The role of 2-18F-fluoro-2-deoxy-D-glucose positron emission tomography in the diagnosis of giant cell arteritis of the temporal arteries.

OBJECTIVE: As one of the diagnostic criteria for giant cell arteritis affecting the temporal arteries (temporal arteritis) is still biopsy-proven vasculitis of the affected artery, the aim of our study was to evaluate the value of a non-invasive procedure, 2-(18)F-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (F-18-FDG-PET), in the diagnosis of Horton's disease. METHODS: During a period of 10 months, 22 consecutive patients with the clinical diagnosis of giant cell arteritis and a positive hypoechogenic halo in duplex sonography were re-examined with F-18-FDG-PET. Six patients had giant cell arteritis involving both the large arteries and the temporal arteries; five patients showed giant cell arteritis only in the large arteries without concomitant involvement of the temporal arteries, and the remaining 11 patients showed only involvement of the temporal arteries. All patients were examined by sonography and F-18-FDG-PET, which was performed before treatment with corticosteroids. RESULTS: All patients with positive signs of giant cell arteritis in duplex sonography, i.e. a hypoechogenic halo in the large arteries (thoracic, subclavian, axillary, iliac, aorta), also showed elevated FDG uptake in the same vessels, with complete agreement in the anatomical distribution of changes. When positive sonography was limited to the temporal arteries, FDG-PET was completely negative in the temporal arteries and all other arterial locations. CONCLUSION: PET is not yet suitable for the diagnosis of temporal arteritis and therefore cannot replace invasive biopsy. F-18-FDG-PET is well suited to the demonstration of giant cell arteritis in arteries exceeding 4 mm in diameter.

Gallium-67-citrate scintigraphy of high-grade T-cell non-Hodgkin's lymphoma.

Scintigraphy with 67Ga-citrate indicated the transition of an orbital pseudotumor into a lymphoma by a distinct increase in 67Ga avidity. The patient initially presented with a pseudotumor in the right orbit that was verified by CT and MRI. It was caused by a chronic reactive lymphocytic inflammation extending from the lacrimal gland. At that time, scintigraphy was negative. Six and a half weeks later, the tumor had not responded to therapy and scintigraphy then showed a striking increase in gallium avidity. Consequently the tumor was excised and histology ultimately revealed a high-grade non-Hodgkin's T-cell lymphoma.

Intraoperative radiation therapy, endotracheal hyperthermia and IR-192-brachytherapy in patients with advanced thyroid cancer.

Tracheal stenosis due to infiltrative nonresectable thyroid cancer causes severe reduction in life quality. Palliative therapy, apart from tracheostomy is--up to now--intraluminal and/or external radiation. Good tumor control is achieved by local hyperthermia. A combined modality treatment (CMT) consisting of surgery, brachytherapy and intraoperative radiation, eventually combined with intraluminal NdYg-Laser-desobliteration was performed. An intraoperative radiation therapy (IORT)-protocol was designed for poorly differentiated non-anaplastic thyroid carcinoma. Out of 155 cases of differentiated thyroid tumors, 12 showed marked vascular and/or capsular invasion. Five entered the study (3 primarily local invasive tumors, 2 local recurring). IORT was administered after tumor surgery (4-10 Gy) and combined with postoperative percutaneous irradiation. The tumor control rate in the thyroid bed is 5/5, 1/5 developed mediastinal nodes, 1/5 with primary mediastinal tumor extend shows tumor progression. No specific complications occurred.

Radiolabeled octreotide for the demonstration of somatostatin receptors in malignant lymphoma and lymphadenopathy.

UNLABELLED: This prospective study evaluated somatostatin receptor-specific scintigraphy as a clinical tool for routine detection of malignant lymphoma. METHODS: Forty-one consecutive patients were examined using 111In-DTPA-D-Phe-1-octreotide. Thirty-four patients had diagnoses of Hodgkin's disease (n = 11) or non-Hodgkin's lymphoma (n = 23) previously verified and staged by hematology, histology and imaging methods (CT, chest x-ray and abdominal ultrasonography). The remaining seven patients initially suspected of presenting lymphoma (n = 5) or lymphoma recurrence after chemotherapy and radiotherapy (n = 2) were subsequently shown to have other diseases. Planar images were recorded 4, 24 and 48 hr after intravenous injection and evaluated without knowledge of other results. In case of negative planar scintigraphy, additional SPECT images were obtained. Since these failed to increase sensitivity, they were omitted after 15 negative recordings. RESULTS: Octreotide scintigraphy did not yield false-positive results. The sensitivity for detecting Hodgkin's disease was 70% and varied from 88% in the neck and chest to 13% in the abdomen and pelvis. The sensitivity for non-Hodgkin's lymphoma was not influenced by localization and amounted uniformly to 35% but varied with the degree of malignancy between 44% (high-grade) and 29% (low-grade malignancy). CONCLUSION: Our results suggest that radiolabeled octreotide is better suited to characterize somatostatin receptor expressing lymphomas than to localize lesion sites. It is useful for imaging Hodgkin's disease, especially above the diaphragm.

