On the autonomus thyroid adenoma

Prema najnovijim stavovima, autonomni adenom štitnjače (AAŠ) je vjerojatno istog porijekla kao i poliadenomatozna struma (Struma nodosa toxica) i struma s diseminiranom mikroadenomatozom. Pretpostavlja se da je razvoj AAŠ ovisan o stimulaciji tireotropinom i unosu joda kod strume s endemskim opterećenjem. AAŠ histološki se ne razlikuje od benignog folikulamog adenoma. Osnovni kriterij u dijagnostici AAŠ i dalje je scintigram štitnjače. Bateriji klasičnih testova u dokazu autonomnosti čvora, kao i u ocjeni metaboličkog statusa, pridružuje se zadnjih godina TR test, ultrazvuk i kvantitativni scintigram štitnjače. Terapija AAŠ je operativna za mlađe bolesnike, a radiojodna za starije. Za sada nije dokazan povećani rizik razvoja karcinoma štitnjače nakon aplikacije radiojoda.According to the recent attitudes, an autonomous thyroid adenoma (AAT) is probably of the same origin as a polyadenomous goiter (struma nodosa toxica) and a goiter with a disseminated microadenomatosis. It is strongly suggested that the development of AAT depends upon the stimulation by thyrotrophin and import washin in endemic goiter. Histologically the AAT does not differ from a benign folicullar adenoma. The basic criterion in diagnostics for AAT is still the scyntigramme of the thyroid. To the battery of classical tests as a proof of an autonomous nodule, so as injudgement of actual metabolic status, the TRH test, ultrasound and quantitative scyntigramme of AAT have been added recently. The therapy of AAT is surgical for younger patients, and radioiodine for the older ones. After application of radioiodine the increasing risk of development of thyroid cancer has not been proved so far

The effects of suppressive therapy of difuse euthyroid goitre with levothyroxine (comparation on effects in younger and middle-aged patients)

U prospektivnoj studiji kojom je obuhvaćeno 67 bolesnika s difuznom eutireoidnom strumom, starosne dobi od 17 do 21 god. (grupa I n=28) i dobi od 33 do 45 god. (grupa II, n=39), liječenih godinu dana sa 100 ug tiroksina dnevno, ocijenjeni su učinci supresijske terapije ultrazvučnom volumetrijom i palpacijskim nalazom. Nakon 3, 6, 9 i 12 mjeseci praćenja uslijedilo je značajno smanjenje volumena strume u obje grupe bolesnika u odnosu na početnu veličinu strume. U obje grupe volumen struma najviše se smanjio u prvih 6 mjeseci primjene terapije. Poslije 6 mjeseci prosječno smanjenje volumena struma u grupi I iznosilo je 19.2%, u grupi II 28.6%, a nakon 12 mjeseci u grupi I volumen struma smanjen je za 23.5%, a u grupi II za 32.3% u odnosu na početni volumen. U grupi I nakon mjesec dana (u grupi II nakon dva mjeseca) uočen je značajan porast tiroksina (T4) i njegove slobodne frakcije (fT4) u odnosu na normalne vrijednosti prije početka primjene supresijske terapije, dok se vrijednosti trijodtironina (T3) i njegove slobodne frakcije (fT3) nisu mijenjale. U obje grupe u prvih 6 mjeseci i nakon godinu dana terapije tiroksinom ustanovljena je učinkovitost u smanjenju strume sa statistički signifikantnom razlikom u korist grupe II.In a prospective study 67 patients with diffuse euthyroid goitre, between 17 and 21 years old (group I, n=28) and between 33 and 45 years old (group II, n=39), were treated for one year with 100 levothyroxine daily, have been evaluated effects of supressive therapy measured by sonography and palpation. After 3, 6, 9 and 12 months the reduction of the goitre volume was significantly different from the initial volume in both groups. In both forms of treatment maximum volume decrease was already seen within the first six months. After treatment for 6 months the mean decrease of thyroid volumes was 19.2% in group I and 28.6% in group II. After treatment for 12 months the mean decrease of thyroid volumes was 23.5% in group I and 32.3% in group II compared to the initial volume. In group I after 1 month (in group II after 2 months) a more significant increase of T4 and of fT4 values within the normal range was observed immediately after supressive therapy. There were no changes of the T3 and fT3 values. In both groups it has been found out that in the first 6 months and after 1 year therapy with levothyroxine exist a comparable efficiency for the reduction of goiters with statistically significant differences in favour group II

