Immunologic findings in tissue of thyroid carcinoma.

We studied the occurrence of DR-antigen (DR-Ag) positive thyroid epithelial cells (TEC), lymphocyte (Ly)-subsets, and antigen-presenting cells (APC) in thyroid carcinoma and the influence of thyroid-stimulating hormone (TSH) on immunologic behavior. Tissue slices from various thyroid carcinomas (n = 14) and endemic goiters (n = 12) were investigated by immunohistochemical methods (PAP/APAAP/FITC) using monoclonal antibodies (MoAbs) against DR-Ag, dendritic cells (APC), endothelial cells, CD-3 Ly, CD-4 Ly, and CD-8 Ly. Monolayers of TEC were cultured in the presence or absence of TSH (0.01 mU/ml) and/or PHA (0.1 mg/ml) over 24 h and screened for DR-Ag expression. Various ranges of DR-Ag expression were detectable in 13 thyroid carcinomas. One thyroid carcinoma and all endemic goiters were DR-Ag-. The amount of APC and local infiltrating Ly correlated very well with the presence and intensity of DR-Ag+ TEC. The lymphocytic CD-4/CD-8 ratio varied in a wide range. No prevalence of Ly-distribution for any type of carcinoma was found. PHA induced DR-Ag expression in all thyroid carcinomas and endemic goiters. This effect was enhanced significantly by TSH. DR-Ag expression on thyroid carcinoma cells may be considered as an immune activating factor. These "neoantigens" may be induced by lymphokines released by the local immune competent cells. The distribution of Ly and DR-Ag+ TEC in thyroid carcinoma seems to represent the individual immunologic response against the tumor. Whether TSH acts as an immune modulator directly or indirectly, as described elsewhere, cannot be concluded from these results.     

Spatial orientation in normal children and in children with early brain injury

Fifty-one brain-injured children (7:7—17:0) were compared with fifty-two normal children (4:11—9:11) with respect to their ability to walk the paths indicated on ten visually presented maps. In an earlier study, using the same patterns, adults with cerebral injury sustained at maturity showed spatial orientation deficits associated with language deficits and elevated two-point somatosensory thresholds. Brain-damaged children were worse than controls beyond differences in their respective MA's, but their deficits were not associated with either language or somatosensory impairment. Rather, spatial errors were most pronounced in Ss with low performance scores on the WISC whether or not their language scores were relatively high. Unlike either normal children or normal and brain-damaged adults, the Ss of this study had inordinate difficulty taking diagonal routes.     

Indole aus cyclischen 1.3-Dicarbonylverbindungen mit substituierter 2-Stellung

Indoles from Cyclic 1,3-Dicarbonyl Compounds with Substituents at Position 2 The phenylhydrazones 1b–g, 11 of cyclohexane-1,3-diones alkylated at C-2 suffer β-dicarbonyl fission under the conditions of the Fischer indole synthesis. A lactam ring is closed and the pyrido[1,2-a]indoles 6b–g, 12 are formed. This reaction also applies to heterocyclic diones (13→14) . The carboxylic acids corresponding to the lactams of type 5 cannot be isolated as intermediates, nor are they obtained in the course of the synthesis of 6b and c from 5-(phenylhydrazono)-n-heptanoic and 5-(phenylhydrazono)-n-octanoic acid. The reaction pathway is discussed.     

