general psychology class on the basis of responses to a questionnaire on sexual experiences. All of the subjects were female and included 44 rape survivors and 57 controls. As predicted, rape survivors reported greater fear surrounding intimacy. Survivors also differed from the controls on all of the attachment dimensions. They reported less confidence in others' dependability, less comfort with closeness, and more fear of abandonment. Trait anxiety was also controlled in the analyses, and except for fear of abandonment, it attenuated the differences between the groups such that they were no longer significantly different.

Fear of intimacy among dating couples.

Fear of intimacy among heterosexual dating couples was examined with the Fear-of-Intimacy Scale (FIS) and the Personal Assessment of Intimacy in Relationships (PAIR). Following a 6-month interval, couples were again contacted to determine whether they continued to date. Males reported higher FIS scores than females, and FIS scores were positively correlated within couples. Also, FIS scores of males and females were significantly correlated with indices of actual and desired intimacy; however, for females, correlations of FIS scores with desired intimacy were significantly lower than correlations with actual intimacy. Females who were no longer in the dating relationship at the 6-month follow-up had higher FIS scores than those who were continuing in their dating relationship. These findings increase our understanding of fear of intimacy, especially gender differences in dating couples.

Predictors of body image dissatisfaction in elementary-age school girls.

Concerns about weight, shape, body image, dieting, and eating are evident among elementary-age school girls [Int. J. Eating Disord. 10 (1991) 199; J. Adolesc. Health 12 (1991) 307; Pediatrics 84 (1989) 482; J. Clin. Psychol. 21 (1992) 41; Addict. Behav. (2000).]. Body image dissatisfaction, found to predict the formation of eating disturbances in longitudinal studies [Eating Disord.: J. Treat. Prev. 2 (1994) 114; Int. J. Eating Disord. 18 (1995) 221.], is likely a necessary precursor of eating disturbance development [J. Abnorm. Psychol. 102 (1993) 438.]. Turning back the etiological clock, this study examines the association between body image dissatisfaction and four potential areas of influence, including peer relationships, family characteristics, personality features, and body mass index, among girls in grades three, four, and five. Each conceptual area significantly contributed to the prediction of body image dissatisfaction. The combination of statistically significant variables, including teasing, peer modeling of weight and shape concerns, daughters' perceptions of parental influence to lose or control weight, appearance comparison, sensitivity, and body mass index, accounted for 50% of the variance in general body image dissatisfaction and 45% in weight and shape dissatisfaction. Implications for prevention, treatment, and future research are discussed.

Double-phase Tc-99m MIBI scintigraphy in secondary hyperparathyroidism relapsing after parathyroidectomy and removal of a parathyroid autograft.

A 53-year-old woman with chronic renal failure had secondary hyperparathyroidism relapsing after undergoing a second parathyroidectomy and excision of an autologous parathyroid graft that had been implanted after her first parathyroidectomy. Double-phase scintigraphy with Tc-99m MIBI disclosed pathologic MIBI uptake in the right anterior thorax where the parathyroid transplant had been placed. Histopathologic examination of three nodules excised from this region yielded hyperplastic parathyroid tissue. This case report further illustrates the value of double-phase Tc-99m MIBI scintigraphy in atypical cases of hyperparathyroidism.