The effects of suppressive therapy of difuse euthyroid goitre with levothyroxine (comparation on effects in younger and middle-aged patients)

U prospektivnoj studiji kojom je obuhvaćeno 67 bolesnika s difuznom eutireoidnom strumom, starosne dobi od 17 do 21 god. (grupa I n=28) i dobi od 33 do 45 god. (grupa II, n=39), liječenih godinu dana sa 100 ug tiroksina dnevno, ocijenjeni su učinci supresijske terapije ultrazvučnom volumetrijom i palpacijskim nalazom. Nakon 3, 6, 9 i 12 mjeseci praćenja uslijedilo je značajno smanjenje volumena strume u obje grupe bolesnika u odnosu na početnu veličinu strume. U obje grupe volumen struma najviše se smanjio u prvih 6 mjeseci primjene terapije. Poslije 6 mjeseci prosječno smanjenje volumena struma u grupi I iznosilo je 19.2%, u grupi II 28.6%, a nakon 12 mjeseci u grupi I volumen struma smanjen je za 23.5%, a u grupi II za 32.3% u odnosu na početni volumen. U grupi I nakon mjesec dana (u grupi II nakon dva mjeseca) uočen je značajan porast tiroksina (T4) i njegove slobodne frakcije (fT4) u odnosu na normalne vrijednosti prije početka primjene supresijske terapije, dok se vrijednosti trijodtironina (T3) i njegove slobodne frakcije (fT3) nisu mijenjale. U obje grupe u prvih 6 mjeseci i nakon godinu dana terapije tiroksinom ustanovljena je učinkovitost u smanjenju strume sa statistički signifikantnom razlikom u korist grupe II.In a prospective study 67 patients with diffuse euthyroid goitre, between 17 and 21 years old (group I, n=28) and between 33 and 45 years old (group II, n=39), were treated for one year with 100 levothyroxine daily, have been evaluated effects of supressive therapy measured by sonography and palpation. After 3, 6, 9 and 12 months the reduction of the goitre volume was significantly different from the initial volume in both groups. In both forms of treatment maximum volume decrease was already seen within the first six months. After treatment for 6 months the mean decrease of thyroid volumes was 19.2% in group I and 28.6% in group II. After treatment for 12 months the mean decrease of thyroid volumes was 23.5% in group I and 32.3% in group II compared to the initial volume. In group I after 1 month (in group II after 2 months) a more significant increase of T4 and of fT4 values within the normal range was observed immediately after supressive therapy. There were no changes of the T3 and fT3 values. In both groups it has been found out that in the first 6 months and after 1 year therapy with levothyroxine exist a comparable efficiency for the reduction of goiters with statistically significant differences in favour group II

Primary malignant lymphoma of the thyroid gland : a case report

Opisan je slučaj primarnog malignog limfoma štitnjače, udruženog sa kroničnim limfocitarnim tireoiditisom, koji se odlikovao brzim tokom i diseminacijom procesa. Citološki je postavljena sumnja na maligni proces, dok je točna dijagnoza dokazana patohistološkim pregledom ekstirpirane štitnjače. Uz osvrt na literaturu, ukazano je na bitne kliničke, dijagnostičke, terapeutske i prognostičke odlike tumora.A case of primary lymphoma of the thyroid gland, associated with chronic lymphocytic thyroiditis is presented. The lymphoma was characterized by rapid progression and dissemination into the gastrointestinal tract. The cytological finding (by fine needle aspiration biopsy) was suspect malignant and the exact diagnosis was provided by pathohistological examination of the tissue, obtained by surgical extirpation of the thyroid. The essential clinical, diagnostic, therapeutic and prognostic characteristics of the tumor are pointed to, with a review of references