The effect of treatment with levothyroxine or iodine on thyroid size and thyroid growth stimulating immunoglobulins in endemic goitre patients.

OBJECTIVE: We assessed the effect of levothyroxine or iodine on thyroid size and on thyroid growth stimulating immunoglobulins in endemic goitre patients. DESIGN: Levothyroxine or iodine was given orally in an open randomized prospective study (100 and 200 micrograms respectively). PATIENTS: Thirty-seven euthyroid patients with diffuse iodine deficiency goitres and thyroid growth stimulating immunoglobulins were studied. MEASUREMENTS: Thyroid size, thyroid growth stimulating immunoglobulins (mitosis arrest assay), basal TSH, free T3, free T4, thyroid anti-microsomal antibodies, antithyroglobulin antibodies, anti-TSH receptor antibodies and urinary iodine excretion were measured. RESULTS: Thyroid size decreased significantly in both groups, in the levothyroxine group more than in the iodine treated group. Thyroid growth stimulating immunoglobulins levels also decreased significantly in both groups. Between groups there was no statistically significant difference. A statistically significant correlation between thyroid growth stimulating immunoglobulins reduction profiles and goitre size reduction could not be established. TSH levels became suppressed in the levothyroxine group while the T4 values rose; in the iodine treated group TSH levels stayed constant as did T4. None of the patients developed thyroid microsomal or thyroglobulin auto-antibodies and/or hyperthyroidism during the treatment. CONCLUSIONS: Levothyroxine as well as iodine was effective in reducing thyroid size as well as thyroid growth stimulating immunoglobulins levels in endemic goitre patients. Since in both groups TSH levels were not related to thyroid size reduction, other factors than TSH suppression must be responsible for the observed thyroid size reduction. Iodine itself by virtue of its antiproliferative action on thyrocytes may have had a direct action on the goitre reduction during iodine treatment; however, the levothyroxine dose, containing less iodine, had a similar effect. A complicated picture hence emerges with regard to factors involved in the shrinkage of iodine deficiency goitre during thyroxine or iodine therapy. These findings indicate that TSH and thyroid growth promoting immunoglobulins are not the only influences on the size of endemic goitres, although it cannot be excluded that these two factors contribute to influence the pathogenetic process.

A simple scintigraphic method for continuous monitoring of gastric emptying.

A new and simple scintigraphic method for the measurement of gastric emptying was developed and validated. The test meal consists of 200 g potato mash mixed with 0.5 g Dowex 2X8 particles (mesh 20-50) labelled with 37 MBq (1 mCi) technetium-99m. After ingestion of the meal, sequential dynamic 15-s anteroposterior exposures in the supine position are obtained for 90 min. A second recording sequence of 20 min is added after a 30-min interval. The results can be displayed as immediate cine-replay, as time-activity diagrams and/or as activity retention values. Complicated mathematical fittings are not necessary. The method lends itself equally to the testing of in- and outpatients.

[Clinical value of the various methods of ACTH determination]. / Klinische Wertigkeit unterschiedlicher ACTH-Bestimmungsmethoden.

We determined 293 plasma-ACTH levels out of 49 patients. In 12 patients with various pituitary diseases 168 samples were collected during a standardized pituitary stimulation test. For this purpose we used the following kits: the DYNOtest ACTH and LUMItest ACTH and Allegro HS-ACTH test. Additionally, morning ACTH levels were analyzed from 49 patients using Allegro HS ACTH test and DYNOtest ACTH. Regarding ACTH concentrations during pituitary stimulation the clinical usefulness of the 3 named tests were comparable. Pair differences of morning ACTH levels were not statistically significant. In a setting of a wide range of ACTH levels all 3 trials proved appropriate for making a diagnosis. Practicability of all 3 tests was similar. For all 3 methods incubation can be done overnight which saves time. Reagents can be reused when frozen immediately after reconstitution.

