WorldWideScience

Sample records for abordar peligros graves

  1. Modelo para abordar integralmente la mortalidad materna y la morbilidad materna grave

    Ariel Karolinski; Raúl Mercer; Paula Micone; Celina Ocampo; Pablo Salgado; Dalia Szulik; Lucila Swarcz; Vicente R Corte; Belén Fernández del Moral; Jorge Pianesi; Pier Paolo Balladelli

    2015-01-01

    La mortalidad materna es un importante problema de salud pública y de derechos humanos y refleja los efectos de los determinantes sociales sobre la salud de las mujeres. El conocimiento de la magnitud y las causas de las muertes maternas ha sido insuficiente para intervenir efectivamente en el alcance de los Objetivos de Desarrollo del Milenio. Por ello, se plantea un modelo para abordar integralmente la mortalidad materna, con siete campos: priorización y definición del problema, caracteriza...

  2. Cinco paradigmas para abordar lo real

    Eva Pasek de Pinto

    2006-01-01

    Full Text Available Considerando la crisis de la investigación social, el propósito del estudio fue configurar un fundamento paradigmático para la investigación en ciencias sociales. Partiendo de dos cuerpos teóricos: Mardones, (1991; y Padrón, (1994, 1998, por medio de la deducción y del análisis se obtuvieron cuatro paradigmas de investigación que, integrados, permitieron obtener un quinto paradigma. Así, como resultado del estudio se presentan cinco paradigmas posibles para abordar la realidad: el empírico- inductivo; el racionalista deductivo; el fenomenológico vivencial, el reflexivo crítico y el holístico o de la complejidad. A lo largo del estudio, cada uno de ellos se analiza en cuatro aspectos paradigmáticos: el Ontológico, el Epistemológico, el Axiológico y el Metodológico.

  3. [Graves' ophthalmopathy].

    Eckstein, A; Dekowski, D; Führer-Sakel, D; Berchner-Pfannschmidt, U; Esser, J

    2016-04-01

    Graves' orbitopathy (GO) is the main extrathyroidal manifestation of Graves' disease and the full clinical picture can impair the quality of life of the patients considerably. Active inflammation can often be effectively treated by intravenous steroids/immunosuppression, however does not lead to full remission, since inflammation rather quickly results in irreversible fibrosis and increase of orbital fat. Very important is the control of risk factors (smoking cessation, good control of thyroid function, selenium supplementation) to prevent progression to severe stages. Treatment should rely on a thorough assessment of activity and severity of GO. Rehabilitative surgery (orbital decompression, squint surgery, eyelid surgery) is needed in many patients to restore function and appearance. Anti-thyroid-stimulating hormone (TSH) receptor antibodies do specifically occur in these patients and correlate to the course of thyroid and eye disease. The levels of these antibodies can be used for treatment decisions at certain time points of the disease. PMID:27059986

  4. ANIMALES... ¿EN PELIGRO DE EXTINCIÓN O EN PELIGRO DE QUE LOS EXTINGAMOS?

    Gustavo Rodríguez García

    2008-01-01

    Full Text Available El presente artículo expone la problemática de los animales en peligro de extinción desde la perspectiva del Law & Economics. Así, en lugar de abogar por mecanismos legales orientados hacia la protección estatal de los animales (entendidos como una suerte de patrimonio de la humanidad, el autor sustenta las razones por las cuales se debería someter a los animales en peligro de extinción a un régimen de propiedad privada mediante el cual se generen incentivos para el cuidado de los mismos y para la productividad.This paper presents the issue of endangered species from a Law & Economic's perspective. In this way, instead of defending the creation of legal mechanisms oriented to public protection of animals (seen as a heritage of humanity, the author maintains the reasons why animals should be considered under a private property regime that provides incentives for their care and for productivity.

  5. EPISTEMOLOGIA EDUCAŢIEI – O ABORDARE INTERDISCIPLINARĂ

    Florentina Olimpia AVRAM

    2015-12-01

    Full Text Available Epistemologia educaţiei, ca parte, deopotrivă, a disciplinei filosofiei educaţiei (prin urmare, aparţinând domeniului filosofiei, poate să se constituie şi ca disciplină în cadrul ştiinţelor educaţiei. Un parcurs similar l-au avut şi alte discip­line considerate a fi „de graniţă” şi având o abordare interdisciplinară, care fac parte în acelaşi timp din două discipline distincte, cum ar fi, de exemplu, sociologia educaţiei, care este, deopotrivă, o ramură a sociologiei dar şi o subdisciplină a ştiinţelor educaţiei. Prin urmare, în contextul actual, de hibridare metodologică, conceptuală şi disciplinară, rolul epistemologiei educaţiei este acela de a întemeia cunoaşterea din domeniul ştiinţelor educaţiei; ea are, de asemenea, un rol de fundamentare normativă, evidenţiind rolul şi importanţa enunţurilor celor mai generale ale ştiinţei – axiome, legi, principii şi reguli, în întemeierea critică a cunoaşterii şi legătura acestor legităţi cu praxis-ul educaţional. De asemenea, aspecte legate de sursele cunoaşterii în educaţie, de tipurile şi modalităţile de cunoaştere specifice acestor ştiinţe, de analiza critică a conceptelor, principiilor, legităţilor educaţiei, constituie un demers epistemologic în câmpul educaţiei, care are scop de clarificare, de elucidare şi întemeiere a cunoaşterii.EPISTEMOLOGY OF EDUCATION – AN INTERDISCIPLINARY APPROACHFrom an epistemological perspective the scientific research in the area of education sciences has some specific characte­ristics we would like to emphasize in this article, in a synthetic approach. One of the purposes considered is to briefly present some of the most recurrent forms of knowledge in the field of education, namely: reflexive, material, taxonomic, experimental and statistical knowledge. We will emphasise the specificity of each approach and we will insist on the forms encountered in the education sciences unlike

  6. El turismo ante el reto de peligros naturales recurrentes: una visión desde Cancún

    Frank Babinger

    2012-01-01

    Full Text Available Este artículo analiza la dualidad existente entre el desarrollo económico basado en la actividad turística y las repercusiones de su ocupación territorial a expensas de un medio ambiente que engloba unos peligros naturales determinados. La transformación de los espacios costeros al ser ocupados por el turismo, es uno de los graves problemas que no se tienen en cuenta a la hora de planificar la actividad. Cancún es un modelo paradigmático en el cual un crecimiento explosivo de turistas, habitantes y construcciones turísticas ha llevado a la masiva ocupación de un espacio costero afectado histórica y actualmente por tormentas tropicales y huracanes. De ello resulta un claro aumento de la exposición al riesgo y de la vulnerabilidad. Esta colonización espacial por el turismo y los impactos de los huracanes tienen repercusiones directas sobre los establecimientos hoteleros y las urbanizaciones turísticas que ponen en entredicho el mantenimiento de la actividad turística en un futuro.

  7. Graves opthalmopathy and psychoendocrinopathies

    Ghanem Asaad; Amr Mostafa; Araafa Lamiaa

    2010-01-01

    Purpose: To assess the psychiatric and endocrinological changes in patients with Graves ophthalmopathy (GO). Design: A prospective, controlled, University Hospital based study Subjects and Methods: The current study comprised 60 patients diagnosed with GO at Mansoura Ophthalmic Center. Thirty five patients of them with moderate to severe GO formed the study group and twenty five patients with negligible to very mild GO formed the control group in the euthyroid state. The study group was...

  8. Digging One's Own Grave

    Arvo Krikmann

    2007-01-01

    Full Text Available The paper aims to demonstrate that some points in the explicationof the figurative expression digging one’s own grave via the concept of blending given by Gilles Fauconnier and Mark Turner are problematic: (1 Not understanding the consequences of one’s deeds is an almost universal presuppositionof and impulse or motivation for actualizing any utterance with a forewarning or gloating content (e.g., proverbs, not the singularity characterizing just the expression of grave-digging as such. (2 The inversion of causal and temporal structure is not the case because of metonymic association between the concepts of the grave and death, as a result of which specific causal and temporal order loses any significance. Many synonymous examples can be given in which the image refers to events before the death, between the death and funeral, as well as those after burial. (3 The source domain needs not to be restricted to natural death and modern civilized funerals but should include also the cases of violent deaths, e.g., the scenario of execution and the scenario of hunting and trapping. Preliminarily, a very brief synopsis of the main phases of development of cognitive linguistic theory of metaphor and some favourite examples of blends, used also in previous works, is provided.

  9. Infantile Graves Disease

    Altıncık, Ayça; Gençpınar, Pınar; Demir, Korcan; Çatlı, Gönül; Abacı, Ayhan; Böber, Ece

    2013-01-01

    Graves rsquo; disease is an autoimmune disorder presenting with hyperthyroidism and the disease is rare in childhood Two year old female patient was admitted to our clinic for her evident orbital puffiness Physical examination revealed propitosis tachycardia and a hyperpigmented spot with a diameter of 6x4 cm on the skin of the left hemithorax Evaluation of thyroid function tests showed the following values: fT4: 4 00 ng dl N: 0 8 1 9 fT3: 7 7 pg ml N: 1 57 4 71 TSH: 0 004 uIU ml ...

  10. Prevention of Graves' ophthalmopathy.

    Bartalena, Luigi

    2012-06-01

    Smoking is the most important risk factor for the occurrence/progression of Graves' ophthalmopathy (GO), as well as for its lower/slower response to immunosuppression. Accordingly, refrain from smoking should be urged, both as primary prevention (removal of risk factors in Graves' patients without GO), secondary prevention (early detection and treatment of asymptomatic/very mild GO) and tertiary prevention (reduction of complications/disability of overt GO). A 6-month course of 200 μg/day sodium selenite can prevent progression of mild GO to more severe GO and is, therefore, a form of secondary prevention and, probably, primary prevention. Correction of thyroid dysfunction and stable maintenance of euthyroidism are important preventive measures. The optimal treatment for hyperthyroidism in patients with GO is uncertain, because evidence demonstrating the superiority of antithyroid drugs over thyroid ablation (radioiodine, thyroidectomy, or both) is lacking. If radioiodine is used, low-dose steroid prophylaxis is recommended, particularly in smokers, to prevent radioiodine-associated GO progression. PMID:22632372

  11. Infancia en peligro tóxico. Experiencia y negación

    Javier Auyero

    2010-07-01

    Full Text Available Utilizando el caso de Villa Inflamable, este artículo examina un tipo de riesgo que buena parte de la literatura sobre pobreza urbana en América Latina tiende a ignorar: el peligro ocasionado por la contaminación medioambiental. El artículo también inspecciona las maneras en que un poderoso actor social, implicado en la producción de dicho riesgo, se apropia y niega simbólicamente el sufrimiento colectivo creado por este peligro toxico.

  12. Fisiopatologia da asma grave

    Todo-Bom, Ana; Mota-Pinto, Anabela

    2006-01-01

    Não tem resumo. Transcreve-se o primeiro parágrafo: A história natural da asma e os condicionalismos de uma evolução para formas moderadas ou graves não está completamente estabelecida. Contudo, quer os factores genéticos quer os factores ambientais, serão determinantes na fisiopatologia e no prognóstico da doença. A asma é, por definição, uma doença inflamatória crónica das vias aéreas caracterizada por uma obstrução brônquica generalizada mas variável que é, pelo menos parcialmente, reve...

  13. Aes grave iz Jesenica

    Bonačić Mandinić, Maja

    2009-01-01

    U zbirci Arheološkog muzeja u Splitu čuva se primjerak aes grave tipa Apolon/Apolon (RRC 18/1). Pripada emisiji kovnice u Rimu iz 275. do 270. godine prije Krista. Nađen je oko 1901. godine u Jesenicama. Bilo kakve pojedinosti o kontekstu nalaza nisu poznate. Jesenice su selo na oko 200 do 250 m nadmorske visine, na padini Peruna - južna kosa planine Mosor. Uz ostale helenističke nalaze sa šireg područja Jesenica, na potezu uz obalu između Splita i Omiša, ovaj nalaz bi mogao svjedočiti o vezi...

  14. Hashimoto's thyroiditis following Graves' disease.

    Umar, Husaini; Muallima, Nur; Adam, John M F; Sanusi, Harsinen

    2010-01-01

    Both Graves' disease and chronic thyroiditis (Hashimoto's thyroiditis) are autoimmune diseases of thyroid gland. Graves' disease is caused by stimulation of TSH receptor located on the thyroid gland by an antibody, which is known as TSH receptor antibody (TRAb). Furthermore, this may lead to hyperplasia and hyperfunction of the thyroid gland. On the contrary, the cause of Hashimoto's thyroiditis is thought due to a TSH stimulation-blocking antibody (TSBAb) which blocks the action of TSH hormone and subsequently brings damage and atrophy to thyroid gland. Approximately 15-20% of patients with Graves' disease had been reported to have spontaneous hypothyroidism resulting from the chronic thyroiditis (Hashimoto's disease). Pathogenesis for chronic thyroiditis following anti-thyroid drug treatment in patients with Graves' disease remains unclear. It has been estimated that chronic thyroiditis or Hashimoto's disease, which occurs following the Graves' disease episode is due to extended immune response in Graves' disease. It includes the immune response to endogenous thyroid antigens, i.e. thyroid peroxidase and thyroglobulin, which may enhance lymphocyte infiltration and finally causes Hashimoto's thyroiditis. We report four cases of chronic thyroiditis (Hashimoto's disease) in patients who have been previously diagnosed with Graves' hyperthyroidism. In three cases, Hashimoto's thyroiditis occurs in 7 to 25 years after the treatment of Grave's disease; while the other case has it only after few months of Grave's disease treatment. The diagnosis of Hashimoto's disease (chronic thyroiditis) was based on clinical manifestation, high TSHs level, positive thyroid peroxidase antibody and thyroglobulin antibody, and supported by positive results of fine needle aspiration biopsy. Moreover, the result of histopathological test has also confirmed the diagnosis in two cases. All cases have been successfully treated by levothyroxine treatment. PMID:20305330

  15. Los Peligros de Madrid en el Semanario Pintoresco Español

    Rubio Cremades, Enrique

    2012-10-01

    Full Text Available Los Peligros de Madrid portrays in detail the habits and customs of a swathe of Spanish society in the 19th century. Urban Madrid is beset with a series of hazards making it impossible for its inhabitants to walk the streets in safety. The Semanario Pintoresco Español satirises the incivility of the residents of 19th century Madrid with a series of etchings illustrating breaches of urban logic, acts of vulgarity and bad taste. The etchings illustrate in minute detail the hazards facing pedestrians in the streets of urban Madrid in the mid-19th century.Los peligros de Madrid reflejan con exactitud los hábitos y costumbres de un sector de la sociedad española del siglo XIX. El Madrid urbano está sometido a una serie de peligros que imposibilita el trasiego normal de sus moradores. Gracias a la nula urbanidad de quienes viven en el Madrid decimonónico, el Semanario Pintoresco Español se propone zaherir desde sus páginas y grabados la inveterada costumbre de incumplir la más lógica urbanidad con obstáculos o actuaciones groseras y de mal gusto. Grabados que reflejan con minuciosidad y detalle los peligros que sufren los viandantes madrileños en su deambular por el Madrid urbano de mediados del siglo XIX.

  16. Graves opthalmopathy and psychoendocrinopathies

    Ghanem Asaad

    2010-01-01

    Full Text Available Purpose: To assess the psychiatric and endocrinological changes in patients with Graves ophthalmopathy (GO. Design: A prospective, controlled, University Hospital based study Subjects and Methods: The current study comprised 60 patients diagnosed with GO at Mansoura Ophthalmic Center. Thirty five patients of them with moderate to severe GO formed the study group and twenty five patients with negligible to very mild GO formed the control group in the euthyroid state. The study group was further subdivided based on their predominant clinical signs into a proptosis subgroup and a muscle restriction subgroup . Psychiatric changes were assessed with the Middlesex Hospital Questionnaire (MHQ. Biochemical analyses included serum-free thyroxine and thyroid-stimulating hormone (TSH concentrations, TSH receptor antibody (TRAb activity and anti-thyroglobulin particle agglutination (TGPA and antithyroid microsomal particle agglutination (MCPA. Results: The proptosis group reported significantly higher scores on anxiety, depression, and phobia than the muscle restriction group (P< 0.0001. The proptosis and muscle restriction subgroups reported significantly higher scores on all subscales compared to the control group (P < 0.05. The scale scores of depression and phobia showed a positive correlation with scores of anxiety (P< 0.0001. The serum TRAb activity showed a significant correlation with anxiety, phobia and hysteria (P < 0.0001. Conclusion: The psychiatric aspect of GO should be evaluated during routine follow-up and should be considered when making management decisions. Thyroid specific antibodies may be useful in confirming the diagnosis of GO.

