Papillary thyroid carcinoma in a toxic adenoma

The technique of amniocentesis, by which an abnormal fetus can be detected in utero, has brought a technological advance in medical science but attendant medical and moral problems. Dr Seller describes those congenital disabilities which can be detected in the fetus before birth, for which the "remedy" is selective abortion. She then discusses the arguments for and against selective abortion, for the issue is not simple, even in the strictly genetic sense of attempting to ensure a population free of congenital abnormality.     

Autonomous thyroid adenoma, papillary thyroid carcinoma, and ectopic parathyroid adenoma in a patient with primary hyperparathyroidism and a nontoxic multinodular goiter

OBJECTIVE: To discuss the method for nipple-areola preserved mastectomy with one-stage breast reconstruction in cancer surgery. METHODS: Because of the merits of sufficient blood supply and plasticity of rectus abdominis musculocutaneous flap, we used one-stage breast reconstruction after modified radical mastectomy. The incision line was covered and the nipple-areola was preserved. The reconstructed breast was naturally in contour. RESULTS: 21 cases were treated from 1990 to 1995, and 18 of them received horizontal-rhombus shaped rectus abdominis musculocutaneous flaps and 3 longitudinal-rhombus flaps for breast reconstruction. Nipple-areola was preserved in 16 cases. Objective evaluation after operation showed that the excellent and satisfied rate reached to 90.5%; and subjective evaluation showed that the excellent and satisfied rate reached to 95.2%. Thirteen cases have been followed up for 3 years, and 9 for 5 years. Three-year survival rate was 100% (13/13), and 5-year 88.9% (8/9). CONCLUSION: The method is recommendable for the treatment of stage I-II breast cancer.     

高频彩色多普勒超声对甲状腺腺瘤的诊断分析

目的 探讨高频超声对甲状腺腺瘤的诊断价值.方法 使用高频探头对87例甲状腺腺瘤的声像图特点进行价值分析.结果 甲状腺腺瘤多表现为圆形或类圆形异常团块,以单个多见,周边可见低回声晕,病灶周围可见正常甲状腺组织.彩色多普勒显示:腺瘤周围可见较丰富的动静脉血流信号,呈环状分布,腺瘤所在侧甲状腺上动脉血流速度高于健侧.结论 高频彩色多普勒超声对甲状腺腺瘤具有良好的诊断价值,在影像检查中实应作为首选.     

A conceptual framework and methodological criteria for family therapy process research.

This article presents a conceptual framework for family therapy process research that integrates a new process perspective with family systems theory. Consistent with a systemic epistemology, the framework focuses on the circular interaction, over time, between and within the therapist and family systems and their subsystems. Attacking the process–outcome distinction, the framework targets key variables and patterns in change processes that occur within and outside of sessions. The empirical implications of each framework component are explored. The article concludes with three methodological criteria for developing and evaluating certain research instruments to be used in process studies within the new conceptual framework. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Oncogenic rearrangements of the ret proto-oncogene in thyroid tumors induced after exposure to ionizing radiation

A high frequency (approximately 60%) of ret rearrangements in Chernobyl papillary thyroid carcinomas (PTC) has been reported recently. The data suggested that the radiation exposure may be a direct inducer of activating rearrangements in the ret gene. In our study, we have analyzed for the presence of RET/PTC oncogenes using the RT-PCR, XL-PCR, Southern blot and direct sequencing techniques, 39 human thyroid tumors from patients who had received external radiation for benign or malignant conditions. As controls, we studied 39 'spontaneous' tumors. Our results indicate that: 1) the overall frequency of ret rearrangements was 84% in papillary carcinomas (16/19) and 45% (9/20) in follicular adenomas; 2) in contrast with the results obtained in the Chernobyl tumors, the most frequently observed chimeric gene was RET/PTC1; and 3) all the tumors were negative for RET/PTC2. In the 'spontaneous' tumors, only the papillary carcinomas presented a ret rearrangement (15%: 3/20). Our data confirm the crucial role played by the ret proto-oncogene activating rearrangements in the development of radiation-associated thyroid tumors, and show, for the first time, the presence of RET/PTC genes in follicular adenomas appeared after external irradiation.     

