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Letters from Medicine-Info-O.
Körper Vitruv

We present you two examples of letters from Medicine-Info-Online to illustrate our service (fee: euro 90,--).


Letter no. 1:

Dear Mr B.

we thank you for your kind enquiry and for your interest in Medicine-Info-Online.

Your family doctor has examined your neck by palpation. He suspects that your thyroid is pathologically enlarged. He recommends a nuclear medical examination of the thyroid (scintigraphy) to you now. You ask whether such a scintigraphy or an ultrasound examination (sonography) of the thyroid should be prefered in your case.

Normally an ultrasonic examination of the thyroid should be carried out first. Under normal circumstances the thyroid can be examined with ultrasound very well. The ultrastructure of the thyroid can be examined well if the quality of the equipment is adequate (sonograph with a high resolution small part transducer, frequency about 7,5 or 10 megahertz/MHz).  The volume of the thyroid can be measured rather precisely, too. Therefore it can be clarified by a sonography, whether the thyroid is actually pathologically enlarged or not. An enlargement of the thyroid can occasionally be simulated by soft parts of the neck region trained strongly. Nodes, Cysts and other pathological alterations of the thyroid or soft parts of the neck can also be recognized very well by ultrasound. Such an ultrasonic examination doesn't cause any radiation exposure. In accordance with today´s knowledges this procedure is without any harmful effects.

An additional scintigraphy of the thyroid can be required, if nodes in the thyroid have been found by ultrasound. In this cases the scintigraphy gives informations about the function, i.e. the secretory activity of the node.  One can differentiate  by scintigraphy between cold and warm nodes. Warm nodes are characzerized by high secretory activity and can cause hyperactivities of the thyroid (hyperthyrosis). Cold nodes are characterized by low secretory activity. Such cold nodes are mostly degeneratively caused, but they may be malignant in rare cases though. The additional informations of the scintigraphy are required to decide whether and how a thyroid node has to be treated. Disadvantages of the scintigraphy are certain radiation exposures since radioactive substances must be used.

Therefore you should ask your family doctor first to arrange an ultrasonoic examination for you.

In addition a blood test can be useful to exclude a functional disorder of the thyroid, i.e. an hyperactivity (hyperthyrosis) or an insufficient function (hypothyroidism). For this purpose the blood levels of thyroid hormones can be investigated (TSH, thyroxine and liothyronine).

We hope very much that our information are helpful to you.

Yours sincerely

Jörg Piper, MD, Senior consultant



Letter no. 2:

Dear Mrs K.

You suffer from sudden pallors and coolings of your fingers, sometimes also of your toes. Sometimes your urine is discolored brownishly, sometimes reddish. You suspect that these discolorations of your urine are caused by additions of blood. Now you ask, whether these symptoms require a medical treatment or are harmless. You write to us that you are afraid of visiting your physician. So you would like to take advice from us on this way.

Naturally it isn't possible to make diagnoses "from the distance". However, we can give you some general advices. Perhaps our informations are suitable to reduce your fear of a physician visit.

Pallors of fingers and toes can be caused by temporary circulatory disorders. Such circulatory disorders can be caused by temporary vasospasms of the blood vessels in the fingers or toes. This phenomenon is called "Raynaud syndrome". This Raynaud syndrome can be harmless. It can be caused by various drugs (for example ergotamine, beta blockers, contraceptives). This syndrome also can point to some rare illnesses being called "collagenoses".

Discolorations of the urine not always have to indicate that there is blood in the urine. The color of the urine can be very different depending on drinking quantity, nutrition composition and metabolic situation. So discolorations of the urine can have many different causes.

A simple laboratory examination of the urine canshow, whether there is actually blood in the urine or not.

If blood is actually found in the urine, it must be investigated by additional examinations whether there is a pathological cause. Ultrasonic examinations  of kidneys and urinary bladder are suitable for this, furthermore a X-ray examination of the urinary organs (intravenous urography). An endoscopy of the urinary bladder (cystoscopy) can supplementally be necessary in addition. An urinary tract infection also should be excluded by urine examinations. An urinary tract infection also can cause blood in the urine and does not always affect the urination.

On the other hand a Raynaud syndrome combined with blood in the urine also could point to a relatively rare collagenosis (systemic lupus erythematosus). This disease can damage different organs, also the kidneys. On the other hand this disease is very rare and it is normally characterized by several additional symptoms which aren't indicated by you.

A capillary microscopy (capillaroscopy, microangioscopy) as an additional examination can be discussed with regard to angiology. The capillaries are examined microscopically at this examination in the nail fold of the fingers. These capillaries can already show typical morphological alterations in very early phases of those rare collagenoses.

Moreover some special blood tests have to be be carried out to diagnose these diseases.

Reddish or brownish discolorations of the urine also can rarely be caused by certain metabolic diseases (porphyrias). These illnesses can be diagnosed by special laboratory examinations. On the other hand porphyrias are usually characterized by other additional symptoms which are not described by you.

All aforementioned examinations are painless and harmless with the exception of the cystoscopy, which may be unpleasant. A cystoscopy, however, need not be carried out in every case. If these examinations do not have any pathological results, serious diseases should be rather improbable.

Since the symptoms stated by you can have many different causes you should consult your physician as soon as possible.

We hope very much that our information are helpful for you.

Yours sincerely

Jörg Piper, MD, Senior consultant



Copyright: Jörg Piper, MD, senior consultant, Clara-Viebig-Str. 4, D-56864 Bad Bertrich, Germany

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