  17. ¿Hay diferencias entre la violencia grave y la violencia menos grave contra la pareja?: un análisis comparativo

    Enrique Echeburúa

    2008-01-01

    Full Text Available En este estudio ex post facto se lleva a cabo una descripción de las características presentadas por 1.081 casos denunciados por violencia contra la mujer en las comisarías de la Ertzaintza del País Vasco. En primer lugar, se presentan las variables psicológicas y sociodemográficas del agresor y de la víctima, así como de la relación de pareja. Y en segundo lugar, se determinan las diferencias más significativas entre la violencia grave y la violencia menos grave en relación con esas mismas variables. Los resultados ponen de manifiesto que tanto los agresores como las víctimas tienden a ser jóvenes, con una sobrerrepresentación de agresores y víctimas extranjeros inmigrantes. En el caso de los maltratadores graves, tienden a ser celosos o posesivos, a sentirse humillados por la ruptura de la pareja, lo que redunda directamente en un descenso de su autoestima y a consumir abusivamente alcohol o drogas. Por lo que se refiere a las víctimas de la violencia grave, se suelen sentir con frecuencia en peligro de muerte y están más fácilmente en circunstancias de vulnerabilidad, como una edad muy joven, una personalidad muy dependiente, una situación de enfermedad crónica o de dependencia económica, un consumo de drogas o un entorno de soledad. Se comentan las implicaciones de este estudio para la investigación y para la práctica clínica.

  18. Immunosuppression in Graves' ophthalmopathy

    Objective: Graves' ophthalmopathy (GO) is a disease that seriously threatens the health of patients. But up to now, no optimal therapies have been established. Immunosuppressive treatment is usually used in the management of GO, but they may cause side effects. Recently, 99Tc-MDP, commercially named 'Yun Ke', is used in the management of autoimmune disease. Therefore, a randomized trial was done to compare the values in the treatment of GO with between Yun Ke and immunosuppression. Methods: 42 consecutive patients with moderate or severe GO were randomly assigned to receive either Yun Ke therapy or immunosuppressive therapy. The degree of ocular involvement and responses to the treatment were evaluated by numerical scoring (ophthalmopathy index, OI) and clinical assessment. Therapy outcome was assessed 4 months after the start of treatment by the change in the highest NOSPECS class and OI. Data analysis was performed with the SPASS statistic software. Chi-square test was used to compare percentages, logistic regression was performed to identify which variables might correlated with the treatment outcome. Results: The remarkably effective outcome was observed in 14 (67%) cases in immunosuppression treated group and 13 (62%) cases in Yun Ke treated group. There were no significant differences in the degree of improvements in ocular involvements. There was a marked decrease of thyroid antibody titres in both groups. The variables found to correlated significantly with treatment outcome were thyroid antibody titres and GO activity. Side effects were more frequent and severe during immunosuppressive therapy. No side effects were found during Yun Ke treatment. Conclusion: Yun Ke and immunosuppression appeared to be equally effective in the management of GO, but Yun Ke is safer for patients during treatment

  19. Propuesta para abordar el modelo cuántico del átomo en el bachillerato

    Segarra Alberú, M.; Huerta Romero, V.; Ortiz Flores, M.

    2009-01-01

    Objetivo: Dar las bases para abordar el modelo cuántico del átomo a nivel bachillerato. Marco teórico: Aprendizaje significativo y colaborativo. Metodología: Con la secuencia diseñada y probada en el aula se lleva a los estudiantes al proceso de construcción de los elementos que implican un modelo del átomo: existe, tiene estructura (electrones y núcleo), la estructura electrónica determina todas sus propiedades. La meta es que los alumnos entiendan que el modelo cuántico explica la física at...

  20. La capacitaci??n institucional para abordar la violencia. Un camino a construir conjuntamente (Segunda parte)

    Garc??a G??mez, Rodrigo Juan; Gonz??lez Jim??nez, M?? Antonia; Espinosa Mart??nez, Raquel

    2011-01-01

    Este documento supone la puesta en pr??ctica de los principios de complejidad, reflexi??n y construcci??n a la hora de capacitar a las escuelas para abordar la violencia. Describe el trabajo de asesoramiento en dos situaciones institucionales distintas: (I) Una iniciativa de la Administraci??n en un instituto de educaci??n secundaria; (II) Demanda social y escolar de un colegio de infantil y primaria. Pretende demostrar la viabilidad real de una capacitaci??n profesional, colegiada e instituc...

  1. Evaluación y cartografiado del peligro por deslizamientos en el municipio de Moa

    Yexenia Viltres-Milán

    2014-10-01

    Full Text Available La ocurrencia de deslizamientos en el municipio de Moa genera situaciones de amenaza a la industria, las comunidades, las actividades socio-económicas y al medio ambiente. El presente trabajo tuvo el propósito de evaluar y cartografiar, aplicando los Sistemas de Información Geográfica (SIG, el peligro por deslizamiento en el municipio. Como basamento metodológico se utilizó la guía para el estudio de peligro, vulnerabilidad y riesgo por deslizamientos del terreno, elaborada por el Grupo Nacional de Gestión de Riesgos, del año 2012. El resultado fue el mapa de peligrosidad total por deslizamiento del municipio de Moa, a escala 1: 100 000, el cual constituye una herramienta más de gestión y reducción del riesgo en el ordenamiento territorial

  2. Biologiske behandlingsmuligheder ved Graves' oftalmopati

    El Fassi, Daniel; Nielsen, Claus; Hegedüs, Laszlo

    2008-01-01

    The current medical treatment options for Graves' ophthalmopathy (GO) are unsatisfactory. Recent treatment of GO patients with the B-lymphocyte depleting monoclonal antibody rituximab or with the anti-tumor necrosis factor-alpha agents etanercept and infliximab has shown promising results. We...

  3. Índice de peligro de incendios forestales de largo plazo

    Juan Manuel Torres Rojo; Grodecz Alfredo Ramírez Fuentes; Octavio S. Magaña Torres

    2007-01-01

    En este documento se describe un índice de peligro de incendios forestales de largo plazo. El índice se basa en el principio de quelos incendios forestales siguen un comportamiento crítico auto organizado, el cual establece que bajo una amplia variedad de circunstancias, los incendios forestales mantienen una relación exponencial sobre varias órdenes de magnitud entre la frecuencia de ocurrencia y el área quemada. Se describe el principio deun comportamiento crítico auto organizado de los inc...

  4. Riesgos, peligros, armas y violencia en la sociedad colombiana en el comienzo del siglo XXI

    Patiño Villa, Milena

    2015-01-01

    Con el objetivo de poner a prueba las explicaciones actuales sobre el uso de la fuerza en Colombia, indagar si es fácil ejercer violencia y si los colombianos tendrían una tendencia a armarse —dada la persistencia de altas tasas de violencia letal y la facilidad existente en el país para acceder a un arma—, y explicar cómo se producen las situaciones violentas, qué papel juegan las armas y cuáles son los principales motivadores en su uso, se usó el enfoque de riesgos y peligros, que se aplica...

  5. Infancia en peligro tóxico. Experiencia y negación

    Javier Auyero

    2010-01-01

    Utilizando el caso de Villa Inflamable, este artículo examina un tipo de riesgo que buena parte de la literatura sobre pobreza urbana en América Latina tiende a ignorar: el peligro ocasionado por la contaminación medioambiental. El artículo también inspecciona las maneras en que un poderoso actor social, implicado en la producción de dicho riesgo, se apropia y niega simbólicamente el sufrimiento colectivo creado por ...

  6. Peligros constantes y cambiantes en la percepción social del paisaje de amenazas en la ciudad de Mexicali

    Judith Ley García; Fabiola Maribel Denegri de Dios; Guadalupe Sánchez Contreras

    2016-01-01

    En este artículo se exploraron los cambios ocurridos en la percepción social del paisaje de amenazas en la ciudad de Mexicali, México, en 2006 y 2011. Esto se llevó a cabo mediante la comparación del número y tipo de peligros que los habitantes reportaron en dos encuestas locales. Este ejercicio permitió clasificar los peligros en “constantes” y “cambiantes”, y también identificar, a través de la obser - vación de su manifestación física en el espacio urbano, ...

  7. PREGO (presentation of Graves' orbitopathy) study

    Perros, Petros; Žarković, Miloš; Azzolini, Claudio;

    2015-01-01

    BACKGROUND/AIMS: The epidemiology of Graves' orbitopathy (GO) may be changing. The aim of the study was to identify trends in presentation of GO to tertiary centres and initial management over time. METHODS: Prospective observational study of European Group On Graves' Orbitopathy (EUGOGO) centres...

  8. Graves disease and atrial fibrillation

    Bello-Espinosa Ariel

    2010-06-01

    Full Text Available A clinical case of am 26 year old male is presented, with a diagnosis of hypothyroidism 2 years before admission. The patient consulted because he presented the following clinical symptoms: palpitation, exhaustion, fatigue, loss of weight, and trembling. The physical exam reveals ocular proptosis and a notable mass in the anterolateral region of the neck, besides classical symptomatology of Graves’ disease. After the realization of different labs (TSH, Electrocardiogram, a Graves’ disease and auricular paroxystic fibrillation are diagnosed. The patient is treated with Metimazol, Propranolol, and Hidrocortisona. Following that, the patient improves his clinical condition, for which he is discharged. Additionally, in concord with current bibliography, clinical and epidemiological aspects of Graves’ disease are presented and physiopathological mechanisms that trigger this disease are illustrated with the aim to show the medical community about a pathology infrequently presented in young males.RESUMENSe presenta el caso clínico de un paciente masculino de 26 años de edad condiagnóstico de base de hipertiroidismo dos años previos al ingreso que consulta por cuadro clínico de palpitaciones, cansancio excesivo, fatiga, pérdida de peso y temblor generalizado. El examen físico revela protrusión ocular y masa notable en región antero - lateral del cuello, además de la presentación de signos clásicos de enfermedad de Graves. Después de la realización de diferentes estudios, entre ellos análisis de hormonas tiroideas y electrocardiograma, se diagnostica enfermedad de Graves y fibrilación auricular paroxística. El paciente es tratado con Metimazol, Propranolol e hidrocortisona, presentando mejoría clínica por lo que es dado de alta. Adicionalmente, en concordancia con la bibliografía se señalan no solo los aspecto clínicos y epidemiológicos más relevantes de la enfermedad de Graves, sino que también se expone con claridad los

  9. Mamíferos mexicanos en peligro de extinción

    Arpella Villalpando, Miguel Ángel; Yañez López María de Lourdes

    2011-01-01

    Basándonos en la Norma Oficial Mexicana 059 de SEMARNAT, que establece los parámetros para considerar a una especie dentro de las diferentes categorías de riesgo, podemos encontramos que actualmente más de la mitad de las especies de mamíferos silvestres que viven en México son reconocidos en algún nivel de peligro de extinción. La mayoría de las especies de mamíferos mexicanos la componen los pequeños, como roedores y murciélagos. Éstos, al igual que otros animales de pequeña talla, se encue...

  10. Mass Graves, Landscapes of Terror

    Ferrándiz, Francisco

    2009-06-01

    Full Text Available The recent exhumation of mass graves from the Spanish Civil War and the Post-War years, mostly involving the largely abandoned graves of the Francoist rearguard, have become a central element in contemporary debates about the conflict and the regime following it. In this paper, the complexity and dynamism of this process is analysed, including from political and legal initiatives of great social and media impact to local actions on the ground, at times failed, ephemeral or almost imperceptible, but no less crucial. From the point of view of many of the people involved in the pro-exhumation associations, opening up the graves is part of a basic exercise in justice and ‘dignification’, showing the scope and systematic nature of repression while reverting the ‘infrahuman’ disposition of the executed corpses, a feeling crystallised in the common expression ‘thrown’ or ‘buried like dogs’, used very often to justify the need of carrying out exhumations. Politics of dignification and ‘rehumanization’ of these ‘incorrectly’ buried bodies are incorporating, in the last few months, elements drawn from international law, such as the concept of ‘crimes against humanity’.

    Las exhumaciones de fosas comunes de la Guerra Civil española y la posguerra de la última década, muy especialmente de fosas abandonadas de la retaguardia franquista, se han colocado en un lugar central de los debates contemporáneos sobre la naturaleza y alcance de la contienda y el régimen que surgió de ella. En este artículo, se analiza la complejidad y dinamismo del proceso, que incluye desde iniciativas políticas y judiciales de enorme proyección pública y mediática, como la Ley de la Memoria o el controvertido auto de Garzón sobre los crímenes del franquismo, hasta acciones locales a veces fallidas, imperceptibles o efímeras, pero no menos cruciales. Desde el punto de vista de muchos de los actores sociales implicados en las exhumaciones

  11. Evaluación espacial de los peligros naturales en el valle de Oiartzun (Gipuzkoa = Spatial evaluation of natural hazards in the valley of Oiartzun (Gipuzkoa

    P. Etxeberria, J.M. Edeso, A. Brazaola

    2005-01-01

    Full Text Available Se presenta y analizan los resultados obtenidos en la aplicación de una metodología de creacción de mapas de peligro en la parte media-alta del valle de Oiartzun. La metodología ha sido diseñada para evaluar la susceptibilidad a los peligros naturales en gipuzkoa, a escala comarcal. Se han estudiado los tres peligros naturales más habituales en este territorio: los movimientos de ladera, los incendios forestales y las inundaciones fluviales. El territorio a sido a si mismo zonificado en relación a la susceptibilidad a la combinación de los tres peligros mencionados.

  12. Medical Treatment of Graves' Orbitopathy.

    Salvi, M; Campi, I

    2015-09-01

    The medical treatment of Graves' orbitopathy (GO) is usually reserved to moderate to severe disease. Steroids have been widely employed and possess anti-inflammatory activity, but about 20-30% of patients are not responsive and about 20% present with disease recurrence. Immunosuppressive therapy alternative to corticosteroids may target the different antigens involved in pathogenic mechanisms of GO. Some have already been employed in clinical studies and showed interesting results, although the lack of randomized and controlled trials suggests caution for their use in clinical practice. Potential targets for therapy in GO are the TSH receptor and the IGF-1 receptor on the fibroblasts, inflammatory cytokines, B and T cells. Most promising results are obtained by interacting with the PIK3/mTORC1 signaling cascades for adipogenesis and the anti-IGF-1R with the monoclonal antibody teprotumumab. A recent open study has shown that tocilizumab, an anti-sIL-6R antibody, inactivates GO. Consistent reports on the efficacy of rituximab have recently been challenged by randomized controlled trials. Clinical practice will greatly benefit from the use of disease modifying agents in GO, as compared to steroids, currently standard treatment for GO. Among these, rituximab may be useful, especially in patients resistant to steroid or with contraindications to steroids. However, larger randomized controlled trials are needed for definitive data on the potential disease-modifying role of rituximab in GO. Direct targeting of the orbital fibroblast via immunosuppression or nonimmunosuppressive drugs is emerging as a promising alternative. PMID:26361263

  13. Bronze Statuettes in Roman Graves

    Margherita Bolla

    2014-02-01

    Full Text Available This research follows the investigations about the relationship between bronze statuettes and contexts in Roman times, particularly explored by Annemarie Kaufmann-Heinimann. The rarity of bronze figures (human, divine and animals in Roman tombs of Imperial age has been repeatedly emphasized. The aim of the paper is the collection, not exhaustive, of evidences in funerary contexts, to determine their meaning. From a methodological point of view, it was necessary to exclude figurines placed in graves but with other originary functions and several bronzes whose finding in tombs is unreliable. This preliminary survey has given about eighty all-round bronzes from burials, distributed in different areas, both in the Empire and marginal. Considering the huge amount of Roman burials known today, the overall evidence is scarce but allows some observations; it is evident the pre-eminence of Venus and Mercury, gods which had a funerary role. There is also an attempt to find the reasons of the rarity of metal statuettes in the tombs of roman period.