[Primary and follow-up studies of patients with carcinoid metastases using indium 111 octreotide--rational use of Sandostatin]. / Primär- und Verlaufsuntersuchungen von Patienten mit Karzinoidmetastasen mittels Indium-111-Octreotid--Rationale Anwendung von Sandostatin.

Carcinoids may express Somatostatin receptors. Therefore, a Somatostatin-analogue, In-111 Octreotide (OctreoScan), was used for their demonstration. A total of 6 patients who presented with radiologically verified carcinoid-metastases was examined. In order to control tumor progress, 4 of these patients were reexamined within a period of 3 to 11 months. All of the radiological findings were confirmed scintigraphically, except some small retroperitoneally located lymph nodes. The follow-up examinations of 2 patients revealed additional metastases by scintigraphy only. There were no false positive results. The results of OctreoScan scintigraphy may be used for predicting the success of receptor-specific therapies and therefore, permit the rational and efficient application of Sandostatin.

New continuous cell-line from human medullary-thyroid carcinoma - sinj - phenotypic analysis and invivo carcinogenesis.

SINJ is a new continuous human cell line derived from a lymph node metastasis of a probably sporadic medullary thyroid carcinoma. It is compared to MTC-SK, another medullary thyroid carcinoma cell line, established earlier (1). SINJ has been continuously cultivated in vitro for two years. The cells grow as a suspension of single cells and cell clusters. Repeated immunocytochemistry showed positive immunoreactivity with antibodies to CT, CGRP and GRP. The maintenance of NSE and chromogranins were proved. Northern blot analysis confirmed endocrine activity at mRNA level. Flow cytometry of 27 SINJ - clones showed 25 diploid and two tetraploid subpopulations. Cytogenetic analyses strengthened these findings. According to DNA analysis the cells are free of SV40 sequences. Tumorigenicity was proved in nude mice. The new cell line SINJ has potential use for in vitro studies of medullary thyroid carcinomas in sporadic as well as hereditary forms - the MEN2A syndrome.

Racemic (R,S)-propranolol versus half-dosed optically pure (S)-propranolol in humans at steady state: Hemodynamic effects, plasma concentrations, and influence on thyroid hormone levels.

In a randomized, double-blind, crossover study in 10 healthy volunteers the hemodynamic effects, drug plasma concentrations, and thyroid hormone profiles were compared after oral administration for 1 week of 40 mg t.i.d. racemic (R,S)-propranolol versus 20 mg t.i.d. optically pure (S)-propranolol. During exercise, both substances decreased heart rate (-14%, p less than 0.01), as well as the overall rate pressure product (-19%, p less than 0.01) to the same extent, indicating similar beta-blocking effects. After oral application of (R,S)-propranolol the maximal plasma concentration (Cmax) and the area under the plasma concentration-time curve (AUC) of (S)-propranolol were higher than those of (R)-propranolol (eudismic ratios (S)- over (R)-propranolol Cmax, 1.36 [p less than 0.01] and AUC, 1.42 [p less than 0.01]) despite dose-equivalence of both enantiomers in the administered racemic (R,S)-propranolol preparation indicating different pharmacokinetic properties. Mean values of Cmax and the AUC of (S)-propranolol did not differ significantly after 1 week of oral administration of 40 mg (R,S)-propranolol and 20 mg (S)-propranolol t.i.d., respectively. The ratio of triiodothyronine to thyroxine was decreased by (R,S)-propranolol (-25%, p less than 0.01) but not by (S)-propranolol, suggesting that only the (R)-enantiomer inhibits the conversion of thyroxine to triiodothyronine. Thus, half-dosed optically pure (S)-propranolol is an equally effective beta-adrenergic receptor antagonist compared with currently used racemic (R,S)-propranolol. By contrast, the conversion of thyroxine to triiodothyronine is inhibited by (R)-propranolol only.(ABSTRACT TRUNCATED AT 250 WORDS)

Long term follow-up after enucleation and resection for autonomously functioning thyroid nodules.

The aim of the study was to evaluate the influence of the operative method (i.e. std. resection vs. enucleation) on postoperative function of the thyroid. Uni- or multifocal thyroid autonomy was resected (group I & III) or selectively enucleated (group II & IV). Postoperative function was determined after 6 and 12 months and again after 3-5 years. "Selective" treatment showed minor postoperative hypothyroidism, but goitrous, nodular or functional disorders are more often present compared to resection cases (4.4% vs 12%).

