SERUM THYROGLOBULIN IN THE DIAGNOSIS AND MANAGEMENT OF THYROID CARCINOMA

Serum thyroglobulin (Tg) was measured by radioimmunoassay in sixty-two control subjects, 163 euthyroid patients with nodular goitre and eighty-one patients with previously treated differentiated thyroid carcinoma. Tg was elevated in 65% of nodular goitres and failed to fall with thyroxine treatment in ten/fifteen patients treated. A diagnosis of differentiated carcinoma was confirmed in fourteen/sixty-four of these patients and Tg was elevated in twelve. Of sixty-five treated thyroid carcinoma patients without evidence of residual tumour, serum Tg was undetectable in thirty-nine, normal in twenty-four and elevated in two. There was evidence of residual tissue in the thyroid in seventeen of the patients with detectable Tg. Of the sixteen patients with residual tumour or metastases Tg was elevated in fifteen. There was a positive correlation between goitre size and Tg levels in multinodular goitre, and thyroid carcinomas of large bulk were associated with higher Tg levels. Serum Tg was normal in medullary carcinoma and in two patients with thyroid metastases from extra-thyroidal malignancies. High Tg levels in patients with residual metastases from thyroid carcinoma following thyroid ablation indicates Tg production by tumour tissue. Measurement of serum Tg of limited value in the differential diagnosis of nodular thyroid disease. It is particularly useful following surgery and 131I therapy for differentiated thyroid carcinoma. In these patients it gives confirmation of thyroid albation and may provide evidence of residual tumour tissue when the other tests are negative.     

DISCRIMINANT ANALYSIS IN THE DIFFERENTIAL DIAGNOSIS OF HYPERCALCAEMIA

Linear discriminant analysis, a multivariate statistical procedure, applied to serum calcium, phosphate, alkaline phosphatase, bicarbonate, chloride, creatinine and tubular reabsorption of phosphate, proved to be effective in distinguishing patients with Primary Hyperparathyroidism from other hypercalcaemic patients in eighty-four retrospective cases. The application of the model to thirty-four prospective cases enabled us to separate correctly, hyperparathyroid patients from non-parathyroid hypercalcaemic patients.     

THE MEASUREMENT OF SERUM THYROGLOBULIN IN THE PRESENCE OF THYROGLOBULIN ANTIBODIES

In a significant proportion of patients with thyroid disorders, thyroglobulin antibodies (TgAb) invalidate double-antibody radioimmunoassays (RIA) for thyroglobulin (Tg). A modified RIA procedure for determining serum Tg in the presence of TgAb, is described. Two measurements are made on each sample.

• a Ratio of immunoglobulin (Ig)-bound thyroglobulin to free thyroglobulin (bound:free ratio). This is measured by the distribution of a trace quantity of ¹²⁵I-Tg between bound and free fractions.
• b Concentration of free, i.e. unbound thyroglobulin. This is measured in the supernatant after precipitation of IgG-bound Tg.

Then, bound Tg = B:F x (free Tg) and total Tg = (bound Tg) + (free Tg). Critical factors examined in the validation of the modified method were: (1) use of immunologically intact ¹²⁵I-Tg (specific activity ± 5 mCi/mg); (2) equilibration of tracer Tg with endogenous serum Tg, and (3) clean separation of IgG-bound and free fractions of Tg with goat anti-human IgG. Recovery of added Tg in the presence of TgAb was 105% and interassay precision of total Tg assay was ≤ 9·3%. In euthyroid subjects without TgAb, the correlation between total Tg levels by the modified and standard double-antibody method was 0·931. The correlation was much poorer in the presence of TgAb (r = 0·752) reflecting their interference in the standard method. Reference ranges for serum total Tg levels by the modified method in euthyroid, hyper-and hypothyroid subjects with and without TgAb are detailed.     

DIFFERENTIAL DIAGNOSIS OF GASTRIC LESIONS BY MAGNIFYING ENDOSCOPY

We performed magnifying endoscopy for patients with suspected gastric diseases. Among these patients, 67 patients with early gastric cancer and 31 benign gastric diseases were enrolled in this study. The patients with early gastric cancer included 46 differentiated tubular adenocarcinoma (33 mucosal cancer, 13 submucosal cancer) and 21 non‐differentiated tubular adenocarcinoma (12 mucosal cancer, 9 submucosal cancer). The benign gastric lesions included 23 gastric ulcer or gastric ulcer scars, three gastritis, and five gastric adenomas. Small regular patterns were observed; 39% in differentiated adenocarcinoma, 5% in undifferentiated adenocarcinoma, and 19% in benign gastric diseases. Irregular patterns were observed 37%, 52%, and 6%. Lack of visible structure was observed 18%, 90%, and 10%. Abnormal vessels were observed 26%, 81%, and 16%. Small regular patterns were observed significantly more frequently in differentiated adenocarcinoma than in undifferentiated adenocarcinoma (P < 0.001). Lack of visible structure and Irregular patterns were observed significantly more frequently in undifferentiated adenocarcinoma than in differentiated adenocarcinoma (P < 0.001). In order to spread this useful endoscopy widely easy recognition of abnormality, histological backbone, and further technical developments in hardware and software should be required.     