  14. Orbital Volumetry in Graves' Orbitopathy

    Al-Bakri, Moug; Rasmussen, Åse Krogh; Thomsen, Carsten;

    2014-01-01

    Purpose. We wanted to investigate the relative significance of fat and muscle enlargement in the development of dysthyroid optic neuropathy (DON) in Graves' orbitopathy (GO). Methods. Preoperative coronal CT scans of 13 patients with and without DON who subsequently underwent orbital decompression...... were retrospectively analyzed. Thirteen patients imaged for unilateral orbital fractures served as controls. Results. The retrobulbar muscle volume was 2.1 ± 0.5 cm(3) (mean ± SD) in controls, 4.3 ± 1.5 cm(3) in GO without DON, and 4.7 ± 1.7 cm(3) in GO with DON. The retrobulbar fat volume was 5.4 ± 1.......6 cm(3) in controls, 8.7 ± 8.0 cm(3) in GO without DON, and 9.4 ± 3.1 cm(3) in GO with DON. The muscle and fat volumes were higher in patients with GO than in controls (P < 0.001), but the volumes in orbits with and without DON were not significantly different. The volume of the optic nerve were...

  15. Peligros constantes y cambiantes en la percepción social del paisaje de amenazas en la ciudad de Mexicali

    Judith Ley García

    2016-01-01

    Full Text Available En este artículo se exploraron los cambios ocurridos en la percepción social del paisaje de amenazas en la ciudad de Mexicali, México, en 2006 y 2011. Esto se llevó a cabo mediante la comparación del número y tipo de peligros que los habitantes reportaron en dos encuestas locales. Este ejercicio permitió clasificar los peligros en “constantes” y “cambiantes”, y también identificar, a través de la obser - vación de su manifestación física en el espacio urbano, las pautas de invisibilidad social, que ameritan ser considera- das en las estrategias de prevención de desastres.

  16. Caracterización del peligro por inundaciones en el oasis La Purísima, Baja California Sur, México

    Jobst Wurl

    2015-01-01

    Full Text Available En el estado de Baja California Sur existen solo cuatro oasis con extensiones mayores a 2.0 km 2 ; La Purísima (2.25 km 2 representa el tercero en extensión. En el pasado el oasis fue frecuentemente afectado por inundaciones resultantes de los eventos extremos de precipitación, que generaron graves daños en la cuenca. Se realizó un diagnóstico del oasis La Purísima, con respecto a posibles inundaciones como consecuencia de lluvias extremas, lo cual incluye el análisis estadístico de la precipitación para la elaboración de un modelo hidrológico e hidráulico, con el fin de calcular el caudal máximo, el volumen y la frecuencia de crecidas en los cursos del arroyo Cadegomo bajo diferentes escenarios de lluvias extremas. Finalmente se elaboró un mapa de peligro por inundación según los escenarios elaborados Se efectuó un análisis de la ocurrencia de inundaciones en el pasado y sus efectos en el oasis por medio de evidencias históricas de inundación de la zona, para verificar su posible aplicación en la calibración de los modelos. Los caudales resultantes de los eventos de precipitación extremos generan un incremento importante de los niveles en el drenaje de la cuenca. La respuesta del arroyo es un incremento en el área de inundación de hasta 14% respecto al tiempo de retorno de 20 años. Un evento de 1 000 años generaría un incremento en el área de inundación de 67% y bajas, afectando las zonas de la región urbana, así como todos los lotes de cultivo

  17. Uso de plaguicidas en cultivos agrícolas como herramienta para el monitoreo de peligros en salud

    Virya Bravo Durán; Elba de la Cruz Malavassi; Gustavo Herrera Ledezma; Fernando Ramírez Muñoz

    2013-01-01

    Costa Rica ha incrementado el uso de plaguicidas de mayor toxicidad, debido entre otras cosas al desarrollo de plagas más resistentes y la necesidad que tienen algunos productos agrícolas de exportación de mantener su posición en el mercado internacional. El ser humano al entrar en contacto con los plaguicidas puede experimentar efectos adversos en su salud desde agudos hasta crónicos que se manifiestan en diferentes grados. Para generar indicadores de peligro en salud en algunos cultivos por...

  18. Asymptomatic Graves' disease during lithium therapy.

    Thompson, C J; Baylis, P. H.

    1986-01-01

    Lithium salts are widely recognized to cause biochemical hypothyroidism and have been used to treat thyrotoxicosis. We present a case of Graves' disease which developed during lithium therapy. The patient was asymptomatic until the lithium was discontinued; she subsequently developed florid symptoms of thyrotoxicosis.

  19. Prevención de los menores ante los peligros de la Red: una propuesta de formación a las familias

    Martínez-Antolino, María Teresa

    2014-01-01

    Los menores crecen de la mano de las nuevas tecnologías. Necesitan de guías que puedan educarlos en la protección de los posibles peligros que derivan del uso de éstas. Este trabajo, pretende analizar la importancia que tiene crear un entorno seguro en la Red para los menores y plantear un taller de formación en el que los padres de alumnos de Educación Primaria comprendan, entiendan y aprendan a trasmitir a sus hijos, los posibles peligros que derivan del uso de Internet. Como metodología, s...

  20. Sobre el peligro de una «petitio principa» en la teoría del conocimiento. [Reseña

    Sánchez-Migallón, S. (Sergio)

    2008-01-01

    reseña de Roman INGARDEN, Sobre el peligro de una «petitio principa» en la teoría del conocimiento (traducción de Mariano Crespo), Colección Opuscula Phibsophica. Ediciones Encuentro, Madrid 2006, 103 pp., 15 X 21, ISBN 84-7490-815-9.

  1. Elementos teóricos que contribuyen a la identificación, evaluación y control de los riesgos laborales y peligros.

    Hortensia Hernández Fernández

    2015-03-01

    Full Text Available El hombre como ser social ha desarrollado nuevos instrumentos y tecnologías junto a los cuales surgen riesgos y peligros que pueden desencadenar sucesos no deseados que afectan al hombre, la sociedad, la economía y al medio ambiente. El trabajo se realizó con el objetivo de contribuir a la identificación, evaluación y control de los riesgos y peligros para la prevención de incidentes, accidentes de trabajo, enfermedades profesionales y afectaciones al medio ambiente, mediante el aporte de aspectos teóricos relacionados con los mismos. Se emplearon métodos de la investigación científica de los niveles teóricos y empíricos, obteniendo como resultados elementos teóricos sobre: definiciones relacionadas con el tema; técnicas como la observación, la entrevistas y las listas de chequeo que contribuyen a la identificación de riesgos y peligros; métodos cuantitativos y cualitativos para la evaluación de riesgos; los riesgos y peligros asociados a los contaminantes físicos, químicos y biológicos del ambiente laboral; y el control de las medidas preventivas según la magnitud de los riesgos para minimizar la probabilidad que ocurran sucesos no deseados.

  2. Utilización de MOOCS en la formación docente: ventajas, desventajas y peligros

    Ilich Silva Peña

    2014-01-01

    a la luz de las necesidades de formación de docentes. Se presentan las grandes ventajas que tendrían estos cursos para resolver algunos de los problemas de dotación docente a nivel internacional y actualización del conocimiento del profesorado. Se muestran también algunas desventajas frente a los procesos formativos más tradicionales. Sin embargo, el artículo discute principalmente los peligros a los que se enfrenta la utilización de MOOCs en la formación docente presentando una alerta a los problemas de la regulación a través del mercado y los que podrían generarse a través de una neocolonización.

  3. Anaplastic Thyroid Carcinoma Following Radioactive Iodine Therapy for Graves' Disease

    Kim, Sun Hwa; Kim, Hee Young; Jung, Kwang Yoon; Choi, Dong Seop; Kim, Sin Gon

    2013-01-01

    Radioactive iodine (RAI) therapy has been used as a treatment option for Graves' disease, and it has been widely accepted to be safe. On the other hand, some evidence suggests that RAI therapy is possibly associated with a small increased risk of thyroid cancer. Herein, we report a rare case of anaplastic thyroid carcinoma (ATC) associated with Graves' disease, following RAI treatment. A 42-year-old woman had been diagnosed with Graves' disease and although she was treated with an antithyroid...

  4. The Influence of Prior Hyperthyroidism on Euthyroid Graves' Ophthalmopathy

    Karolien Termote; Brigitte Decallonne; Ilse Mombaerts

    2014-01-01

    Background. To investigate the influence of previous exposure to elevated thyroid hormones in euthyroid Graves' ophthalmopathy. Design. Retrospective, observational case series in university setting Median follow-up of 1 year with ranges of 0,8–7,6 years. Study performance of 10 years. Participants. We reviewed the clinical records of 731 Graves' ophthalmopathy patients. There were 88 (12%) patients with onset of Graves' ophthalmopathy during euthyroidism: 37 (5%) patients had ophthalmopathy ...

  5. 75 FR 65030 - Native American Graves Protection and Repatriation Review Committee: Nomination Solicitation

    2010-10-21

    ... National Park Service Native American Graves Protection and Repatriation Review Committee: Nomination Solicitation AGENCY: National Park Service, Interior. ACTION: Native American Graves Protection and... nominations for two members of the Native American Graves Protection and Repatriation Review Committee....

  6. 75 FR 13140 - Native American Graves Protection and Repatriation Review Committee: Nomination Solicitation

    2010-03-18

    ... National Park Service Native American Graves Protection and Repatriation Review Committee: Nomination Solicitation AGENCY: National Park Service, Interior. ACTION: Native American Graves Protection and... nominations for one member of the Native American Graves Protection and Repatriation Review Committee....

  7. Graves' ophthalmopathy and 131I therapy

    Graves' ophthalmopathy is an autoimmune process initiated and maintained by antigen(s) shared by the thyroid and the orbit. A matter of argument concerns the choice of the method of treatment for Graves' hyperthyroidism when clinically evident ophthalmopathy is present. Restoration of euthyroidism appears to be beneficial for ophthalmopathy. On the other hand the continuing disease activity associated with the recurrence of hyperthyroidism appears to adversely affect the course of ophthalmopathy. For these reasons it is our opinion that in patients with Graves' hyperthyroidism and ophthalmopathy the permanent control of thyroid hyper function by ablation of thyroid tissue should be obtained by radioiodine therapy or thyroidectomy. The rationale for an ablative strategy is the following: i) permanent control of hyperthyroidism avoids exacerbations of eye disease associated with recurrence of hyperthyroidism; i i) hypothyroidism, which follows thyroid tissue ablation, should be regarded as a therapeutic end point rather than as an undesirable result; iii) ablation of thyroid tissue may result in the removal of both the thyroid-orbit cross-reacting antigen(s) and the major source of thyroid-auto reactive lymphocytes. The relationship between radioiodine therapy and the course of GO is a matter of controversy, and some authors have suggested that radioiodine administration ma be associated with a worsening of preexisting ophthalmopathy. This was not observed when radioiodine treatment was associated with a 3-month oral course of prednisone. The development or progression of GO after radioiodine therapy might be due to the release of thyroid antigens following radiation injury and to subsequent exacerbations of autoimmune reactions directed towards antigens shared by the thyroid and the orbit. The view that radioiodine therapy may be associated with a progression of ophthalmopathy is not shared by some authors who claim that the apparent link between progression of

  8. Nicotinamide phosphoribosyltransferase leukocyte overexpression in Graves' opthalmopathy.

    Sawicka-Gutaj, Nadia; Budny, Bartłomiej; Zybek-Kocik, Ariadna; Sowiński, Jerzy; Ziemnicka, Katarzyna; Waligórska-Stachura, Joanna; Ruchała, Marek

    2016-08-01

    To investigate the role of NAMPT/visfatin in euthyroid patients with Graves' disease without (GD) and with Graves' ophthalmopathy (GO), we analyzed NAMPT leukocyte expression and its serum concentration. This was a single-center, cross-sectional study with consecutive enrollment. In total, 149 patients diagnosed with Graves' disease were enrolled in the study. We excluded subjects with hyper- or hypothyroidism, diabetes mellitus, other autoimmune disorders, active neoplastic disease, and infection. The control group was recruited among healthy volunteers adjusted for age, sex, and BMI with normal thyroid function and negative thyroid antibodies. Serum levels of visfatin, TSH, FT4, FT3, antibodies against TSH receptor (TRAb), antithyroperoxidase antibodies, antithyroglobulin antibodies, fasting glucose, and insulin were measured. NAMPT mRNA leukocyte expression was assessed using RT-qPCR. NAMPT/visfatin serum concentration was higher in GD (n = 44) and GO (n = 49) patients than in the control group (n = 40) (p = 0.0275). NAMPT leukocyte expression was higher in patients with GO (n = 30) than in GD patients (n = 27) and the control group (n = 29) (p < 0.0001). Simple linear regression analysis revealed that NAMPT/visfatin serum concentration was significantly associated with GD (β = 1.5723; p = 0.021). When NAMPT leukocyte expression was used as a dependent variable, simple regression analysis found association with TRAb, fasting insulin level, HOMA-IR, GD, and GO. In the stepwise multiple regression analysis, we confirmed the association between higher serum NAMPT/visfatin level and GD (coefficient = 1.5723; p = 0.0212), and between NAMPT leukocyte expression and GO (coefficient = 2.4619; p = 0.0001) and TRAb (coefficient = 0.08742; p = 0.006). Increased NAMPT leukocyte expression in patients with GO might suggest a presently undefined role in the pathogenesis of GO. PMID:26767650

  9. Radiotherapy in the management of Graves` ophthalmopathy

    Sakata, Koh-ichi; Hareyama, Masato; Oouchi, Atsushi; Shidou, Mitsuo; Nagakura, Hisayasu; Morita, Kazuo; Osanai, Hajime; Ohtsuka, Kenji; Hinoda, Yuji [Sapporo Medical Univ. (Japan). School of Medicine

    1998-06-01

    To report the results of radiotherapy for patients with failure, adverse reactions or relative contraindications to the use of steroids or immunosuppressants, by using newly developed quantitative indexes. Fourteen female and six male patients with Graves` ophthalmopathy were treated with radiotherapy between 1989 and 1996. Prior to radiotherapy, eight patients received treatment with prednisone, four received immunosuppressants and four received a combination of both. Four patients with contraindications to steroids were initially managed with radiotherapy. Most of the patients received a dose of 24-28 Gy in 2 Gy fractions. We used the newly developed motility limitation index to assess extraocular motility. Treatment was well tolerated. There have been no late complications. All 12 patients with soft tissue signs such as edema, irritation, tearing and pain were improved. Proptosis did not improve or improved only slightly, 3 mm at best. However, proptosis in all but two has been stabilized and has not deteriorated in the follow-up period. Most of the patients have experienced an improvement of eye-muscle motility. Extraocular muscles that work for elevation were impaired more severely than the other muscles and this tended to remain. Of the 16 patients using steroids before or when radiotherapy was initiated, 15 were tapered off and only one patient required additional steroids, thus sparing the majority from steroid adverse reactions. Radiotherapy was effective in preventing exacerbations of active inflammatory ophthalmopathy in patients with Graves` disease with minimal morbidity and thus eliminated the adverse reactions associated with protracted corticosteroid use. The newly developed motility limitation index was useful in detecting delicate changes in motility of individual extraocular muscles. (author)

  10. Metodología para la estimación del peligro sísmico con base en la teoría de vibraciones aleatorias

    Jesús Valdés González

    2008-01-01

    Full Text Available Se pretende mostrar la metodología a seguir para estimar el peligro sísmico en un sitio que cuenta con escasa información al respecto. Para ello se formulan y aplican dos planteamientos deterministas diferentes (teoría de vibraciones aleatorias y simulación de acelerogramas usando registros pequeños como funciones de Green empíricas por medio de los cuales es posible estimar el peligro sísmico que enfrenta el sitio que se estudia. En particular se analiza el caso de la ciudad de Toluca y se estudian dos grandes temblores, el primero corresponde al temblor del 19 de septiembre de 1985 (Ms= 8.1 cuya intensidad se considera la máxima registrada en dicha ciudad, el segundo evento se refiere a un temblor hipotético de magnitud Ms= 8.3 en la brecha de Guerrero. Adicionalmente se analizan otros dos tipos de temblores (falla normal y Acambay que pudiesen afectar el sitio en estudio. El peligro sísmico se valora en términos de los espectros de respuesta elásticos de los sismos analizados.

  11. Uso de plaguicidas en cultivos agrícolas como herramienta para el monitoreo de peligros en salud

    Virya Bravo Durán

    2013-03-01

    Full Text Available Costa Rica ha incrementado el uso de plaguicidas de mayor toxicidad, debido entre otras cosas al desarrollo de plagas más resistentes y la necesidad que tienen algunos productos agrícolas de exportación de mantener su posición en el mercado internacional. El ser humano al entrar en contacto con los plaguicidas puede experimentar efectos adversos en su salud desde agudos hasta crónicos que se manifiestan en diferentes grados. Para generar indicadores de peligro en salud en algunos cultivos por el uso de estas sustancias, se utilizaron la cantidad de plaguicidas aplicada y su toxicidad. Los datos de uso se recopilan directamente de los productores, a través de un cuestionario, los ingredientes activos identificados se caracterizaron por su toxicidad y se clasificaron por la manifestación de los efectos. Se calculó como indicador la cantidad de plaguicidas aplicada (kg ia/ha/año por las clases de toxicidad consideradas más peligrosas: 1. Efectos de toxicidad aguda en grado de alto a extremo y 2. Tres o más efectos crónicos positivos. Se recomienda vigilar el uso de bromuro de metilo, metam sodio, terbufos, etoprofos, endosulfan, MCPA y carbofuran por toxicidad aguda de alta a extrema y mancozeb, paraquat, diazinon, 2,4-D y carbofuran por efectos crónicos.  