Morphological changes in a hyperfunctioning thyroid adenoma after percutaneous ethanol injection: histological, enzymatic and sub-microscopical alterations

Autonomic nervous dysfunction has recently been considered to be an etiological factor in syncope and sudden death in cases of hypertrophic cardiomyopathy. However, the precise mechanism is still unknown. A 73-year-old woman with obstructive hypertrophic cardiomyopathy was hospitalized with complaints of impaired consciousness; faintness 3 to 4 h after meals, lightheadedness while walking, and syncope during and after defecation and micturition. Faintness was induced by alimentary hypoglycemia related to gastrectomy performed 5 years previously. Lightheadedness and syncope were accounted for by autonomic nervous failure combined with an impairment of alpha 1-adrenoceptor in vasoconstriction and the carotid sinus hypersensitivity which accompanied preceding events such as abdominal pain, defecation and micturition, which could enhance the vagally-mediated baroreceptor reflex.     

Somatic mutations in the thyrotropin receptor gene cause hyperfunctioning thyroid adenomas

The pituitary hormone thyrotropin stimulates the function, expression of differentiation and growth of thyrocytes by cyclic AMP-dependent mechanisms. Tissue hyperplasia and hyperthyroidism are therefore expected to result when activation of the adenylyl cyclase-cAMP cascade is unregulated. This is observed in several situations, including when somatic mutations impair the GTPase activity of the G protein Gsa (ref 6, 7). Such a mechanism is probably responsible for the development of a minority of monoclonal hyperfunctioning thyroid adenomas. Here we identify somatic mutations in the carboxy-terminal portion of the third cytoplasmic loop of the thyrotropin receptor in three out of eleven hyperfunctioning thyroid adenomas. These mutations are restricted to tumour tissue and involve two different residues (aspartic acid at position 619 to glycine in two cases, and alanine at position 623 to isoleucine in one case). The mutant receptors confer constitutive activation of adenylyl cyclase when tested by transfection in COS cells. This shows that G-protein-coupled receptors are susceptible to constitutive activation by spontaneous somatic mutations and may thus behave as proto-oncogenes.     

Hyalinizing trabecular adenoma of the thyroid gland: recognition and characterization of its cytoplasmic yellow body

In Williams syndrome (WS), a deletion of approximately 1.5 Mb on one copy of chromosome 7 causes specific physical, cognitive, and behavioral abnormalities. Molecular dissection of the phenotype may be a route to identification of genes important in human cognition and behavior. Among the genes known to be deleted in WS are ELN (which encodes elastin), LIMK1 (which encodes a protein tyrosine kinase expressed in the developing brain), STX1A (which encodes a component of the synaptic apparatus), and FZD3. Study of patients with deletions or mutations confined to ELN showed that hemizygosity for elastin is responsible for the cardiological features of WS. LIMK1 and STX1A are good candidates for cognitive or behavioral aspects of WS. Here we describe genetic and psychometric testing of patients who have small deletions within the WS critical region. Our results suggest that neither LIMK1 hemizygosity (contrary to a previous report) nor STX1A hemizygosity is likely to contribute to any part of the WS phenotype, and they emphasize the importance of such patients for dissecting subtle but highly penetrant phenotypes.     

Changes in radioiodine turnover in patients with autonomous thyroid adenoma treated with percutaneous ethanol injection

In 24 patients with autonomous thyroid adenoma, we studied the hormonal pattern (free thyroxine, free triiodothyronine and thyroid stimulating hormone) and markers of radioiodine turnover before and after nodule ablation with percutaneous ethanol injection. METHODS: The hormonal pattern was studied before treatment and at various intervals after nodule ablation. Changes in radioiodine turnover were studied measuring 131I protein-bound iodine and the biologic half-life of radioiodine in the thyroid (calculated from thyroid uptake at 24 and 48 hr) before and after ethanol treatment. RESULTS: The hormonal pattern was normalized by treatment in all patients and remained normal for the follow-up period. Before treatment, protein-bound 131I was elevated in all patients but 4; after treatment, it normalized in 15 patients with the disappearance of the adenoma on scintigraphy. In the remaining 9 patients with only partial nodule destruction on scintigraphy, protein-bound 131I remained elevated although markedly reduced. Biologic half-life was shortened in 18 of 24 patients before treatment; after treatment, it was normal in 18 of 24 patients (13 of 15 with complete nodule ablation and 5 of 9 with partial ablation). CONCLUSION: Ethanol treatment normalized the hormonal pattern in all patients. Measures of radioiodine turnover were better markers of residual disease in that they normalized in almost all patients with complete nodule ablation, whereas they remained abnormal in a high proportion of patients with incomplete ablation. Thyroid hormones remained normal over a follow-up period of 3-7 yr in all patients.     