Primary malignant lymphoma of the thyroid gland : a case report

Opisan je slučaj primarnog malignog limfoma štitnjače, udruženog sa kroničnim limfocitarnim tireoiditisom, koji se odlikovao brzim tokom i diseminacijom procesa. Citološki je postavljena sumnja na maligni proces, dok je točna dijagnoza dokazana patohistološkim pregledom ekstirpirane štitnjače. Uz osvrt na literaturu, ukazano je na bitne kliničke, dijagnostičke, terapeutske i prognostičke odlike tumora.A case of primary lymphoma of the thyroid gland, associated with chronic lymphocytic thyroiditis is presented. The lymphoma was characterized by rapid progression and dissemination into the gastrointestinal tract. The cytological finding (by fine needle aspiration biopsy) was suspect malignant and the exact diagnosis was provided by pathohistological examination of the tissue, obtained by surgical extirpation of the thyroid. The essential clinical, diagnostic, therapeutic and prognostic characteristics of the tumor are pointed to, with a review of references

Blood volume in hyperthyrodism

Pomoću tehnike dilucije indikatora (131J HSA) ispitan je volumen krvi, a pomoću hematokrita volumen plazme i volumen mase eritrocita u skupini od 35 oboljelih od M. Basedovv-i (Gravesova bolest), u dobi od 20. do 40. godine. Ispitivanje je vršeno u fazi floridnog hipertireoidizma, te nakon postizanja stabilne eutireoidne faze tijekom medikamentoznog tretmana s karbimazolom (Favistan), te je otkrivena značajna razlika u vrijednostima volumena krvi između skupine floridnih hipertireoza i kontrolne skupine ispitanica. Nije nađena značajna razlika između floridnih hipertireoza i istih bolesnica nakon postizanja stabilne eutireoidne faze.Using the indicator (131J HSA) dilution tehnique blood volume was determined by means of hematocrit, plasma volume and red cell volume in group of 35 patients with M. Basedow-i (Grave’s disease) aged 20—40 years. The examination was performed in the stage of florid hyperthyroidism, as well as after achieving stable euthyroid phase during drug treatment with carbimazole (Favistan). A significant difference in the blood volume values was found between the hyperthyroidism group and control examinees. There was no singnificant difference betwen the florid hyperthyroidism group and the same patients after archieving the stable euthyroid phase

Some experiences in organization and establishing of the medical unit of a battalion in a brigade of the Croatian army