  12. Concomitant Graves' disease and Hashimoto's thyroiditis, presenting as primary hypothyroidism.

    Cronin, C C

    2012-02-03

    Hypothyroidism in patients with Graves\\' disease is usually the result of ablative treatment. We describe a 58 year old man with Graves\\' ophthalmopathy and pre-tibial myxoedema, who presented with spontaneous primary hypothyroidism. Circulating TSH receptor antibody activity was increased, while thyroid microsomal antibody was detectable in titres greater than one in one hundred thousand. It is likely that the TSH receptor antibody of Graves\\' disease was ineffective in stimulating hyperthyroidism because of concomitant thyroid destruction due to Hashimoto\\'s disease. Alternatively, primary hypothyroidism could have resulted from the effects of a circulating TSH receptor blocking antibody.

  13. Graves' disease with special reference to radiation therapy

    Graves' disease, although not malignant, nevertheless can lead to serious events such as permanent loss of vision if it remains untreated. This review article describes the clinical symptoms of the disease, includes a commentary on the Graves' disease subgroup of thyroid-associated orbitipathy (TAO), and defines clinical activity scoring systems which grade the severity of the disease in patients (clinical activity, NOSPECS and LEMO scoring ). An review of radiotherapy in the 1980s is followed by a summary of the 2003 German national survey on radiotherapy for Graves' disease. Radiation therapy technique is then described and discussed. Case histories are from the Alfred Krupp Hospital in Essen. (author)

  14. Strategies of radioiodine therapy for Graves' disease

    Several therapeutic options are available for the treatment of Graves' disease (GD), including long-term antithyroid drug medication (ATD), near-total resection (NTR) and radioiodine therapy (RIT). These treatments are used with different frequencies depending on geographical location, size of the goitre, age of the patient and experience of the physician. It should be noted that RIT is still being applied more frequently in the United States than in Europe. Despite the fact that RIT was introduced as long ago as 1941, several questions are still the subject of debate: Should a fixed dose or a calculated dose be used. If the dose is calculated, how many Grays (Gy) should be delivered to the thyroid? What is the goal of RIT in GD? Which factors, including ATD, influence the outcome of RIT? Is RIT appropriate in GD with Graves' ophthalmopathy (GO)? Although not all these questions have been answered yet, conclusions can be derived regarding a general strategy for use of RIT in GD. As with surgery, the goal of RIT in GD is euthyroidism with or without L-thyroxine medication. There is a clear advantage of dose calculation over use of a fixed dose because the only factor influencing the outcome is the dose delivered to a certain thyroid volume. To minimise recurrent hyperthyroidism, an ablative approach using a delivered dose of 250 Gy is widely accepted. Beside pretherapeutic T3 levels, thyroid volume and 24-h thyroid uptake, ATD may influence the outcome of RIT. Today it is accepted by most thyroidologists that, if ATD medication is necessary in overt hyperthyroidism, it should be withdrawn at least 2 days before RIT. In patients with GD and GO, RIT may worsen GO. If RIT is performed in GO it should be done under a 3-month steroid medication regimen. In conclusion, RIT can be considered an appropriate and cost-effective therapy in GD, although the decision regarding treatment should be taken on an individual basis, paying due respect to the course and severity of

  15. Historic Sites and Grave Markers at Litttle Bighorn Battlefield, Montana

    National Park Service, Department of the Interior — This is a vector point file showing the historic sites and grave markers at Little Bighorn Battlefield National Monument (LIBI). The coordinates for this dataset...

  16. Paracentral Corneal Dellen:A Rare Sign of Graves Ophthalmopathy

    Jianhua Yan; Zhongyao Wu

    2003-01-01

    Purpose: To report a rare sign, paracentral corneal dellen that developed in a middleaged female patient with Graves ophthalmopathy.Methods:A paracentral corneal dellen developed in the left eye in a 42-year-old woman who was diagnosed as Graves ophthalmopathy. The patient had remarkable upper eyelid retraction, upper eyelid lag and upward motility restriction. The Graves ophthalmopathy was classified as Grade V according to NOSPECS classification.Results:Local artificial tear film and 0.3% Tobramycin eye drops were administered to both eyes.Twenty-four hours later, the left corneal dellen disappeared.Conclusions:Graves ophthalmopathy can lead to paracentral corneal dellen because of severe upper eyelid retraction and upward motility restriction of the eye in spite of the lack of lagophthalmos. Artificial tear drop and antibiotic eye drop therapy helped even though the patient did not have corneal exposure.

  17. Chronic idiopathic urticaria and Graves' disease.

    Ruggeri, R M; Imbesi, S; Saitta, S; Campennì, A; Cannavò, S; Trimarchi, F; Gangemi, S

    2013-01-01

    Chronic urticaria is a common condition characterized by recurrent episodes of mast cell-driven wheal and flare-type skin reactions lasting for more than 6 weeks. In about 75% of cases, the underlying causes remain unknown, and the term chronic idiopathic urticaria (CIU) is used to emphasize that wheals develop independently of identified external stimuli. Although CIU affects about 1.0% of the general population, its etiopathogenesis is not yet well understood. It is now widely accepted that in many cases CIU should be regarded as an autoimmune disorder caused by circulating and functionally active IgG autoantibodies specific for the IgE receptor (FceRI) present on mast cells and basophils or for IgE itself. The well-known association of CIU with other autoimmune processes/diseases represents further indirect evidence of its autoimmune origin. Autoimmune thyroid diseases, especially autoimmune thyroiditis, represent the most frequently investigated diseases in association with CIU. Here we review this topic with particular regard to the association between Graves' disease and CIU. The possible pathogenetic mechanisms and the clinical implications of such an association are discussed. PMID:23609949

  18. Miastenia grave distal: relato de caso

    Scola Rosana Herminia

    2003-01-01

    Full Text Available Relatamos o caso de uma mulher de 30 anos com quadro de fraqueza muscular nos membros inferiores com predomínio distal com início há 7 anos. Na evolução apresentou fraqueza muscular nos membros superiores. O exame físico mostrava nervos cranianos sem alterações, hipotrofia bilateral de quadriceps e interósseos dos pés, redução da força muscular mais intensa em tibiais anteriores e interósseos dorsais dos pés e reflexos tendinosos globalmente hipoativos. Foi realizado teste de estimulação repetitiva que mostrou decremento maior que 10% no nervo fibular e ulnar. A dosagem de anticorpos anti-receptor de acetilcolina foi positiva. Tomografia computadorizada de tórax foi normal. Dosagem de hormônios tireoidianos mostrou evidências laboratoriais de hipertireoidismo, porém sem manifestações clínicas. Foi iniciado tratamento com piridostigmina havendo melhora importante do quadro clínico. A fraqueza distal é um sintoma inicial raro na miastenia grave (MG. Contudo, a MG deve entrar no diagnóstico diferencial de doenças que cursam com fraqueza muscular distal de membros superiores ou inferiores.

  19. Delineation of graves using electrical resistivity tomography

    Nero, Callistus; Aning, Akwasi Acheampong; Danuor, Sylvester K.; Noye, Reginald M.

    2016-03-01

    A suspected old royal cemetery has been surveyed at the Kwame Nkrumah University of Science and Technology (KNUST) campus, Kumasi, Ghana using Electrical Resistivity Tomography (ERT) with the objective of detecting graves in order to make informed decisions with regard to the future use of the area. The survey was conducted on a 10,000 m2 area. Continuous Vertical Electrical Sounding (CVES) was combined with the roll along technique for 51 profiles with 1 m probe separation separated by 2 m. Inverted data results indicated wide resistivity variations ranging between 9.34 Ωm and 600 Ωm in the near surface. Such heterogeneity suggests a disturbance of the soil at this level. Both high (≥ 600 Ωm) and low resistivity (≤ 74.7 Ωm) anomalies, relative to background levels, were identified within the first 4 m of the subsurface. These were suspected to be burial tombs because of their rectangular geometries and resistivity contrasts. The results were validated with forward numerical modeling results. The study area is therefore an old cemetery and should be preserved as a cultural heritage site.

  20. Determinants of Extraocular Muscle Volume in Patients with Graves' Disease

    Samer El-Kaissi; Wall, Jack R

    2012-01-01

    Background. To examine factors contributing to extraocular muscle (EOM) volume enlargement in patients with Graves' hyperthyroidism. Methods. EOM volumes were measured with orbital magnetic resonance imaging (MRI) in 39 patients with recently diagnosed Graves' disease, and compared to EOM volumes of 13 normal volunteers. Thyroid function tests, uptake on thyroid scintigraphy, anti-TSH-receptor antibody positivity and other parameters were then evaluated in patients with EOM enlargement. Resul...

  1. Association of Alopecia Universalis, Generalized Vitiligo, and Graves' Disease

    Z Shahmoradi; Afshin Darougheh; S Misaghian

    2005-01-01

    We present a 21-years old woman with alopecia universalis, generalized vitiligo, and Graves' disease. She had had thyroidectomy in early childhood and was receiving replacement therapy with levothyroxine. The patient was treated with systemic PUVA and glucocorticoid in combination with topical treatment for alopecia. After 6 months of treatment, alopecia was reversed but vitiligo was unchanged. Key words: alopecia areata, vitiligo, Graves' disease, glucocorticoid , systemic PUVA therapy

  2. Hyperparathyroidism after radioactive iodine therapy for Graves disease

    Esselstyn, C.B. Jr.; Schumacher, O.P.; Eversman, J.; Sheeler, L.; Levy, W.J.

    1982-11-01

    The association of external ionizing radiation to the head and neck and the subsequent development of hyperfunctioning parathyroid glands has been documented in recent years. This also has been demonstrated experimentally in animals. Despite the numbers of patients with Graves disease who have been treated with radioactive iodine, there are no reports in the literature of parathyroid surgery for hyperparathyroidism secondary to earlier treatment with radioactive iodine for Graves disease. This report describes the operative and pathologic findings in four patients with hyperparathyroidism. These patients had previously been treated with radioactive iodine for Graves disease. The pathologic findings at surgery included in three cases a single enlarged hyperplastic gland consistent with a parathyroid adenoma. One patient had hyperplasia of all four glands. The two largest glands and halves of the two remaining glands were removed. In a long-term follow-up of children and adolescents treated with radioactive iodine for Graves disease, Levy and Schumacher found calcium elevations in 10 of 159 patients. The increased incidence of hyperparathyroidism following radioactive iodine treatment for Graves disease in children and adolescents would seem several times higher than normal. Whether adults who have radioactive iodine treatment for Graves disease have a similar increase incidence is not known. Meanwhile it would seem reasonable to suggest that patients whose hyperthyroidism is treated with radioactive iodine should have their serum calcium levels determined at 5-year intervals.

  3. Relationship between the management of Graves' disease and the course of Graves' ophthalmopathy: a systematic review

    Objective: To perform literature search and review on the controversial relationship between therapies of hyperthyroidism due to Graves' disease (GD) and the course of Graves' ophthalmopathy (GO). Methods: We searched the database of MEDLINE (1966-2006.3), EMBASE (1984-2005), Cochrane Library(2006 No. 1), CBMdisc (1978.1-2006.4) and CNKI (1994-2006). The methodological quality of the studies selected for review was assessed according to the quality assessment criteria suggested by the Cochrane systematic review guideline. Meta-analysis was performed by RevMan 4.2 software. Results: Eight studies were included in the systematic review. Meta-analysis showed that there was statistically significant difference between mi and other forms of therapy [surgery or antithyroid drugs (ATD)] (test value: 2.31, 5.97, 3.70, 5.55; all P0.05). There were not yet any studies on the impact between early prevention of hypothyroidism after mi therapy and GO. Conclusions: Based on meta-analysis on literature data, if early measures are not performed to prevent hypothyroidism after mi therapy, it may induce or aggravate GO more frequently than ATD or surgical treatment. Symptomatic relief of GO after 131I therapy is also less effective than the other 2 forms of therapy. Therefore, 131I therapy should be delivered carefully in those patients with GO. (authors)

  4. Importación de plaguicidas y peligros en salud en América Central durante el periodo 2005 - 2009

    Virya Bravo-Durán; Silvia Elena Berrocal-Montero; Fernando Ramírez-Muñoz; Elba de la Cruz-Malavassi; Nonato Canto-Mai; Anabel Tatis-Ramírez; Winston Mejía-Merino; Teresa Rodríguez-Altamirano

    2015-01-01

    Se analizaron datos de importación de plaguicidas agrícolas en América Central, para el quinquenio 2005-2009 para el monitoreo de peligros en salud. La metodología usada ya fue publicada para el análisis del quinquenio 2000-2004 (Bravo et al., 2011). Durante este segundo quinquenio, se importaron 353 ingredientes activos (ia), en una cantidad promedio anual de 39 000 ton ia. Catorce ia se importaron en cantidades ≥ 2 000 ton ia y representaron el 77% de la importación. Las acciones biocidas m...

  5. Epidemiological survey of graves' disease in Tianjin area

    Objective: To study the incidence of Graves' disease and associated factors. Methods: From 1997.4 to 1999.12, by using cluster and stratified sampling, total of 31530 people aged 6 years and over were surveyed epidemiologically for Graves' disease in five districts and one county of Tianjin area where the study subjects had been resided for at least one year. The researching team consisted of endocrinologists, epidemiologists and technicians and was divided into three branches, they served as investigators, professional experts and technicians, respectively. The serum thyroid hormones, thyroid antibodies, iodine in table salt, urine iodine and B-US were examined for the suspected cases, the final diagnoses were concluded by the professional experts. Results: Eighty-nine patients with Graves' disease were confirmed, 26 (0.166%) of them were males and 63(0.397%) of them were females, the total incidence was 0.282%. The incidence significantly associated with sex (female higher than male, P<0.001), age (50-60 group for male and 30-40 group for female higher than others, P<0.001) and family history (the patients with vs without family history, P<0.001). The survey showed an ascending trend of incidence of Graves' disease, along with decreasing of goiter rate and increasing of iodine contents in table salt and in urine. Further research work should be pursued. Conclusion: This study may provide some theoretical basis for prevention and treatment of Graves' disease

  6. Significance of changes of serum TPOAb and TRAb levels in patients with Graves' disease (GD)

    Objective: To investigate the significance of changes of serum TPOAb and TRAb levels in patients with Graves' dis- ease (GD). Methods: Serum TPOAb (with RIA) and TRAb (with RRA) levels were determined in 27 patients with Graves' disease, before treatment 10 patients with Graves' disease clinically cured and 35 controls. Results: The serum levels and positive rates of TPOAb and TRAb in patients with Graves' disease before treatment were significantly higher than those in the patients with Graves' disease clinically cured and controls (P<0.01). Conclusion: TPOAb and TRAb were involved in the pathogenesis of Graves' dis- ease and could be used as diagnostic and treatment indicators. (authors)

  7. Guía para la selección y aplicación de las técnicas de PHA (análisis de peligros de procesos)

    Puerta, Fernando Alonso de la

    2007-01-01

    En los últimos años están adquiriendo una gran relevancia los estudios y las técnicas que permiten la identificación, evaluación y control de los peligros que pueden aparecer en la industria química de procesos y nuclear. Dichas técnicas reciben el nombre de técnicas PHA (Process Hazad Analysis o análisis de los peligros de los procesos) y su aplicación permite prevenir los accidentes que pueden suceder en las instalaciones industriales y asegurar la productividad de las mismas. La numeros...

  8. A case of severe autoimmune hepatitis associated with Graves' disease

    Samia Abdulla Bokhari

    2016-01-01

    Full Text Available Graves' disease is a common condition and is known to have a wide range of effects on a variety of organs. Hepatic dysfunction ranging from mild to severe due to direct effect of high circulating thyroid hormones as well as a deleterious effect of antithyroid medications (methimazole and propylthiouracil has been well - documented in literature. However, severe autoimmune hepatitis (AIH associated with Graves' disease is rare and limited to few case reports only. A 38-year-old woman presented with abdominal pain and yellowish discolouration of conjunctivae. On investigation, she was found to have Graves' disease and AIH. The liver histopathology showed typical features of AIH. She responded excellently to glucocorticoid therapy with normalisation of thyroid function and liver histology. The case is discussed with relevant literature review.