Morphometric determination of the methodological criteria for the diagnosis of intestinal neuronal dysplasia (IND B)

Intestinal neuronal dysplasia of the submucous plexus (IND B) is an indicator of a developmental abnormality of vegetative gut innervation. It is the mildest form of an inborn error of intestinal innervation. The diagnosis of IND B does not result in a functional conclusion or clinical recommendation but is often accompanied by oligoneuronal hypoganglionosis of the myenteric plexus or an aganglionosis of the rectum. The aim of this study was to demonstrate by morphometric means a way in which the diagnosis of IND B could be made much more reliable. In 20 control subjects, 40 IND B cases and 10 hypoganglionoses with IND B, it was shown that a specific nerve cell staining (e.g. Lactic dehydrogenase, Succinic dehydrogenase, Diaphorase reaction or an immunohistochemical nerve cell staining) was necessary for diagnosis. Cross sections of giant ganglions and cross sections with large nerve cell numbers (> 7 nerve cell profiles) were the most reliable diagnostic criteria. The morphometric examinations were performed with an optic electronic image analysis system. Biopsy serial sections of the rectum-mucosa that contained submucosa demonstrated that 30-40% of the sections contained no submucous ganglion. Sixty to 70% of the sections showed ganglia of the submucous plexus. In 100 biopsy sections in subjects with IND B, 20 +/- 5% contained giant ganglions cross sections. In the patients with hypoganglionosis of the submucous plexus, 55 +/- 4% sections had no ganglion and 18 +/- 3% had giant ganglion cross sections. The data demonstrate that for a reliable diagnosis of IND B, at least 30 sections are necessary, stained with a dehydrogenase reaction that contain a minimum of 4 giant ganglion cross sections. These data demonstrate that IND B is not a qualitative diagnosis as Hirschsprung's disease but rather a quantitative diagnosis.     

Stress-induced hyperthermia in mice: a methodological study

When the rectal temperature of group-housed mice is measured sequentially, the temperature of the last measured mouse is higher than that of the first mouse. This phenomenon is called stress-induced hyperthermia (SIH). We varied several experimental parameters to elucidate the mechanism behind this SIH. SIH was stable and found by all technicians performing the experiments. The large intertechnician difference in the mean rectal temperature could be eliminated by training in an identical fixation and handling technique. SIH was both independent of the number of handling days preceding the experiment and of the number of disturbances (0, 1, 2, or 5) implied on the mice per minute. The percentage of hyperthermic mice in 10-mice cages increased when the time interval between the individual measurements increased from 1 to 2, 5 or 10 min. In all groups the maximum increase was reached after an interval of approximately 10 min. SIH of mouse 10 returned time dependently in approximately 60 min to basal temperature. When SIH was tested on 2 or 5 successive days no tolerance developed. When animals were reused after 7 or 14 days SIH did not differ from day 1, implying that animals can be reused. When the number of mice was decreased from 10 to 5 mice per cage, the SIH of vehicle-treated mice was slightly lower in 5-mice cages compared to 10-mice cages. The blocking effects on SIH by anxiolytics was also less clear in 5-mice cages compared to 10-mice cages.(ABSTRACT TRUNCATED AT 250 WORDS)     

Aging and cognition: methodological differences in outcome

A series of longitudinal and cross sectional studies, collected as part of the Seattle Study, were reanalyzed. A longitudinal sequential analysis (N = 232), wherein subjects were measured every seven years for four time periods, was completed on the Primary Mental Abilities test. Cohort differences were at least as strong as age differences; cohorts were generally relatively stable over the measured periods, showing little cognitive decline. A cross-sectional sequential analysis (N = 2813) was completed for the same time periods; decline with age was more evident than with the longitudinal sequential analysis. A cross-sectional analysis for the fourth time period (N = 611) showed the most marked decline of all. Interpretation of outcome was highly dependent on the analysis used.     

Clonal origin of toxic thyroid nodules with constitutively activating thyrotropin receptor mutations

The effects of intraventricular administration of ethylcholine aziridinium ion (AF64A) were studied in male Wistar rats. Bilateral injections of AF64A (3 nm/3 mcl) reduced the reactions to biological alarm signal and produced a decrease in the open-field activity 3 weeks after this lesion. The lesioned rats also displayed deficit in retention of a passive avoidance task.     

Comments on health indicators: methodological perspectives

This paper discusses several basic conceptual and methodological problems in the development and use of health indicators. We observe that two tendencies of the health indicators movement may deter progress toward producing informations of health status indexes and the tendency to conceptualize "health" in terms of expansive definitions should measure variables specified by a social system model and should be scaled according to units that are relevant to decision-making criteria.