Significance of latent hyperthyroidism

Summary In euthyroidism the circadian rhythm and pulsatility of TSH is well known. With regard to hyperthyroidism only very preliminary data were described. In this tudy we investigated the secretion pattern of the pituitary-thyroid axis hormones during 24 h in latent and overt hyperthyroidism and in euthyroidism with regard to common and different properties. Blood was obtained for 24 h at 10-min intervals. In euthyroidism we found intraindividually three overlapping patterns of TSH, which are different in amplitude and frequency and can be found interindividually, too. These patterns are equal to the circadian rhythm, pulsatile secretion and lastly to the methodic rustle. The circadian rhythm in latent hyperthyroidism is distinctly suppressed and in overt hyperthyroidism totally. Whereas in latent hyperthyroidism pulsatile secretion is extant, in overt hyperthyroidism the TSH pulses are absent. To record the patients' TSH circadian rhythm with only three blood samples, we defined the TSH-Triplex. In young as well as in elderly healthy volunteers it demonstrated significantly higher TSH levels at midnight (at 24:00 h) than it did at 4 p.m. and 8 a.m. The present study shows a significantly different TSH pattern in latent hyperthyroidism compared to euthyroidism. It should be discussed whether latent hyperthyroidism could be defined as hyperthyroidism stage I. On the other hand, latent hyperthyroidism could be an illness with its own cause, different from hyperthyroidism. Our data suggest that the laboratory findings of latent hyperthyroidism in each age are non-physiological. However, the cause for this disorder is unclear until now; hence further investigations are necessary.Abbreviations TT4 total thyroxine - TT3 total triiodothyronine - TSH thyroid stimulating hormone - TBG thyroxin binding globin - mean - SD standard deviation - TRH thyrotropin releasing hormone - MR methodic rustle Supported by Deutsche Forschungsgemeinschaft (SFB 258)     

Screening for thyroid disorders in a working population

Summary Subclinical thyroid disorders have received increasing attention in recent years due to refined laboratory methods and a stronger emphasis on the role of preventive medicine. We performed a screening for thyroid-stimulating hormone (TSH) on 6884 persons in a working population. In cases in which TSH was not within the normal range we also measured the levels of triiodothyronine (T₃), thyroxine (T₄), and thyroxine-binding globulin (TBG). All persons who did not present with exclusion criteria or other nonthyroidal illnesses (n = 59) and the controls (n = 39) were submitted to thyrotropin-releasing hormone (TRH)-testing. Additionally, sonography of the thyroid was performed on 120 persons (59 subjects with abnormal hormone levels and 61 controls) to determine thyroid size and rule out morphological abnormalities. Based on the TRH test and T₃, T₄, and TBG measurements we found a prevalence of 0.03% (2/6884) for overt hyperthyroidism, 0.33% (23/6884) for subclinical hyperthyroidism, 0.09% (6/6884) for subclinical hypothyroidism, and 0.015% (1/6884) for overt hypothyroidism in the healthy population. In subjects with overt or subclinical hyperthyroidism the prevalence of goiters (thyroid volume > 18 ml in women, > 25 ml in men) was 28%. Of this group 48% had structural abnormalities. All persons with goiters and/or structural abnormalities were over 35 years of age. Among the euthyroid, 20% had thyroid enlargement, and the same proportion presented with structural abnormalities. There were no differences between the two age groups. In the group with overt/subclinical hypothyroidism 47% presented with structural abnormalities of the thyroid; however, none presented with thyroid enlargement. Thyroid nodules were found only in older persons (> > 35 years) with euthyroidism or hypothyroidism. These data confirm the relatively high prevalence of functional and morphological abnormalities of the thyroid. An early substitution with iodine is warranted to prevent functional and morphological disorders of the thyroid in older age. People with subclinical hyperthyroid disorders must avoid exposure to iodine, which can cause an exacerbation of the disease.Abbreviations TBG thyroxine-binding globulin - TRH thyrotropin-releasing hormone - TSH thyroid-stimulating hormone - T₃ triiodothyronine - T₄ thyroxine Dedicated to Prof. Dr. N. Zöllner on the occasion of his 70th birthday     

Nonunion After an Open Trimalleolar Ankle Fracture: An Extended Clinical Course and a Novel Approach to Tibio-Talo-Calcaneal Arthrodesis

Nonunion in the setting of chronic osteomyelitis after severe open ankle fractures is a feared outcome with severe loss in patient quality of life. Tibio-talo-calcaneal arthrodesis is a good salvage treatment option in this difficult patient cohort. We report a case of chronic osteomyelitis with severe destruction of the ankle joint after failed fracture fixation of an open trimalleolar ankle fracture. Fusion was ultimately achieved 5 years later using a novel-staged Masquelet technique with external ring fixator stabilization and bone graft reconstruction including femoral harvested autograft using reamer-irrigator-aspirator. This case shows that infection free arthrodesis of the ankle can be achieved even years after failed treatment. This procedure restored significant quality of life through pain relief and much improved mobility and may be a helpful technique in complex tibio-talo-calcaneal arthrodesis in the setting of chronic osteomyelitis and significant joint destruction.