  9. Graves' Disease Pharmacotherapy in Women of Reproductive Age.

    Prunty, Jeremy J; Heise, Crystal D; Chaffin, David G

    2016-01-01

    Graves' disease is an autoimmune disorder in which inappropriate stimulation of the thyroid gland results in unregulated secretion of thyroid hormones resulting in hyperthyroidism. Graves' disease is the most common cause of autoimmune hyperthyroidism during pregnancy. Treatment options for Graves' disease include thioamide therapy, partial or total thyroidectomy, and radioactive iodine. In this article, we review guideline recommendations for Graves' disease treatment in women of reproductive age including the recent guideline from the American College of Obstetricians and Gynecologists. Controversy regarding appropriate thioamide therapy before, during, and after pregnancy is reviewed. Surgical and radioactive iodine therapy considerations in this patient population are also reviewed. In patients who may find themselves pregnant during therapy or develop Graves' disease during their pregnancy, consideration should be given to the most appropriate treatment course for the mother and fetus. Thioamide therapy should be used with either propylthiouracil or methimazole at appropriate doses that target the upper range of normal to slightly hyperthyroid to avoid creating hypothyroidism in the fetus. Consideration should also be given to the adverse effects of thioamide, such as agranulocytosis and hepatotoxicity, with appropriate patient consultation regarding signs and symptoms. Individuals who wish to breastfeed their infants while taking thioamide should receive the lowest effective dose. Surgery should be reserved for extreme cases and limited to the second trimester, if possible. Radioactive iodine therapy may be used in nonpregnant individuals, with limited harm to future fertility. Radioactive iodine therapy should be withheld in pregnant women and those who are actively breastfeeding. Clinicians should keep abreast of developments in clinical trials and evidence-based recommendations regarding Graves' disease in reproductive-age women for any changes in evidence

  10. TSH Anti-Receptor Antibodies in Graves' Disease

    Sérgio, M.; Godinho, C; Guerra, L; Agapito, A; Fonseca, F.; Costa, C.

    1996-01-01

    Neste trabalho os AA avaliam a sensibilidade, especificidade e valor predictivo do doseamen to dos anticorpos anti-receptor da TSH (TRAb) no diagnóstico da doença de Graves. A população estudada incluiu 80 doentes com doença de Graves recentemente diagnosticada e sem tratamento prévio (grupo 1), 63 doentes com outras patologias tiroideias (grupo II) e 60 indivíduos sem patologia tiroideia (grupo III). Utilizaram uma técnica de radioreceptor, o kit TRAK Henning, que considera positividad...

  11. Robert Graves y Mallorca: su narrativa breve mallorquina

    Segui Aznar, Juana Mª

    2005-01-01

    Aquest treball d'investigació explora i analitza divuit narracions curtes de Robert Graves publicades al llarg dels anys 1947 a 1962. Està dirigit a establir la relació entre Graves i Mallorca mitjançant els elements autobiogràfics i locals que es poden trobar en les narracions. La idiosincràsia de l'illa queda reflectida en la descripció i comportament dels personatges, en els aspectes socials, polítics, culturals i lingüístics, i en l'escenari espaciotemporal d'aquestes narracions; tots aqu...

  12. Messiniense: compleja y grave crisis ecologica

    Aguirre, E.

    2003-08-01

    yacimientos de mamíferos fósiles en España y otras regiones con importantes novedades, entre ellas diversos intercambios intercontinentales, en el mismo intervalo cronológico añaden cuestiones de interés además de obligar a la correlación entre la estratigrafía basada en series marinas y la biostratigrafía continental. A las singularidades de estas series se añade el descubrimiento reciente de homínidos fósiles con indicios de bipedia en edades comprendidas en este intervalo. En el mismo se han datado graves eventos paleogeográficos, geodinámicos, paleoambientales y paleoclimáticos, que empezaron a investigarse hace 40 años como la «Crisis de Salinidad del Mediterráneo*, y sobre cuyo desarrollo e interacciones se han publicado diversos modelos más o menos incompletos: aislamiento del mediterráneo, descenso global del nivel del mar, acreción continental y orogenia, glaciación, deterioro de la cubierta vegetal. Una interpretación de la secuencia de eventos en estos diversos campos de estudio de Historia de la Tierra y de la Vida, y sus interacciones, puede trazarse con una calibración del orden de los cien mil años.

  13. Auto-estima na forma inativa da oftalmopatia de Graves Inactive Graves' ophthalmopathy and self-esteem

    Carlos Henrique de Toledo Magalhães

    2008-04-01

    Full Text Available OBJETIVOS: Avaliar a auto-estima dos pacientes com oftalmopatia de Graves na fase inativa. MÉTODOS: Foram avaliados 30 pacientes portadores de oftalmopatia de Graves, eutireoideanos, na fase inativa, com idade variando entre 26 e 65 anos, média 43 ± 11,0 anos, denominado grupo estudo e 39 indivíduos que não apresentavam oftalmopatia de Graves, com idade variando entre 18 e 67 anos, média de 41 ± 13,4 anos, selecionados na população geral denominado grupo controle. Para avaliar a auto-estima foi utilizada a escala de auto-estima Rosenberg Unifesp-EPM aplicada por meio de entrevista. Os valores dos escores de auto-estima nos dois grupos estudados foram comparados pelo teste não paramétrico de Mann-Whitney. O mesmo teste foi aplicado com objetivo de comparar os resultados obtidos no grupo oftalmopatia de Graves considerando a gravidade da doença. RESULTADOS: Não foi observada alteração com significância estatística na auto-estima dos pacientes com oftalmopatia de Graves (p=0,057. O grupo estudo apresentou, em média, valores inferiores de auto-estima, comparado ao grupo controle. Não houve diferença da auto-estima entre os pacientes dos subgrupos leve e moderado-grave (P=0,2710. CONCLUSÃO: A oftalmopatia de Graves na fase inativa não afetou a auto-estima dos pacientes, no grupo estudado.PURPOSE: To assess the self-esteem of Graves' ophthalmopathy patients in the inactive phase. METHODS: Thirty euthyroid patients were evaluated in the inactive phase of disease with age ranging from 26 to 65 years, average of 43 ± 11,0 years, called study group and 39 individuals without Graves' ophthalmopathy with age ranging from 18 to 67 years, average of 41 ± 13,4 years, selected from the general population called control group. To evaluate the self-esteem the Rosenberg UNIFESP/EPM self-esteem scale, applied by means of an interview, was utilized. The self-esteem scores in the two studied groups were compared by means of the non

  14. 77 FR 65406 - Native American Graves Protection and Repatriation Review Committee: Notice of Nomination...

    2012-10-26

    ... National Park Service Native American Graves Protection and Repatriation Review Committee: Notice of.... SUMMARY: The National Park Service is soliciting nominations for one member of the Native American Graves... nominations submitted by Indian tribes, Native Hawaiian organizations, and traditional Native...

  15. Demerara [i.e. Demerara-Mahaica]. Orinoco Indian's Grave

    Unknown

    2004-01-01

    171 x 235 mm. A view showing an Indian grave in a forest clearing. The corpse has been wrapped in palm leaves and tied onto a crude wooden trestle. The wrapped corpses of three more Indians can be seen in the background. Photograph taken during the 1880's.

  16. Diagnosis and management of Graves disease: a global overview.

    Bartalena, Luigi

    2013-12-01

    Graves disease is an autoimmune disorder characterized by goitre, hyperthyroidism and, in 25% of patients, Graves ophthalmopathy. The hyperthyroidism is caused by thyroid hypertrophy and stimulation of function, resulting from interaction of anti-TSH-receptor antibodies (TRAb) with the TSH receptor on thyroid follicular cells. Measurements of serum levels of TRAb and thyroid ultrasonography represent the most important diagnostic tests for Graves disease. Management of the condition currently relies on antithyroid drugs, which mainly inhibit thyroid hormone synthesis, or ablative treatments ((131)I-radiotherapy or thyroidectomy) that remove or decrease thyroid tissue. None of these treatments targets the disease process, and patients with treated Graves disease consequently experience either a high rate of recurrence, if receiving antithyroid drugs, or lifelong hypothyroidism, after ablative therapy. Geographical differences in the use of these therapies exist, partially owing to the availability of skilled thyroid surgeons and suitable nuclear medicine units. Novel agents that might act on the disease process are currently under evaluation in preclinical or clinical studies, but evidence of their efficacy and safety is lacking. PMID:24126481

  17. Treatment of Graves' hyperthyroidism: evidence-based and emerging modalities

    Hegedüs, Laszlo

    2009-01-01

    Currently there are three well-established treatment options for hyperthyroid Graves' disease (GD): antithyroid drug therapy with thionamides (ATD), radioactive iodine treatment with (131)I, and thyroid surgery. This article reviews the current evidence so the reader can evaluate advantages and...

  18. 78 FR 21410 - Native American Graves Protection and Repatriation Review Committee: Meetings

    2013-04-10

    ... National Park Service Native American Graves Protection and Repatriation Review Committee: Meetings AGENCY... Federal Advisory Committee Act, 5 U.S.C. Appendix (1988), of two meetings of the Native American Graves... Advisory Committee Act, 5 U.S.C. Appendix (1988), of two meetings of the Native American Graves...

  19. 77 FR 65407 - Native American Graves Protection and Repatriation Review Committee: Notice of Nomination...

    2012-10-26

    ... National Park Service Native American Graves Protection and Repatriation Review Committee: Notice of.... SUMMARY: The National Park Service is soliciting nominations for one member of the Native American Graves... Review Committee was established by the Native American Graves Protection and Repatriation Act of...

  20. El mapa, los mapas. Propuestas metodológicas para abordar la pluralidad y la inestabilidad de la imagen cartográfica

    Carla Lois

    2015-06-01

    Full Text Available En tanto “mapa” es toda “representación gráfica que facilita el conocimiento espacial de cosas, conceptos, condiciones, procesos o eventos que conciernen al mundo humano”, el término “mapa” refiere a muchas imágenes muy diferentes, que usan diversas técnicas y soportes, apelan a lenguajes visuales muy heterogéneos, convenciones gráficas que han variado a lo largo del tiempo, etcétera. Este trabajo propone dos categorías metodológicas para abordar la pluralidad de la imagen cartográfica sin renunciar a esa definición amplia e inclusiva. La primera es la noción de género cartográfico, que permite agrupar y clasificar mapas que comparten claves temáticas, estilísticas, técnicas y/o composicionales. La segunda es la noción de serie, porque el armado de una serie crea claves de lectura y de interpretación y, consecuentemente, un mismo mapa no comunica lo mismo en dos series diferentes. Con ejemplos se discutirán las potencialidades y las limitaciones de estas propuestas metodológicas

  1. Planificación de la comunicación las instituciones educativas de Argentina: una propuesta para abordar los conflictos de convivencia

    Lic. Paula Morales

    2000-01-01

    Full Text Available A partir de una aproximación diagnóstica al problema de los conflictos de convivencia realizada con la participación de más de 50 instituciones educativas de la enseñanza general básica de la ciudad de La Plata (Buenos Aires analizamos los sentidos con que los docentes construyen esta problemática. En el marco de una creciente polarización social que afecta a Argentina y que incide fuertemente en los sectores medios y bajos las instituciones educativas se han convertido en uno de los espacios más importantes de emergencia de los conflictos sociales. El trabajo de diagnóstico y las propuestas realizadas surgen a partir de una demanda específica de las autoridades educativas a la carrera de Comunicación Social de la Universidad Nacional de La Plata. Las reflexiones teóricas y otras experiencias realizadas en el Centro de Comunicación y Educación de esa facultad permitieron abordar la conflictiva del incremento de situaciones de violencia en las escuelas desde una perspectiva comunicacional.

  2. Peligro sísmico, exposición y vulnerabilidad de las Villas Vieja y Nueva de Trancas, Tucumán, Argentina

    García Alicia Irene

    2010-01-01

    Las Villas Vieja y Nueva de Trancas, situadas en la cuenca tectónica de Tapia-Trancas, están emplazadas sobre la zona epicentral del terremoto que destruyó a la antigua villa en 1826. El objetivo es estudiar el riesgo sísmico que presentan las villas como sumatoria del peligro sísmico natural más la vulnerabilidad de su población frente a la ocurrencia potencial de otro sismo destructivo. Se recurrió al análisis bibliográfico documental, de estadísticas demográfico-económicas, de técnicas de ...

  3. Importación de plaguicidas y peligros en salud en América Central durante el periodo 2005 - 2009

    Virya Bravo-Durán

    2015-07-01

    Full Text Available Se analizaron datos de importación de plaguicidas agrícolas en América Central, para el quinquenio 2005-2009 para el monitoreo de peligros en salud. La metodología usada ya fue publicada para el análisis del quinquenio 2000-2004 (Bravo et al., 2011. Durante este segundo quinquenio, se importaron 353 ingredientes activos (ia, en una cantidad promedio anual de 39 000 ton ia. Catorce ia se importaron en cantidades ≥ 2 000 ton ia y representaron el 77% de la importación. Las acciones biocidas más usadas fueron los fungicidas y los herbicidas. En estas acciones, los grupos químicos más importados fueron los ditiocarbamatos y los fenoxiácidos, las fosfonoglicinas y los bipiridilos, respectivamente. La cantidad importada de plaguicidas peligrosos correspondió en un 27% a ia con toxicidad aguda alta a extrema, 35% con 2 o más efectos tópicos de moderados a severos y 47% con 4 o más efectos crónicos. Los plaguicidas regulados internacionalmente corresponden al 19% del total importado. Guatemala fue el país que más plaguicidas importó y Costa Rica continuó liderando indicadores como: kg i.a./habitante, kg i.a./habitante rural, kg ia/trabajador agrícola, kg ia/ha agrícola. Los datos indicaron que las poblaciones en América Central continúan expuestas a peligros de salud por los plaguicidas importados.

  4. The clinical value of serum thyrotrophin receptor antibody level in patients with Graves ophthalmopathy

    Objective: To explore the value of serum thyrotrophin receptor antibody (TRAb) on the pathological mechanism of Graves ophthalmopathy. Methods: Two hundred and nineteen newly diagnosed Graves disease patients who were divided into Graves ophthalmopathy group (n=121) and without Graves ophthalmopathy group (n=98) were tested serum concentration with thyroid function, thyroperoxidase antibodies (TPOAb), thyroglobulin antibodies (TgAb) and TRAb. According to the consensus statement of the European Group on Graves ophthalmopathy, clinical activity score (CAS) and severity evaluation were carried out on Graves ophthalmopathy patients. Results: There was no significant difference in serum concentration of free thyroxine (FT4), free triiodothyronine (FT3), TPOAb and TRAb between the Graves ophthalmopathy group and the without Graves ophthalmopathy group. Serum concentration of TRAb was not correlated with the severity and CAS of Graves ophthalmopathy. Conclusions: The CAS and the severity of Graves ophthalmopathy were irrelevant to the serum concentration of TRAb. Therefore, the correlation between TRAb and Graves ophthalmopathy still needs further study. (authors)

  5. Habitat Evaluation Procedures Report; Graves Property - Yakama Nation.

    Ashley, Paul; Muse, Anthony

    2008-02-01

    A habitat evaluation procedures (HEP) analysis was conducted on the Graves property (140 acres) in June 2007 to determine the number of habitat units to credit Bonneville Power Administration (BPA) for providing funds to acquire the property as partial mitigation for habitat losses associated with construction of McNary Dam. HEP surveys also documented the general ecological condition of the property. The Graves property was significantly damaged from past/present livestock grazing practices. Baseline HEP surveys generated 284.28 habitat units (HUs) or 2.03 HUs per acre. Of these, 275.50 HUs were associated with the shrubsteppe/grassland cover type while 8.78 HUs were tied to the riparian shrub cover type.

  6. Clinical efficacy of Yingliu treatment for Graves disease

    Yang, Hua; Bi, Xiaojuan; Tang, Hong; Zeng, Juanhua; Cong, Yilei; Wu, Tengfei; Chen, Qiuye

    2015-01-01

    Objective: To observe the clinical efficacy and safety of the traditional Chinese medicine (TCM) mixture Yingliu combined with methimazole medication for the treatment of Graves disease (GD). Method: In a randomized, paralleled control study, 92 GD patients were randomized into a Yingliu mixture treatment and a control treatment group, both receiving methimazole. Both treatments lasted for 12 weeks and outcome parameter were thyroid function, thyroid autoantibodies, TCM symptome scores and sa...