Sanitetsko odjeljenje (Sn.O) bataljuna u jednoj od brigada Hrvatske vojske (HV) ustrojeno je tijekom srpnja 1991. godine, postavljanjem referenta Sn.O. Osnovni zadatak bio je kontinuirano izvršavanje zbrinjavanja vojaka u postrojbi bataljuna. S tim u svezi organiziran je rad ambulante opće prakse, stomatološke i ambulante za fizikalnu terapiju. Organiziranje i rad sanitetskih ekipa koje prate vojake na položaju, kao i interventne ekipe pri ambulanti opće prakse. Osim izvršavanja navedenoga Sn.O. bataljuna upućuje ranjene vojake na postoperativnu rehabilitaciju u toplice, kako u Republiku Hrvatsku, tako i u inozemstvo. Ovo Sn.O. pokrenulo je inicijativu glede obeštećenja ranjenih i poginulih vojaka na razini bataljuna. U ambulantama koje pokriva ovo Sn.O. (ambulanta opće prakse, stomatološka i ambulanta za fizikalnu terapiju), vodi se protokol bolesnika i kompjutorska obrada relevantnih pokazatelja zbrinutih vojaka. U Sn.O. bataljuna djeluju: referent sanitetskog odjeljenja, dva liječnika, jedna interventna ekipa sa sanitetskim vozilom pri ambulanti, tri sanitetske ekipe koje prate postrojbu na položaju (ekipe sačinjava: vozač, bolničar, medicinski tehničar i sanitetsko vozilo), jedan liječnik stomatolog i asistent u stomatološkoj ambulanti, jedan fizioterapeut i bolničar u ambulanti za fizikalnu terapiju. Ovdje je, međutim, važno pripomenuti da postrojba o kojoj je riječ po broju vojaka dvostruko premašuje postrojbu normalnog bataljuna, pa je organizacija Sn.O. ove postrojbe nešto drukčija od uobičajene sheme organizacije sanitetske službe (odjeljenja) na razini bataljuna. I, konačno, sanitetsko odjeljenje organiziralo je rad bolničara i medicinskih tehničara od razine voda do satnije, čime je u cijelosti zaokružena organizacija sanitetske službe ovoga bataljuna.Medical unit of a battalion in one of the brigades of the Croatian Army has been founded in July 1991 by the appointment of the medical officer. The main task was to perform continously the health care of the members of the battalion. At first, the work of a GP’s surgery has been organized as well as that of a dentist’s surgery and a surgery for physical therapy. The work of medical teams accompanying soldiers on their positions has also been organized as well as that of an emergency team in the GP’s surgery. Besides of these tasks the medical officer of the battalion does also referrals of wounded soldiers to postoperative rehabilitation in rehabilitation institutes or spas both within the Republic of Croatia and abroad. This medical unit has also taken initiative concerning compensations to wounded soldiers or to families of dead soldiers at the level of the batt alion. In surgeries which are parts of this medical unit (GP, dentist, physical therapy) the patients’ records are kept as well as the computer analysis of all relevant data about treated soldiers. The members of the medical unit are: the medical officer, two physicians, one emergency team with an ambulance which is a part of the surgery, 3 medical teams who accompany soldiers on their positions (a team consists of a driver, an aidman and a male nurse equipped with an ambulance), a dentist, a dentist’s assistant, a physiotherapist and a aidman in the surgery for physical therapy. It is, however, important to remark that the military unit in question has twice inore soldiers than a normal battalion, so that its medical unit differs to some extent from the usual organizational scheme of medical units at the level of a battalion. And finally, the medical unit has organized the activity of aidmen and male nurses at the level of platoons up to the level of companies. In this way the organization of the medical service of this battalion has been rounded off completely

Blood volume in hyperthyrodism

Pomoću tehnike dilucije indikatora (131J HSA) ispitan je volumen krvi, a pomoću hematokrita volumen plazme i volumen mase eritrocita u skupini od 35 oboljelih od M. Basedovv-i (Gravesova bolest), u dobi od 20. do 40. godine. Ispitivanje je vršeno u fazi floridnog hipertireoidizma, te nakon postizanja stabilne eutireoidne faze tijekom medikamentoznog tretmana s karbimazolom (Favistan), te je otkrivena značajna razlika u vrijednostima volumena krvi između skupine floridnih hipertireoza i kontrolne skupine ispitanica. Nije nađena značajna razlika između floridnih hipertireoza i istih bolesnica nakon postizanja stabilne eutireoidne faze.Using the indicator (131J HSA) dilution tehnique blood volume was determined by means of hematocrit, plasma volume and red cell volume in group of 35 patients with M. Basedow-i (Grave’s disease) aged 20—40 years. The examination was performed in the stage of florid hyperthyroidism, as well as after achieving stable euthyroid phase during drug treatment with carbimazole (Favistan). A significant difference in the blood volume values was found between the hyperthyroidism group and control examinees. There was no singnificant difference betwen the florid hyperthyroidism group and the same patients after archieving the stable euthyroid phase