HYPERPARATHYROIDISM DUE TO A CYSTIC PARATHYROID ADENOMA AFTER IRRADIATION OF THE NECK

A 48-year-old female with hypercalcaemia diagnosed 3 years prior to admission is described. The patient underwent x-ray therapy of the neck for keloid scars 35 years prior to the diagnosis of hypercalcaemia. The hypercalcaemia was found to be the result of primary hyperparathyroidism. A cystic parathyroid adenoma was identified during surgery and was, on microscopic examination, composed of oxyphil cells rich in mitochondria. The cystic fluid contained 360 times higher C-terminal PTH than peripheral serum and almost 4000 times higher PTH as intact 1–84 amino acid residue species. We concluded that previous X-ray irradiation was related to the pathogenesis of the patient's parathyroid adenoma. The mild nature of the patient's hyperparathyroidism was possibly related to the composition of the tumour of oxyphil cells, known to be a poorly functioning variant of the parathyroid cell. Since parathyroid‘cysts’are obviously necrotic parathyroid adenomas, aspiration of the cysts alone cannot be expected to be curative and, therefore, it is recommended to treat cystic parathyroid adenomas by surgical extirpation.     

咪唑类驱虫药致迟发性脑病与散发性脑炎的鉴别

咪唑类驱虫药迟发性脑病是一种新发现的药源性疾病，既往大多数被误诊为散发性脑炎（散脑）。为探讨两病的鉴别，作者回顾，总结了本病２０２例的临床特点；提出了７条诊断标准；从６方面与散脑进行了比较与区别。指出：本病的临床特点是诊断的重要依据；ＣＳＦ、ＥＥＧ、ＣＴ或ＭＲＩ（磁共振成像）检测应列为常规辅助诊断；初期无发热等感染征象与第一类散脑迥异；病前驱虫药接触史是确诊的首要条件，应多阶段反复查询和认证，借此可资与第二类散脑及其他的急性脱髓鞘脑病鉴别；２０２例中致病的咪唑类驱虫药以左旋咪唑片最多（５８．９％）；四咪唑片次之（３６．１％）。本病８０．７％有中枢神经功能缺损。ＣＳＦ呈轻度炎症反应，异常率６３．３％；ＣＳＦ和血清免疫球蛋白增加，分别为４０．４％和４４．２％。ＥＥＧ出现弥漫性慢波，异常率９３．５％。头颅ＣＴ显示急性脱髓鞘性脑病，异常率９ｌ．５％。病理特征是多灶性出血性白质脑病。     

囊泡型脑囊虫病的诊断与治疗分析

目的　探讨囊泡型脑囊虫病的诊断和最佳治疗方法。　方法　收集所确诊的 2 0 5例脑囊虫病中 17例囊泡型囊虫病病人的资料 ,采用回顾性研究方法 ,分析其影像学检查、诊断和治疗方法的成功与失误。　结果　 13例行全切或部分切除 ,其中 1例死亡 ,其余取得较好疗效。 4例行肠虫清抗囊治疗 ,3例取得较好效果 ,1例未能随访。　结论　囊泡型囊虫绝大部分为多发 ,主要症状是囊泡的占位效应。应与脑包虫、蛛网膜囊肿等鉴别。可以应用常规开颅或神经内镜技术摘除主要的囊泡 ,缓解颅内高压。药物治疗是根本的方法。药物治疗脑实质内的囊虫囊泡效果好于脑池内的囊虫囊泡。     

SERUM THYROGLOBULIN CONCENTRATIONS AND 131I WHOLE BODY SCANS IN THE DIAGNOSIS OF METASTASES FROM DIFFERENTIATED THYROID CARCINOMA (AFTER THYROIDECTOMY)

SUMMARY. Measurements of circulating thyroglobulin (hTg) and ¹³¹I whole body scan were performed in 101 patients with differentiated thyroid carcinoma who had been subjected to surgical thyroidectomy and ¹³¹I ablation of remaining thyroid tissue. All 45 patients with positive scans (i.e. functioning metastases) had elevated hTg concentrations. Of fifty-six patients with negative scans forty-two had undetectable or very low hTg levels and were considered to be free of metastatic thyroid tissue, whereas fourteen showed the presence of non-functioning metastases in the clinical and/or radiological examination. In this group of patients, eleven had elevated serum hTg levels while the other three patients had detectable hTg concentrations within the normal range. These results indicate that serum hTg measurements correlate very well with scan findings and have the added advantage of detecting non-functioning metastases which would not be detected by scanning. We concluded that measurement of serum hTg may be used together with scanning, as the first step in the follow-up of thyroidectomized patients with differentiated thyroid carcinoma.     