  7. Graves' disease: A comparison of CT and orthoptic findings

    The correlation between the loss of function of the extrinsic rectus eyemuscles and their appearance on computed tomography images in patients with Graves' disease was examined. Pathologic changes of a single rectus eyemuscle normally blockade the movement of the corresponding antagonistic muscle. This is caused by the impossibility to relax due to fibrotic alterations. Nevertheless there are some hints, which indicate, that in some cases, especially concerning the lateral rectus muscle, the inherent function of the thickened muscle is restricted. (orig.)

  8. Does radioiodine cause the ophthalmopathy of Graves' disease?

    This editorial briefly reviews studies which might answer the question as to whether radioiodine treatment causes the ophthalmopathy of Graves' disease. However, the data do not allow any conclusion one way or the other. Other possible causal factors are discussed. Further studies are required to define whether treatment of hyperthyroidism aggravates the ophthalmopathy and whether one thereby is worse than the others and by how much. (UK)

  9. Psychosomatic concept of hyperthyroidism - Graves type: Behavioral and biochemical characteristics

    Draganić-Gajić Saveta

    2008-01-01

    Full Text Available Introduction. In this study we test the hypothesis that specific behavioral and biochemical vulnerabilities characterize individuals with hyperthyroidism - Graves type, one of the classically cited 'psychosomatic disorders'. Material and methods. The sample included 24 subjects with Graves disease and 34 controls. All participants were evaluated for personality and temperament characteristics and for platelet MAO activity. A smaller group of panic disorder patients was tested with the same set of measures to ensure a validity of the study, especially regarding results on personality tests. RESULTS. Individuals with hyperthyroidism had lower platelet MAO activity and higher scores on histrionic (Hy, depressive (D and hypochondriac (H subscale on the MMPI-201 than normal controls. Their TPQ temperament scores were characterized by high Harm Avoidance, whereas other temperament traits were average. Platelet MAO activity was inversely correlated with the MMPI-201 psychopatic deviance scale (Pd and positively correlated with the TPQ Reward Dependence scale. CONCLUSIONS. Our results provide support for the psychosomatic concept of Graves' disease. Personality features, temperament traits, and platelet MAO activity of hyperthyroid individuals are different from those in normal controls and correspond to those observed in anxiety disorders. We propose that the observed behavioral and biochemical similaritites between hyperthyroid and anxiety disorder patients represent an equicausality phenomenon, where the same underlying heritable factors, such as variable central monoaminergic activity coupled with temperament-related susceptibility to stress, facilitate phenotypic manifestation of a number of psychosomatic and psychiatric disorders - including Graves disease. The observed correlations between personality traits and MAO activity provide support for the hypothesized functional relationship between the underlying central monoaminergic activity and

  10. Anti-thyroid drugs in pediatric Graves' disease.

    John, Mathew; Sundrarajan, Rajasree; Gomadam, S Sridhar

    2015-01-01

    Graves' disease is the most common cause of hyperthyroidism in children. Most children and adolescents are treated with anti-thyroid drugs as the initial modality. Studies have used Methimazole, Carbimazole and Propylthiouracil (PTU) either as titration regimes or as block and replacement regimes. The various studies of anti-thyroid drug (ATD) treatment of Graves' disease in pediatric patients differ in terms of the regimes, remission rate, duration of therapy for adequate remission, follow up and adverse effects of ATD. Various studies show that lower thyroid hormone levels, prolonged duration of treatment, lower levels of TSH receptor antibodies, smaller goiter and increased age of child predicted higher chance of remission after ATD. A variable number of patients experience minor and major adverse effects limiting initial and long term treatment with ATD. The adverse effects of various ATD seem to more in children compared to that of adults. In view of liver injury including hepatocellular failure need of liver transplantation associated with PTU, the use has been restricted in children. The rate of persistent remission with ATD following discontinuation is about 30%. Radioactive iodine therapy is gaining more acceptance in older children with Graves's disease in view of the limitations of ATD. For individual patients, risk-benefit ratio of ATD should be weighed against benefits of radioactive iodine therapy and patient preferences. PMID:25932387

  11. [Radioiodine therapy for Graves' disease: problems and new developments].

    Reiners, Christoph

    2004-05-01

    In Germany, patients with Graves' disease are usually treated with radioiodine after unsuccessful antithyroid drug medication, occurrence of side effects from antithyroid drugs or an increased risk from surgery. In patients with normal or only slightly enlarged thyroid glands (volume TSH-receptor antibodies and cigarette smoking. Children are still rarely treated with radioiodine in Germany. In contrast, treatment with radioiodine should be more liberally applied in elderly patients with subclinical hyperthyroidism and cardiac symptoms. Individual dosimetry to determine the therapeutic activity is mandatory in Germany. Patients with large goitres obviously need higher organ doses than patients with smaller goitres or normal thyroid glands. Antithyroid drug treatment may interfere with radioiodine therapy. Therefore, it is recommendable to withdraw antithyroid drugs several days before treatment with radioiodine is initiated (and a preceding radioiodine uptake test is performed). In patients with Graves' orbitopathy prophylaxis with corticosteroids can prevent the worsening of symptoms that may be induced by radioiodine treatment. Currently, a risk adapted procedure is recommended according to which prophylactic medication with corticosteroids before applying radioiodine treatment is not necessary in patients with symptoms of orbitopathy and lack of other risk factors (cigarette smoking, in particular). Present results suggest that the risks of radioiodine treatment in Graves' disease patients are very low, while at the same time the cost-effectiveness of this treatment regimen is high. PMID:15255314

  12. Hyperparathyroidism after radioactive iodine therapy for Graves' disease

    Herein we report a 36-year-old man with hyperparathyroidism and a past history of internal irradiation to the thyroid. Twelve years previously at age 24 years he had received 8 mCi of radioactive iodine for Graves' disease. An additional dose of 4 mCi was required 3 years later. A right lower parathyroid adenoma (28 x 23 x 20 mm, 5.7 g) was found at neck exploration. Although the association of external ionizing radiation to the head and neck and the subsequent development of hyperfunctioning parathyroid glands has been described in recent years, there are only 4 cases in the literature of parathyroid surgery for hyperparathyroidism secondary to earlier treatment with radioactive iodine for Graves' disease. In a long-term follow-up of 180 patients treated with radioactive iodine for Graves' disease, neither hypercalcemia nor hypophosphatemia was found. Whether internal radiation therapy can be a causative factor in the development of hyperparathyroidism should be elucidated in future. However, it seems reasonable to suggest that patients whose hyper-thyroidism has been treated with radioactive iodine should have their scrum calcium levels examined at 5-year intervals. (author)

  13. Grave pit modifications and wooden structures in the Great Moravian graves and their information potential for cognition of the social structure of the Great Moravian society

    Mazuch, Marian; Hladík, Marek

    2013-01-01

    Roč. 54, č. 2 (2013), s. 45-55. ISSN 1211-7250 R&D Projects: GA ČR GP13-20936P Keywords : Early Middle Ages * Great Moravia * Mikulčice * burial sites * graves * grave pits * burial pits * wooden structures * funeral rite * social structure * GIS * statistics Subject RIV: AC - Archeology, Anthropology, Ethnology

  14. Enhanced thyroid iodine metabolism in patients with triiodothyronine-predominant Graves' disease

    Some patients with hyperthyroid Graves' disease have increased serum T3 and normal or even low serum T4 levels during treatment with antithyroid drugs. These patients with elevated serum T3 to T4 ratios rarely have a remission of their hyperthyroidism. The aim of this study was to investigate thyroid iodine metabolism in such patients, whom we termed T3-predominant Graves' disease. Mean thyroid radioactive iodine uptake was 51.0 +/- 18.1% ( +/- SD) at 3 h, and it decreased to 38.9 +/- 20.1% at 24 h in 31 patients with T3-predominant Graves' disease during treatment. It was 20.0 +/- 11.4% at 3 h and increased to 31.9 +/- 16.0% at 24 h in 17 other patients with hyperthyroid Graves' disease who had normal serum T3 and T4 levels and a normal serum T3 to T4 ratio during treatment (control Graves' disease). The activity of serum TSH receptor antibodies was significantly higher in the patients with T3-predominant Graves' disease than in control Graves' disease patients. From in vitro studies of thyroid tissue obtained at surgery, both thyroglobulin content and iodine content in thyroglobulin were significantly lower in patients with T3-predominant Graves' disease than in the control Graves' disease patients. Thyroid peroxidase (TPO) activity determined by a guaiacol assay was 0.411 +/- 0.212 g.u./mg protein in the T3-predominant Graves' disease patients, significantly higher than that in the control Graves' disease patients. Serum TPO autoantibody levels determined by immunoprecipitation also were greater in T3-predominant Graves' disease patients than in control Graves' disease patients. Binding of this antibody to TPO slightly inhibited the enzyme activity of TPO, but this effect of the antibody was similar in the two groups of patients

  15. Análisis de los principales peligros naturales y antrópicos que inciden en el turismo del sector Bahía de Vita-Bahía

    Licea Sánchez José Enrique

    2008-12-01

    Full Text Available La subregión turística del Litoral Norte de Holguín, y en particular el sector entre las bahías de Vita y Samá, es uno de los destinos más importantes para el desarrollo del turismo internacional en Cuba. En el presente artículo se hace un análisis de los principales peligros naturales y antrópicos que inciden en la actividad turística del sector de estudio, los cuales fueron caracterizados y sintetizados utilizando como herramienta los Sistemas de Información Geográfica (SiG.Se obtiene como resultado el mapa de superposición de peligros a los que se encuentra expuesta la actividad.

  16. Multiple Fractures in Patient with Graves' Disease Accompanied by Isolated Hypogonadotropic Hypogonadism

    Yi, Hyon-Seung; Kim, Ji Min; Ju, Sang Hyeon; Lee, Younghak; Kim, Hyun Jin; Kim, Koon Soon

    2016-01-01

    Isolated hypogonadotropic hypogonadism (IHH) is known to decrease bone mineral density due to deficiency of sex steroid hormone. Graves' disease is also an important cause of secondary osteoporosis. However, IHH does not preclude the development of primary hyperthyroidism caused by Graves' disease, leading to more severe osteoporosis rapidly. Here, we describe the first case of 35-year-old Asian female patient with IHH accompanied by Graves' disease and osteoporosis-induced multiple fractures...

  17. Whodunnit? Grave-robbery in early medieval northern and western Europe

    Klevn?s, Alison Margaret

    2011-01-01

    This thesis brings together all that is currently known of early medieval grave reopening in northern and western Europe. It investigates in detail an intensive outbreak of grave-robbery in 6th-7th century Kent. This is closely related to the same phenomenon in Merovingia: an example of the import of not only material goods but also a distinctive cultural practice. Limited numbers of similar robbing episodes, affecting a much smaller proportion of graves in each cemetery, are also identified ...

  18. Comparison of Fixed versus Calculated Activity of Radioiodine for the Treatment of Graves Disease in Adults

    Canto, Abigail U.; Dominguez, Paulette N.; Jimeno, Cecilia A.; Obaldo, Jerry M.; Ogbac, Ruben V.

    2016-01-01

    Background Radioactive iodine as a treatment modality has been shown in several studies to be a safe and effective therapy for Graves disease. However, there is still no uniformity regarding optimal dosing method. The aim of this study is to compare the efficacy of calculated and fixed dosing of radioiodine for the treatment of Graves disease. Methods A hundred twenty-two patients diagnosed with Graves disease were randomized to receive either fixed or calculated dose of radioiodine. Those ra...

  19. The Grave Types Seen In Antandros Necropolis In The Hellenistic Period

    Kahraman YAĞIZ

    2009-06-01

    Full Text Available In this article, the Hellenistic graves uncovered in the excavations of Antandros Necropolis between the years of 2001-2008 have been assessed in general. Forty three cremations, 25 tile-graves, 20 simple inhumations, five graves with altar, five sarcophagi, two circle shaped graves and one amphora grave were determined as seven different types of burials during this period. Cremation ranked first among the burial types seen in the Hellenistic period. The increase in the number of the cremations may be due to Alexander the Great’s arriving in the Asia Minor and the changes in the demographic structure. According to their frequencies, roof tile graves and simple inhumations were the second and inhumations were preferred by the individuals with low incoming. The graves with altar and circle shaped graves were the most remarkable ones in this period. Sarcophagi were appeared as the favorite type in Classical period for adults in early Hellenistic Period. The amphora grave, which was for fetuses or new-born babies was represented with only one sample in this period.

  20. Characterization of radioiodine therapy failures in Graves' disease

    Aim of this study was a characterization of radioiodine therapy (RIT) failures in Graves' disease without simultaneous carbimazole. Method: 226 patients with a confirmed diagnosis of Graves' disease received 686.8 ± 376.4 MBq of iodine-131 orally for thyroid ablation. Target dose was 250 Gy. All patients were followed up for 6 months. Therapy failures were compared with successes regarding possible influencing variables initial thyroid volume, thyroid function, immune activity (TRAb), I-131 uptake, effective half-life, absorbed energy dose, age and gender. Results: 212 of 226 patients (93.8%) were treated successfully, 14 (6.2%) showed a hyperthyroidism relapse within 6 months which required a second radioiodine therapy. A success rate of 92.5% (62/67) could also be achieved with 67 patients who were hyperthyroid at the time of RIT. Compared to the therapy successes, the 14 failures achieved significantly lower absorbed doses (223.8 ± 76.6 Gy vs. 285.2 ± 82.1 Gy, p 0.2). Of the 14 failures, n = 8 reached an absorbed dose 250 Gy. Stepwise logistic regression revealed only absorbed energy dose as a variable significantly influencing therapy success (p 0.2) or gender (p = 0.13). Two-tailed Fisher's exact test showed no significant influence of gender on success rates (failures/successes: male 1/36, female 13/176, p = 0.48). Conclusions: Except for the absorbed energy dose, no other significant variable influencing the outcome of radioiodine therapy in Graves' disease without simultaneous carbimazole could be found. It should be noted, though, that 5 therapy failures (2.2%) reached an absorbed energy dose of >250 Gy. (orig.)

  1. Radioiodine thyroid ablation in graves' hyperthyroidism: merits and pitfalls.

    Nwatsock, J F; Taieb, D; Tessonnier, L; Mancini, J; Dong-A-Zok, F; Mundler, O

    2012-01-01

    Ablative approaches using radioiodine are increasingly proposed for the treatment of Graves' disease (GD) but their ophthalmologic and biological autoimmune responses remain controversial and data concerning clinical and biochemical outcomes are limited. The aim of this study was to evaluate thyroid function, TSH-receptor antibodies (TRAb) and Graves' ophthalmopathy (GO) occurrence after radioiodine thyroid ablation in GD. We reviewed 162 patients treated for GD by iodine-131 ((131)I) with doses ranging from 370 to 740 MBq, adjusted to thyroid uptake and sex, over a 6-year period in a tertiary referral center. Collected data were compared for outcomes, including effectiveness of radioiodine therapy (RIT) as primary endpoint, evolution of TRAb, and occurrence of GO as secondary endpoints. The success rate was 88.3% within the first 6 months after the treatment. The RIT failure was increased in the presence of goiter (adjusted odds ratio = 4.1, 95% confidence interval 1.4-12.0, P = 0.010). The TRAb values regressed with time (r = -0.147; P = 0.042) and patients with a favorable outcome had a lower TRAb value (6.5 ± 16.4 U/L) than those with treatment failure (23.7 ± 24.2 U/L, P hyperthyroidism but developed early and prolonged period of hypothyroidism in the context of antithyroid drugs (ATD) intolerance (P = 0.003) and high TRAb level (P = 0.012). On the basis the results of this study we conclude that ablative RIT is effective in eradicating Graves' hyperthyroidism but may be accompanied by GO occurrence, particularly in patients with early hypothyroidism and high pretreatment TRAb and/or ATD intolerance. In these patients, we recommend an early introduction of LT4 to reduce the duration and the degree of the radioiodine-induced hypothyroidism. PMID:22942775

  2. METODOLOGÍAS PARA ABORDAR INFORMACIONES DE LOS MEDIOS DE COMUNICACIÓN IMPRESOS EN LA PERSPECTIVA DE LA EDUCACIÓN GEOGRÁFICA

    Elaiz Aparecida Mensch Buffon

    2015-12-01

    Full Text Available Este documento se centra en el diálogo entre los medios y la forma de pensar y hacer una educación geográfica en la escuela. Con el objetivo de analizar posibilidades del uso del diario para abordar contenidos geográficos, se utilizó una metodología pautada en la investigación bibliográfica en el campo teórico, y basada en la interpretación de artículos de diario, en el campo empírico. El énfasis del análisis se centra en la construcción de argumentos para demostrar que el uso del diario impreso es una herramienta en el proceso de enseñar y aprender contenidos geográficos, considerándolo como generador de informaciones que pueden ser utilizadas para la construcción de conocimientos. Las informaciones disponibles en los artículos de diario necesitan de un análisis crítico, ya que no son informaciones neutras, para esto, se utilizaron dos opciones metodológicas: los padrones de manipulación de los principales medios de comunicación y la dimensión de los discursos. Esos recursos analíticos ofrecen una interpretación pautada en criterios que sirve para filtrar las informaciones utilizadas en la construcción de los conocimientos. De esta manera, enseñar y aprender contenidos geográficos con la ayuda de diarios, en una perspectiva de la Educación Geográfica, implica que el profesor contemple el poder de la información y lo fundamental que es su uso en el proceso de enseñanza-aprendizaje, basándose en criterios relacionados a principios socio ambiéntales. Este trabalho aborda o diálogo entre a mídia e o pensar e fazer uma Educação Geográfica na escola. Com o objetivo de analisar possibilidades do uso do jornal para abordar conteúdos geográficos, utilizamos metodologia pautada na pesquisa bibliográfica no campo teórico, e baseada na interpretação de reportagens de jornal, no campo empírico. A ênfase da análise centra-se na construção de argumentos, para demonstrar o uso do jornal impresso como

  3. [Graves-Basedow disease after allogeneic bone marrow transplantation].

