Orbital Decompression for Endocrine Ophthalmopathy: The Endonasal Approach

A surgical endonasal procedure is described to perform orbital decompression in patients suffering from ophthalmopathy in Grave's disease. The decompression technique employs removal of the lamina papyracea as an exclusive modality or in conjunction with a transmaxillary or lateral decompression approach. This present series contain 23 patients who underwent decompression over a 3-year period and were followed for at least 6 months postoperative. The results of decompression were assessed by measuring reduction in proptosis and visual acuity. All patients demonstrated improved visual acuity. Measuring retroplacement of the globe, the endonasal approach proved to equal the results obtained …

Ciclosporin and prednisone v. prednisone in treatment of Graves' ophthalmopathy: a controlled, randomized and prospective study.

Forty patients with Graves' ophthalmopathy stages III-V were divided into two groups in a random manner according to their year of birth. Group I received prednisone in decreasing dosage. Group II received prednisone at a comparable dosage and ciclosporin. Steroids were discontinued after 10 weeks in the two groups. In the patients of group II, ciclosporin was continued over 12 months. The therapeutic effect was assessed by an activity score based on subjective and objective symptoms (computerized tomography and sonography of the orbit, Hertel values, clinical findings). All signs of endocrine ophthalmopathy improved significantly in both groups (P less than 0.01 in group I; P less than 0.0…

Multiple Peptide Hormone Producing Adenocarcinoma of Lung with Neurotensin and CRF-like Immunoreactivity

Summary A pulmonary cancer of a 43 year-old-man was classified according to WHO-criteria as a poorly differentiated adenocarcinoma because of demonstration of mucinous substances in tumor cells and in rarely occurring acinar lumina. Immunohistochemical reactivity for several peptide hormones was detected in the predominant solid parts of the carcinoma. In many tumor cells an immunoreactivity to neurotensin, bombesin and — according to the elevated serum levels — to ACTH, CRF and calcitonin was found. Therefore the present lung cancer must be defined as a combined carcinoma composed of mucous producing and endocrine cell types. Because peptide hormone production is not restricted to the clas…

Fine-needle biopsy of parathyroid adenomas

High-resolution real-time sonography was performed in 15 cases of clinically and chemically suspected primary hyperparathyroidism and in 20 patients with different thyroid nodules. The suspected enlarged parathyroid glands and the thyroid nodules were percutaneously punctured under sonographic control. Concentrations of parathyroid hormone, human thyroglobulin, and human calcitonin were measured in the aspirate, and immunocytology was performed. The mean concentration of the aspirated parathyroid hormone in the parathyroid glands was 4,013.6 pmol/l +/- 4,519 (SD) as compared with 14.9 pmol/l +/- 8.7 in the thyroid nodules. Thyroglobulin was present in the aspirated fluid of parathyroid aden…

Nonsteroid Immunosuppressants in Endocrine Orbitopathy

Sinusitis in Thyroid Associated Ophthalmopathy

In 19 patients with thyroid associated ophthalmopathy undergoing orbital decompression, histologic examination of paranasal sinus mucosa revealed moderate to severe inflammatory alterations in all patients. Only 2/19 patients had a history of chronic sinusitis. In 4/19 patients, mucosal abnormalities of the paranasal sinuses were found on preoperative computed tomography CT scans. Postoperatively, 10/19 patients developed purulent sinusitis. It is suggested that patients suffering from thyroid associated ophthalmopathy have an increased incidence of histologically detectable inflammatory changes of paranasal sinus mucosa. Because of preexisting mucosal inflammation, these patients are pron…