[Sonography and cytology of cold thyroid nodules]. / Sonographie und Zytologie von kalten Schilddrüsenknoten.

270 patients with a scintigraphically cold thyroid nodule of sonographically increased (n = 34), diminished (n = 72) or neutral (n = 86) echogenity or cystic criteria (n = 78) were subjected to fine needle aspiration biopsy. This revealed unequivocal malignancy in 8 and follicular neoplasia in another 30 patients, 10 of whom proved to have malignomas on further evaluation. A total of 12 papillary and 2 follicular carcinomas, 2 non-Hodgkin lymphomas, 1 sarcoma and the metastasis of a breast carcinoma were diagnosed. The most sensitive criteria for malignancy were diminished echogenity, an inhomogeneous echo pattern and the occurrence of a solitary nodule. The incidence of malignancy was increased among males but not among especially young persons. There was no sonographic feature that would permit omission of fine needle aspiration.

[The role of binding proteins in radioimmunologic determination of the free thyroxine concentration using thyroxine analog methods: thyroxine immunoextraction versus thyroxine analog immunoextraction]. / Die Rolle der Bindungsproteine bei der radioimmunologischen Bestimmung der freien Thyroxinkonzentration mit Thyroxinanalogmethoden: Thyroxinimmunextraktion versus Thyroxinanalogimmunextraktion.

Amerlex FT4-analogue one step RIA was investigated to estimate the 125-Iodine thyroxine immunoextraction in sera with normal and abnormal concentrations of binding proteins. The following results were found: Amerlex analogue FT4 RIA equals an equilibrium-immunoassay. Thyroxin-analogue tracer is strongly bound to an albumin (80%). During the assay procedure, there is no analogue binding to serum proteins. If serum and FT4-antibody diluted in an adequate manner, FT4-analogue values in all serum dilution steps are determined identically. FT4-analogue values are influenced only by thyroxine, bound to albumin and/or prealbumin and not by TBG-bound thyroxine. Serum albumin concentration does not influence FT4-analogue values.

[Congenital hyperthyroidism caused by diaplacental exchange of thyrotropin receptor antibodies]. / Connatale Hyperthyreose durch diaplazentar übertragene Thyreotropin-Rezeptoren-Antikörper (TRAK).

We describe the case of a premature baby, extremely small for date whose mother had an untreated hyperthyroidism during pregnancy. Severe symptoms of connatal hyperthyroidism appeared after a latency period of seven days. As the underlying cause we suggest the placental transmission of thyrotropin-receptor-antibodies (TRAb), which were elevated in the mother and the newborn. Main symptoms in the newborn were tachycardia, tachypnea, sweating and diarrhea.

[Pharmacology and dosage of thyrostatic drugs]. / Pharmakologie und Dosierung der Thyreostatika.

The iodine organification in thyroid gland was inhibited by application of Thyrostatic (Methimazole, Carbimazole) and consequently, thyroid hormone production and excretion were diminished. Carbimazole is converted to Methimazole in vivo and in vitro. Equivalent doses of Carbimazole and Methimazole are 0.6 to 1.0. Methimazole penetrates through the placenta, therefore established therapy with Methimazole (or Carbimazole) and thyroid hormone are contradicted in states of gravidity. In hyperthyroidism, preferred therapy strategy is accepted as Methimazole and/or Carbimazole only and in low doses, respectively (40-60 mg Methimazole as first step, consequently to doses down to 5-10 mg daily); accompaning rates of hematopoetic damage are dose responded.

[Diagnostic significance of immunoradiometric serum TSH determination]. / Diagnostische Bedeutung der immunradiometrischen TSH-Bestimmung im Serum.

TSH measurements using sensitive TSH-IRMA method makes differentiation of euthyroidism and hyperthyroidism possible without TSH stimulation after TRH. TSH-basal values less than 0.1 mU/L proof pituitary TSH suppression (clinical overt and latent hyperthyroidism, thyroid hormone therapy etc.). TSH-basal values between 0.4 and 4.0 mU/L are found in euthyroidism. TSH-basal values greater than 4.0 mU/L indicate latent or manifest hypothyroidism. With basal TSH values between 0.1 and 0.4 mU/L (borderline values between euthyroidism and "relative pituitary hormone excess") a TRH-test ist still necessary as it is not possible to predict stimulated TSH values from basal TSH concentrations with adequate accuracy. TSH measurements using sensitive IRMA methods may be recommanded as a screening test of thyroid function.