    Jakubas, Beata; Kostecka-Matyja, Marta; Darczuk, Andrzej; Gil, Justyna

    2006-01-01

    One severe aplastic anaemia case who presented autoimmune thyroid disease after allogeneic bone marrow transplantation (alloBMT) is described. A 19 year old Polish girl developed Graves' hyperthyroidisms 19 months after allogeneic BMT for severe aplastic anaemia (SAA) donated from her brother. Her serum was positive for thyroid stimulating antibody (TSAb) and anti-thyroid peroxidase autoantibodies (aTPO) while her brother remained euthyroid, seronegative for TSAb, and showed no clinical signs of thyroid pathology. The genetic studies of lymphocytes FISH (fluorescence in situ hybridization) and analysis of STR (short tandem repeated) fragments suggested, that lymphocytes responsible for hyperthyroidisms were of donor origin. PMID:17133320

  4. Violencia en la pareja hacia mujeres con transtorno mental grave

    González Cases, Juan Carlos

    2012-01-01

    Este estudio tiene como objetivo principal analizar la prevalencia y características de la violencia de pareja hacia mujeres con un trastorno mental grave. La muestra consta de 142 mujeres mayores de 18 años, que en algún momento de su vida adulta habían tenido una relación de pareja y que estaban en atención en recursos públicos de salud mental de la Comunidad de Madrid. A través de entrevista se aplicaron cuestionarios validados para la medición de violencia psicológica, sexual y física. Ad...

  5. Graves disease associated with chronic idiopathic urticaria: 2 case reports.

    Bansal, A S; Hayman, G R

    2009-01-01

    Chronic idiopathic urticaria (CIU) is well known to be associated with antithyroid peroxidase antibodies and autoimmune thyroiditis. Coexisting Graves disease has only rarely been observed. We describe 2 patients with CIU who developed autoimmune hyperthyroidism with antithyrotropin receptor antibodies. Antithyroid peroxidase antibodies were also present in 1 of the patients, but both responded poorly to high-dose antihistamine therapy. Both patients improved significantly, and their thyroid function recovered with carbimazole. We advise clinicians to be alert to the symptoms of hyperthyroidism when patients with CIU respond poorly to antihistamine therapy, as prompt treatment of hyperthyroidism significantly improves urticaria. PMID:19274930

  6. Graves' hyperthyroidism and moderate alcohol consumption: evidence for disease prevention

    Carle, A.; Bülow Pedersen, I.; Knudsen, N.; Perrild, H.; Ovesen, L.; Rasmussen, Lone Banke; Jørgensen, T.; Laurberg, P.

    2013-01-01

    BACKGROUND: We recently demonstrated that moderate alcohol consumption is associated with a considerable reduction in the risk of autoimmune hypothyroidism, similar to findings in other autoimmune diseases such as systemic lupus erythematosus and rheumatoid arthritis. We aimed to study a possible...... Graves' hyperthyroidism. For each patient, we recruited four age-sex-region-matched controls with normal thyroid function (n=1,088). MEASUREMENTS: Participants gave detailed information on current and previous alcohol intake as well as other factors to be used for analyses. The association between...

  7. Graves-Basedow disease after allogeneic bone marrow transplantation

    One severe aplastic anaemia case who presented autoimmune thyroid disease after allogeneic bone marrow transplantation (alloBMT) is described. A 19 year old Polish girldeveloped Graves' hyperthyroidisms 19 months after allogeneic BMT for severe aplastic anaemia (SAA) donated from her brother. Her serum was positive for thyroid stimulating antibody (TSAb) and anti-thyroid peroxidase autoantibodies (aTPO) while her brother remained euthyroid, seronegative for TSAb, and showed no clinical signs of thyroid pathology. The genetic studies of lymphocytes FISH (fluorescence in situ hybridization) and analysis of STR (short tandem repeated) fragments suggested, that lymphocytes responsible for hyperthyroidisms were of donor origin. (author)

  8. Visuaalinen kerronta pelissä : Case: Johnny Graves

    Sarakontu, Minna

    2014-01-01

    Opinnäytetyön tavoitteena oli tutkia videopelien visuaalisen kerronnan osa-alueita, kuten käyttöliittymiä ja grafiikkaa, ja soveltaa opittua Johnny Graves -peliprojektissa. Opinnäytetyö toteutettiin kevään 2014 aikana. Teoriataustan lähdemateriaalina käytettiin omaa pohjatietoa, kirjallisuutta ja useita verkkoartikkeleita. Empiriaosuutta varten haastateltiin aiheesta kahta asiantuntijaa, analysoitiin kolmea modernia peliä ja suoritettiin käytettävyystestaamista Johnny Gravesin viimeisimmä...

  9. Extracción convencional de oleorresina de pimentón dulce y picante II. Peligros y puntos de control crítico y requerimientos comerciales

    Fernández-Trujillo, J. Pablo

    2007-12-01

    Full Text Available This paper reviews the hazards analysis and critical control points (HACCP for the conventional extraction of paprika oleoresin, a product with potential to be produced in Africa and South America. These points include the toxicological, fire and explosion risks of the solvents, the temperature for miscella stripping, the risk of oxidations, isomerization and contaminant concentration in the oleoresin. Legal regulations in US and EU are also discussed, as well as some technical requirements and commercial and demand characteristics of the oleoresin.Se revisan los principales peligros y puntos de control crítico del proceso de extracción convencional por disolventes de la oleorresina de pimentón, un producto con potencial para ser producido en África e Iberoamérica. Entre estos puntos se incluyen entre otros el riesgo toxicológico, de incendio y explosión de los disolventes o su descomposición, la formación de finos, la temperatura de desolventización de la miscela, o el riesgo de oxidaciones, isomerizaciones y concentración de contaminantes en la oleorresina. Los condicionantes técnicos derivados de la legislación americana y europea son también discutidos, así como los condicionantes técnicos y características comerciales y de la demanda del producto en la actualidad.

  10. Total thyroidectomy as primary definitive treatment for Graves' hyperthyroidism.

    Snyder, Samuel; Govednik, Cara; Lairmore, Terry; Jiang, Da-Shu; Song, Juhee

    2013-12-01

    The objective of this study was to compare the results of total thyroidectomy (TT) for hyperthyroidism secondary to Graves' disease (GD) with TT for other benign thyroid diseases to determine if TT should be considered more often as first-line therapy for GD. Seven hundred eighty patients underwent TT for benign disease: 203 for GD, 56 for other hyperthyroidisms, and 521 for other benign diseases from March 1, 2003, to December 31, 2009. The perioperative results of these three groups were compared for demographics, blood loss, operative time, complications, and hospitalization. There were no significant differences among the three groups except the patients with GD were more likely to be younger (42 vs 56 vs 57 years; P hyperthyroidism and other benign thyroid diseases. Permanent recurrent laryngeal nerve injury did not occur in the GD group (0 vs 0 vs 0.4% nerves at risk; P = 0.69) with transient recurrent laryngeal nerve injury occurring in 1.7 versus 2.7 versus 3.1 per cent nerves at risk (P = 0.35). The lack of a euthyroid state preoperatively had no influence on surgical outcomes or complications. Eighty percent of the TTs for GD were done as same-day outpatient procedures. TT offers a safe, low-risk, and rapid cure for GD to justifiably be considered as a reasonable first-line therapy in selected patients with Graves' hyperthyroidism. PMID:24351357

  11. Hyperthyroidism in Graves disease. Current trends in management and diagnosis

    The radioimmunoassay for T3 is now widely available and is a useful diagnostic tool for hyperthyroidism, especially in T3-thyrotoxicosis. It is an essential tool in the management of hyperthyroidism that persists after treatment with normal T4 serum levels or, in euthyroid cases, with low T4 serum levels. In these conditions, it reflects the metabolic state more accurately than serum levels of T4. A promising new test is the response of radioimmunoassayable TSH to protirelin relin (TRH) administration. An absent response indicates pituitary suppression and thyroid autonomy as seen in frank hyperthyroidism or euthyroid Graves disease, treated or untreated. It is safer and quicker than the conventional T3 suppression test of thyroid radioactive iodine uptake and may replace it at least partly in the future. The recently recognized sharp decline in the remission rate of patients subjected to thyroid drug therapy in the last decade has made this treatment much less efficacious. By necessity, it will probably lead to greater reliance on treatment with radioactive iodine in the majority of the patients with the hyperthyroidism of Graves disease

  12. Evidence for a major role of heredity in Graves' disease

    Brix, T H; Kyvik, K O; Christensen, Kaare; Hegedüs, L

    2001-01-01

    The etiology of Graves' disease (GD), affecting up to 2% of a population in iodine-sufficient areas, is incompletely understood. According to current thinking, the development of GD depends on complex interactions among genetic, environmental, and endogenous factors. However, the relative contrib...... 21%. In conclusion, our study strongly supports the idea that genetic factors play a major role in the etiology of GD and suggest that a further search for susceptibility genes is worthwhile.......The etiology of Graves' disease (GD), affecting up to 2% of a population in iodine-sufficient areas, is incompletely understood. According to current thinking, the development of GD depends on complex interactions among genetic, environmental, and endogenous factors. However, the relative...... contributions of the genetic and environmental factors remain to be clarified. In this study we report probandwise concordance rates for GD in a new cohort of same sex twin pairs born between 1953 and 1976 (young cohort), ascertained from the nationwide population-based Danish Twin Register. To elucidate the...

  13. Significance of changes of serum FT3, FT4, s-TSH, TGA, TPO-Ab levels in patients with non-Graves' hyperthyroidism and Graves' disease

    Objective: To investigate the clinical significance of the changes of thyroid-related hormones (FT3, FT4, s-TSH, TGA, TPO-Ab) levels in patients with Graves' and non-Graves' hyperthyroidism. Methods: Serum FT3, FT4, TGA, TPO-Ab (with RIA) and s-TSH (with IRMA) were determined in 43 patients with non-Graves' hyperthyroidism, 29 patients with Graves' disease and 40 controls. Results: In both groups of hyperthyroid patients, the serum levels of FT3 (15.01 ± 11.01 pg/ml in the non - Graves' group and 15.23 ± 9.57pg/ml in the Graves' group), FT4 (38.30 ± 19.82, 38.87 ± 17.39pg/ml), TGA(33.89 ± 22. 43%, 49.72 ± 20.55% ) and TPO-Ab (1319.24 ± 1037.78, 2023.24 ± 621.00IU/ml) were significantly higher than those (FT3, 6.76 ± 2.01pg/ml, FT4 16.16 ± 2.58pg/ml, TGA 6.76 ± 2.01%, TPO-Ab 0.01 ± 0.01IU/ml) in the controls (all P 3, FT4 and s-TSH levels in both groups were not significantly different from each other. Conclusion: In this study, serum TGA and TPO -Ab levels were lower in patients with non-Graves' hyperthyroidism than those in patients with Graves' disease. (authors)

  14. Refractory Graves' Disease Successfully Cured by Adjunctive Cholestyramine and Subsequent Total Thyroidectomy

    Yang, Yeoree; Hwang, Seawon; Kim, Minji; Lim, Yejee; Kim, Min-Hee; Lee, Sohee; Lim, Dong-Jun; Kang, Moo-Il; Cha, Bong-Yun

    2015-01-01

    The three major forms of treatment for Graves thyrotoxicosis are antithyroid drugs, radioactive iodine therapy and thyroidectomy. Surgery is the definitive treatment for Graves thyrotoxicosis that is generally recommended when other treatments have failed or are contraindicated. Generally, thyrotoxic patients should be euthyroid before surgery to minimize potential complications which usually requires preoperative management with thionamides or inorganic iodine. But several cases of refractor...

  15. 75 FR 9429 - Native American Graves Protection and Repatriation Review Committee: Meetings

    2010-03-02

    ... National Park Service Native American Graves Protection and Repatriation Review Committee: Meetings AGENCY... Advisory Committee Act, 5 U.S.C. Appendix (1988), of three meetings of the Native American Graves... agreement, of Native American human remains determined to be culturally unidentifiable; and presentations...

  16. 76 FR 12132 - Native American Graves Protection and Repatriation Review Committee: Meeting

    2011-03-04

    ... National Park Service Native American Graves Protection and Repatriation Review Committee: Meeting AGENCY... Advisory Committee Act, 5 U.S.C. Appendix (1988), of a meeting of the Native American Graves Protection and... the Interior, as required by law, in order to effect the agreed-upon disposition of Native...

  17. 76 FR 69282 - Native American Graves Protection and Repatriation Review Committee: Meeting

    2011-11-08

    ... National Park Service Native American Graves Protection and Repatriation Review Committee: Meeting AGENCY... Advisory Committee Act, 5 U.S.C. Appendix (1988), of a meeting of the Native American Graves Protection and... effect the agreed-upon disposition of Native American human remains determined to be...

  18. 77 FR 7180 - Native American Graves Protection and Repatriation Review Committee: Meeting

    2012-02-10

    ... National Park Service Native American Graves Protection and Repatriation Review Committee: Meeting AGENCY... Advisory Committee Act, 5 U.S.C. Appendix (1988), of two meetings of the Native American Graves Protection... of Native American human remains determined to be culturally unidentifiable; presentations by...

  19. 77 FR 53228 - Native American Graves Protection and Repatriation Review Committee: Meeting

    2012-08-31

    ... National Park Service Native American Graves Protection and Repatriation Review Committee: Meeting AGENCY... Federal Advisory Committee Act, 5 U.S.C. Appendix (1988), of a meeting of the Native American Graves..., as required by law, in order to effect the agreed-upon disposition of Native American human...

  20. 78 FR 27078 - Native American Graves Protection and Repatriation Act Regulations

    2013-05-09

    ... Government Relations with Native American Tribal Governments'' (59 FR 22951, April 29, 1994); Executive Order... Office of the Secretary of the Interior 43 CFR Part 10 RIN 1024-AD99 Native American Graves Protection.... SUMMARY: This final rule revises regulations implementing the Native American Graves Protection...

  1. Premature hair greying may predict reduced bone mineral density in Graves' disease.

    Leary, A C

    2012-02-03

    BACKGROUND: Premature hair greying has been associated with low bone mineral density (BMD), and it may be more frequent in Graves\\' disease. AIMS: To determine whether premature greying is associated with reduced BMD in women with Graves\\' disease and in control women, and to examine whether premature greying is more common in Graves\\' disease. METHODS: Premature greying (> 50% grey by 40 years) and BMD were determined in 44 women with a history of Graves\\' disease and 133 female controls referred for routine BMD measurement. Exclusion criteria included diseases or drugs known to affect BMD. RESULTS: Mean Z and T scores at the lumbar spine were significantly lower (P < 0.04) in subjects with premature greying than in those not prematurely grey among women with Graves\\' disease, but not among control women. Multiple regression confirmed this difference between Graves\\' and control women (P = 0.041). There were no differences at other measurement sites. Of Graves\\' patients, 36% were prematurely grey compared with 25% of control women (P = 0.14). CONCLUSION: Premature greying may be a weak marker for reduced BMD in women with a history of Graves\\' disease, but it is not a marker in normal women.