THE VALUE OF THYROID VOLUME MEASURED BY ULTRASONOGRAPHY IN THE DIAGNOSIS OF GOITRE

Thyroid volume was measured by ultrasonography in 80 euthyroid patients with sporadic nontoxic goitre and in 50 healthy adults, all residing in non-iodine deficient areas. All patients were referred because of complaints of goitre and had been diagnosed as cases of goitre by inspection and palpation. The thyroid volume in 15 patients with goitre (19%) was within the normal reference range (4.9-19.1 ml). Fourteen of the 15 patients had thyroid nodules larger (mean diameter 2.9 +/- 1.1 cm) than those detected in nine of the healthy adults (mean diameter 0.8 +/- 0.6 cm; P less than 0.001). Thyroid size as estimated by inspection and palpation (grade OA to III according to Stanbury et al., 1974) was poorly related to thyroid volume measured by ultrasonography. In conclusion: (1) a thyroid volume within the normal reference range does not rule out the presence of nodular goitre; and (2) application of thyroid volume measurement by ultrasonography may prevent overestimation of goitre prevalence in epidemiological surveys.     

骨代谢指标测定在骨质疏松诊治中的应用价值

目的 比较妇女绝经前后骨代谢指标的变化，研究各指标在骨质疏松症治疗后的变化率，对各指标在骨质疏松症诊治中的应用作出初步评价。方法 48例绝经前妇女、48例绝经后妇女测定10项骨代谢指标．45例绝经后骨质疏松症患者．治疗前、治疗6个月后分别测定10项骨代谢指标，观察其变化率。12名绝经后妇女，每两个月测定10项骨代谢指标。共观察一年。结果 绝经后妇女骨代谢指标明显升高，绝经后骨质疏松症患者经抗吸收治疗后．大部分骨代谢指标明显降低，血清骨形成指标比尿骨吸收指标长期个体内的变异要小。结论 绝经后骨质疏松症患者骨转换加快，部分血清骨代谢指标优于尿骨代谢指标，尤以血清骨形成指标N—mid骨钙素和血清骨吸收指标CTX为优。     

DIFFERENTIAL DIAGNOSIS AND MANAGEMENT OF HIP PAIN IN CHILDHOOD

Hip pain in children is always potentially serious. Differentspecialists see a different spectrum of hip diseases. Acutehip pain is usually referred to the surgeons, and the principalconcern is to distinguish sepsis of the hip joint or pelvicbones from irritable hip: untreated sepsis can destroy the hipwithin days, but its presentation may be atypical or mild andinvestigations misleading. A reliable protocol for the managementof acute hip pain in children is now available. Perthe's diseaseand slipped capital femoral epiphysis is usually evident onthe initial radiograph. Hip disorders with a subacute or chronicpresentation are usually referred to the paediatrician or rheumatologist.If examination shows restriction of hip movement or there areradiographic abnormalities, many will have a serious disorderrequiring long-term management. The diagnosis is often apparenton the initial radiographs, although special imaging techniquesmay be needed. In a monoarticular presentation of juvenile arthritis,the hip radiograph will be normal but the diagnosis evidentfrom other clinical features or blood investigations. Recognitionof non-organic syndromes presenting with hip pain requires theexclusion of organic causes and an alertness to the incongruityof the physical signs. KEY WORDS: Hip, Arthritis, Children, Pain, Septic arthritis, Irritable hip.     

A SIMPLE AID TO THE DIFFERENTIAL DIAGNOSIS OF OLIGURIA

A study was conducted in oliguric and acutely azotemic patients, measuring: (i) the fractional excretion of sodium (FE_Na) using creatinine clearance as a measure of glomerular filtration rate, and (ii) sodium clearance relative to urea clearance, designated as the sodium/urea clearance ratio (Na:urea CR). It was found that FE_Na discriminated between “tubular” and “non-tubular” disorders in 96% of patients. Further, Na:urea CR was as discriminating as FE_Na. Patients with Na:urea CR above 2.5% can be reliably diagnosed as having acute tubular necrosis or acute urinary tract obstruction; those with a value less than 2.5% will have acute glomerulonephritis or pre-renal azotemia. As urea and sodium measurements are so readily available, this test can now be applied in the assessment of the oliguric or acutely azotemic patient in any hospital practice. (Aust NZ J Med 1983; 13: 608–612.)     

循环抗原阳性对弓形虫病诊断价值的研究

应用双抗体ＥＬＩＳＡ检测弓形虫循环抗原（ＣＡｇ）阳性者的血液及组织液样本４１例，进行病原学对照检查，结果２９例检获弓形虫，两者的符合率达７０．７％。不同样本中的虫体检出率依次为羊水３／３，乳汁１／１，胚胎组织１／１，脑脊液２１／３０，血清３／６。另外，对２９例疑似中枢神经系统弓形虫病患者，取脑脊液进行不同免疫学指标检测。结果，ＣＡｇ于发病３ｄ即可测出，总阳性数为２６例；ＩＨＡ抗体于发病５ｄ出现阳性，阳性数为４例；ＥＬＩｓＡ一ＩｇＭ及ＩｇＧ抗体在发病７ｄ后逐渐出现阳性，阳性数分别为５例和１例。研究结果证实，ＣＡｇ作为弓形虫早期、急性感染的一个指标，具有重要的诊断学意义。