[Clinical aspects and preoperative diagnosis in differentiated thyroid gland carcinoma]. / Klinik und präoperative Diagnostik bei differenzierten Schilddrüsenkarzinomen.

Etiologic factors such as iodine deficiency and exposure to ionizing radiation especially during childhood are determinants of histological type and malignancy of differentiated thyroid carcinomas. The rarely occurring anaplastic thyroid carcinoma represents a highly malignant tumour of old patients, causing local compression symptoms at an early stage of disorder. Since early symptoms are lacking, sensitivity and specificity of further diagnostic approaches are of particular importance in the care of differentiated thyroid carcinomas. Obligatory procedures at the preoperative stage are ultrasound, scintigraphy, determinations of thyroid hormones and calcium on serum as well as an otolaryngological investigation. The preoperative determination of calcitonin may assist in the differential diagnosis of a cold nodule and in the detection of a medullary thyroid carcinoma. Measurements of thyroglobulin are helpful only for the follow-up of patients with differentiated carcinomas. The highest degree of specificity and sensitivity is achieved by fine-needle aspiration. Finally, if clinical suspicion of malignancy exists, surgical intervention should be performed even if the result of cytological analysis was negative. Whether the color Doppler energy ultrasound provides valuable additional informations especially in the differential diagnosis of thyroid nodules during childhood, is still undecided.

Common warts from immunocompetent patients show the same distribution of human papillomavirus types as common warts from immunocompromised patients.

We studied the papillomaviruses (HPV) found in 131 common warts from 111 immunocompetent patients by amplification of viral DNA sequences with the general-primer-mediated polymerase chain reaction (PCR). The virus types were determined by restriction-enzyme cleavage and reverse-blot analysis. Results were confirmed by using the Southern blot technique. Forty patients harboured HPV 2a, 25 individuals showed HPV 2c and 13 yielded HPV 57. Common warts from 16 patients were induced by a variant of HPV 57. HPV 7 was found in four patients. HPV 1 was identified in two patients, and there was evidence for HPV 4 in only one case. One individual yielded an HPV type which was only weakly related to HPV 2. Three patients were infected by more than one HPV type. PCR did not demonstrate HPV-DNA in warts from six individuals. The distribution and variation of HPV types found in the common warts of immunocompetent patients were similar to the findings in immunocompromised patients reported by other authors.