  2. 38 CFR 38.631 - Graves marked with a private headstone or marker.

    2010-07-01

    ... it is requested or, if placement on the grave is impossible or impracticable, as close to the grave... type and placement of the headstone or marker requested adheres to the policies and guidelines of the selected private cemetery. (f) VA will furnish its full product line of Government headstones or...

  3. Developing the use of Structure-from-Motion in mass grave documentation.

    Baier, Waltraud; Rando, Carolyn

    2016-04-01

    Methods for mass-grave documentation have changed markedly since the first forensic investigations nearly 70 years ago. Recently, however, there has been little advancement in developing new and better methodology, especially when compared to other forensic disciplines and even within traditional archaeology. This paper proposes a new approach, using 3D modelling for the documentation and eventual analysis of mass-graves. Structure-from-Motion (SfM), which creates digital 3D models from a set of still photographs, was tested on a small, simulated mass grave. The results of this test suggest that the method offers resolution previously unavailable to mass-grave investigators, and facilitates stronger analytical potential than the more traditional methods. Further tests are needed to validate these methods, but these initial findings are promising and their application could enhance our knowledge of mass grave dynamics. PMID:26874051

  4. Primary biliary cirrhosis associated with Graves' disease in a male patient.

    Suzuki, Yuji; Ishida, Kazuyuki; Takahashi, Hiroshi; Koeda, Norihiko; Kakisaka, Keisuke; Miyamoto, Yasuhiro; Suzuki, Akiko; Takikawa, Yasuhiro

    2016-04-01

    Primary biliary cirrhosis (PBC), which predominantly affects women, has been associated with various autoimmune diseases. Although hypothyroidism accompanying PBC is well documented, the concomitance of PBC and hyperthyroidism is rare. Herein, we report the case of a 62-year-old man who was diagnosed with PBC several years after the development of Graves' disease. This is the first case of a male patient developing PBC with Graves' disease. Both serum alanine aminotransferase levels and serum thyroid hormone levels were normalized after the administration of thiamazole for Graves' disease. However, the cholestatic liver enzyme abnormalities continued, indicating that the PBC was actualized by the administration of thiamazole. After starting ursodeoxycholic acid treatment, cholestatic liver enzyme abnormalities improved. Taken together, when a cholestatic pattern of liver enzymes is observed during follow-up for Graves' disease, an association between Graves' disease and PBC should be considered as a differential diagnosis. PMID:26935935

  5. Application of lithium carbonate on radioiodine treatment of Graves' hyperthyroidism

    Effectiveness of radioiodine for Graves' hyperthyroidism depends on retention time of 131I in the thyroid, and may be effected by several factors, including previous treatment with antithyroid drugs,goiter volume, 24 h thyroidal radioactive iodine uptake and so on. A short course of therapy with low dose of lithium carbonate increased retention of 131I in the thyroid and prolong the intrathyroidal effective half-life of 131I before and after 131I therapy in patients with Graves' disease, because of the actions that lithium blocks the release of organic iodine and thyroid hormone from the thyroid gland without affecting thyroidal radioactive iodine uptake. Therefore, using lithium as adjunct to radioiodine therapy increases the radiation dose delivered to the thyroid, to result in reduced the activity required and whole-body radiation dose in patients with very short effective half-life, and so improve the cure rate of hyperthyroidism. A short course of lithium carbonate therapy can be considered a useful adjunct to 131I therapy for obtaining a more rapid control of thyrotoxicosis and avoiding its transient exacerbation because of methimazole withdrawal prior to 131I administration or in patients who cannot tolerate or do not respond to antithyroid drugs, and for helping to prevent the radioiodine-associated increase in serum free thyroid hormone concentrations. In addition, lithium carbonate enhances the effectiveness of 131I therapy, in terms of prompter control of hyperthyroidism in patients with small or large goiters. At the same time, lithium also may increases the rate of permanent control of hyperthyroidism in patients with large goiters. In summary, in the short-term lithium plays an important role as an adjunct to 131I, since it helps to prevent the 131I-associated increase in serum free thyroid hormone concentrations and allows a more prompt control of thyrotoxicosis. This is of particular importance in high risk patients, such as the elderly,those with

  6. Padrao epidemiologico das oclusopatias muito graves em adolescentes brasileiros

    Karen Glazer Peres

    2013-12-01

    Full Text Available OBJETIVO: Descrever o padrão de distribuição das oclusopatias em adolescentes brasileiros e identificar fatores associados a esse agravo bucal. MÉTODOS: Foram analisados dados de 7.328 e 5.445 adolescentes de 12 e 15-19 anos, respectivamente, participantes da Pesquisa Nacional de Saúde Bucal (SBBrasil 2010. O desfecho foi oclusopatia muito grave segundo o índice de estética dental. As variáveis de exposição foram sexo, cor da pele, renda familiar mensal, número de bens, aglomeração no domicílio, cárie não tratada, perda dentária, uso, frequência e motivo da consulta odontológica. Foram conduzidas análises de regressão logística considerando a complexidade do desenho amostral, com base em modelo hierarquizado. RESULTADOS: Prevalência de oclusopatia muito grave foi observada em 6,5% e 9,1% nos jovens de 12 e 15-19 anos, respectivamente. Após análise ajustada, a chance do desfecho foi 1,59 (IC95% 1,08;2,34 vez maior nos pardos e pretos em relação aos brancos e 2,66 (IC95% 1,26;5,63 vezes maior dentre aqueles com perda de pelo menos um primeiro molar aos 12 anos. Jovens de 15-19 anos cuja renda familiar mensal foi de até R$ 1.500,00 (OR 2,69 [IC95% 1,62;4,47] e aqueles que consultaram o dentista para tratamento (OR 2,59 [IC95% 2,55;4,34] apresentaram maior chance de oclusopatia muito grave quando comparados aos de maior renda e que procuraram o dentista para prevenção. CONCLUSÕES: A distribuição das oclusopatias em adolescentes brasileiros segue o padrão de iniquidade social de outros agravos à saúde. Essas informações são úteis para a formulação de critérios relacionados tanto com a distribuição e provisão de recursos quanto com as prioridades de tratamento ortodôntico fundamentados no princípio da equidade da atenção à saúde bucal.

  7. Bifocal orbital and nasopharyngeal amyloidomas presenting as Graves disease.

    Wu, Albert Y; Chapman, William B; Witterick, Ian J; Deangelis, Dan D

    2011-01-01

    A 72-year-old man presented with a slowly progressive left hyperglobus, left infraduction deficit, bilateral lower eyelid retraction, and dysphagia. He had a notable chin-down head position, diplopia in primary position, and 3 mm of left proptosis. He had been diagnosed with Graves disease 3 years before presentation. CT scans showed enlargement of the left inferior and medial rectus muscles with associated stranding of the retrobulbar fat and a low-density heterogeneous mass in the left aspect of the neck protruding in the nasopharynx. Biopsies of the orbit and nasopharynx revealed focal areas of amyloid. This represents the first report of bifocal amyloidomas of the orbit and nasopharynx. PMID:21178798

  8. Outcome Prediction of Treatment of Graves' Hyperthyroidism with Antithyroid Drugs.

    Piantanida, E; Lai, A; Sassi, L; Gallo, D; Spreafico, E; Tanda, M L; Bartalena, L

    2015-09-01

    Graves' disease is the most common cause of hyperthyroidism in iodine-replete areas and is ultimately due to antibodies interacting with the TSH receptor on thyroid follicular cells [TSH-receptor antibody (TRAb)]. Antithyroid drugs (ATDs) belonging to the family of thionamides are the first-line treatment in Europe. ATD treatment is commonly continued for 18-24 months. Its major limitation is the high rate of relapses after drug withdrawal. Factors particularly bound to subsequent relapses are the large thyroid volume, smoking habit, persistence of TRAb in the circulation at the end of treatment, and the post-partum period. Under these conditions, consideration should be given to a definitive therapy for hyperthyroidism (radioiodine treatment, thyroidectomy), particularly if the patient is at risk of cardiovascular complications that might be exacerbated by persistence or recurrence of hyperthyroidism. PMID:26197855

  9. Hypothyroidism caused by 131I treatment for Graves disease

    The refollow-up has been carried out in hypothyroidism caused by 131I treatment for Graves disease. The serum HS-TSH(IRMA), FT3, TSH(RIA), TT3, TT4, FT4I, MCA, TGA, Cholesterol and Triglyceride has been measured in 26 patient after 131I treatment for 9.5 years in average. At the same time TRH stimulation test was also performed, and the clinical symptoms and signs assessed. The results showed that TSH is the most sensitive criterion for hypothyroidism, followed by Cholesterol and FT4I. The occurence of hypothyroidism may be related to the presence of thyroid antibody as demonstrated by the elevation of serum MCA, TGA. Therefore measurement of serum TSH, FT4I and Cholesterol during long term follow-up is beneficial for early diagnosis of hypothyroidism and evaluating the effect of substitution treatment

  10. Prise en charge des traumatismes graves du rein

    Lakmichi, Mohamed Amine; Jarir, Redouane; Sadiki, Bader; Zehraoui,; Bentani,; Wakrim, Bader; Dahami, Zakaria; Moudouni,; Sarf, Ismail

    2015-01-01

    Les traumatismes graves du rein de grade III, IV et V selon la classification de l'Amercan Society for Surgery For Trauma (ASST) sont plus rares et se retrouvent dans 5% des cas en moyenne. Leur prise en charge est souvent délicate, nécessitant alors des centres expérimentés dotés de moyen adéquats d'imagerie (scanner spiralé). Cependant, durant ces dernières années, la prise en charge de ces traumatismes a évolué vers une attitude de moins en moins chirurgicale grâce à l’évolution des techni...

  11. Diagnosis and differential diagnosis of Graves' orbitopathy in MRI

    Imaging of Graves' orbitopathy (GO) includes radiological and nuclear medicine procedures. Depending on the method used they provide information about the distribution and activity of the disease. Magnetic resonance imaging (MRI) is not only a helpful tool for making the diagnosis it also enables differentiation of the active and inactive forms of GO due to intramuscular edema. The modality is therefore appropriate to evaluate the disease activity and the course of therapy. The disease leads to the typical enlargement of the muscle bodies of the extraocular muscles. The inferior rectus, medial rectus and levator palpebrae muscles are mostly involved. Signal changes of the intraconal and extraconal fat tissue are possible and a bilateral manifestation is common. The differential diagnosis includes inflammatory diseases and tumors, of which orbital pseudotumor (idiopathic, unspecific orbital inflammation), ocular myositis and orbital lymphoma are the most important. The specific patterns (localization, involvement of orbital structures and signal changes) can be differentiated by MRI. (orig.)

  12. La Educación del consumo una forma de abordar la educación para la sostenibilidad : presentación de un modelo conceptual complejo y su relevancia entre el profesorado

    Querol Palau, Maia; Bonil, Josep; Pujol, Rosa M.

    2009-01-01

    Una forma de abordar la educación para la sostenibilidad es a partir de la educación del consumo, ya que los actos de consumo se pueden entender como formas de intervención de los individuos sobre el medio. Una de las líneas didácticas que puede orientar la educación del consumo es la presencia de los principios de la complejidad. Incluir estos principios supone redefinir el modelo conceptual de consumo, incorporando contenidos estructurantes que contemplen las reglas de la complejidad. Se pr...

  13. 76 FR 39007 - Native American Graves Protection and Repatriation Act Regulations- Definition of “Indian Tribe”

    2011-07-05

    ... Office of the Secretary of the Interior 43 CFR Part 10 RIN 1024-AD98 Native American Graves Protection... regulations implementing the Native American Graves Protection and Repatriation Act (NAGPRA) removes the... implementation of the Native American Graves Protection and Repatriation Act, including the issuance...

  14. Management of Neonates Born to Mothers With Graves' Disease.

    van der Kaay, Daniëlle C M; Wasserman, Jonathan D; Palmert, Mark R

    2016-04-01

    Neonates born to mothers with Graves' disease are at risk for significant morbidity and mortality and need to be appropriately identified and managed. Because no consensus guidelines regarding the treatment of these newborns exist, we sought to generate a literature-based management algorithm. The suggestions include the following: (1) Base initial risk assessment on maternal thyroid stimulating hormone (TSH) receptor antibodies. If levels are negative, no specific neonatal follow-up is necessary; if unavailable or positive, regard the newborn as "at risk" for the development of hyperthyroidism. (2) Determine levels of TSH-receptor antibodies in cord blood, or as soon as possible thereafter, so that newborns with negative antibodies can be discharged from follow-up. (3) Measurement of cord TSH and fT4 levels is not indicated. (4) Perform fT4 and TSH levels at day 3 to 5 of life, repeat at day 10 to 14 of life and follow clinically until 2 to 3 months of life. (5) Use the same testing schedule in neonates born to mothers with treated or untreated Graves' disease. (6) When warranted, use methimazole (MMI) as the treatment of choice; β-blockers can be added for sympathetic hyperactivity. In refractory cases, potassium iodide may be used in conjunction with MMI. The need for treatment of asymptomatic infants with biochemical hyperthyroidism is uncertain. (7) Assess the MMI-treated newborn on a weekly basis until stable, then every 1 to 2 weeks, with a decrease of MMI (and other medications) as tolerated. MMI treatment duration is most commonly 1 to 2 months. (8) Be cognizant that central or primary hypothyroidism can occur in these newborns. PMID:26980880

  15. THERAPY OF ENDOCRINE DISEASE: Endocrine dilemma: management of Graves' orbitopathy.

    Campi, Irene; Vannucchi, Guia; Salvi, Mario

    2016-09-01

    Management of Graves' orbitopathy (GO) must be based on the correct assessment of activity and severity of the disease. Activity is usually assessed with the Clinical Activity Score, whereas severity is classified according to a European Group On Graves' Orbitopathy (EUGOGO) consensus statement as mild, moderate-to-severe, and sight-threatening. Myopathic and chronic congestive forms are uncommon clinical presentations of GO. Restoration and maintenance of stable euthyroidism are recommended in the presence of GO.In moderate-to-severe disease, steroids have been widely employed and have shown to possess an anti-inflammatory activity, but about 20-30% of patients are not responsive and present recurrence. Some novel immunosuppressors have already been employed in clinical studies and have shown interesting results, although the lack of randomized and controlled trials suggests caution for their use in clinical practice. Potential targets for therapy in GO are the thyroid-stimulating hormone and the insulin-like growth factor 1 receptor on the fibroblasts, inflammatory cytokines, B and T cells, and the PIK3/mTORC1 signaling cascades for adipogenesis. A recent open study has shown that tocilizumab, an anti-sIL-6R antibody, inactivates GO. Consistent reports on the efficacy of rituximab have recently been challenged by randomized controlled trials.As the main goal of treatment is the well-being of the patient, the therapeutic strategy should be addressed to better suit the patient needs, more than improving one or more biological parameters. The increasing availability of new therapies will expand the therapeutic options for GO patients and allow the clinician to really personalize the treatment to better suit the patients' personal needs. PMID:27032693

  16. I-131 therapy for graves' disease in children and adolescents

    Graves' disease is the most common thyroid disease in Vietnam. For children and adolescents the therapy with anti-thyroid drugs is often inefficacious or relapsed in a short time after therapy. Therefore the treatment with I-131 is the first choice when the anti-thyroid therapy is failed. 45 patients with the median age 15 (range 8-16), including 9 males and 36 females , were hospitalized and treated with 1-131.28/45 (62%) patients are not cured with antithyroid drug (ATD), 17/45 (38%) were the first use of I-131. Examen findings show: an elevated concentration of serum free thyroxin (fT4) = 92 pmol/L ±62, a decrease of TSH=0.04 UI/L±0.02, the 2h uptake=51%±22%, the 24h uptake=71%± 28%. We have divided the patients in three group of severity, based on pulse rates (PR): 5 patients in mild group (PR 100 <121), 9 patients in severe group (PR 121-140). The hematological and biochemical findings were in normal range. All patients were treated with capsules of I-131, oral administration. The mean dose was: 7±1.2 mCi. The mean dose per gram of thyroid tissue was 274.5±97 mCi. The therapy efficacy was very high: 41/45 (91%) return to euthyroid status with only a single dose, 4/45 (9%) needed a second dose of I-131 after 3 months with several moderate clinical symptoms. Conclusions: The radioiodine therapy for Graves' disease is a method of choice for all juvenile patients non responding to ATD treatment. The mean dose of 7 mCi is sufficient, safe and efficacious. The recurrence rate is relative low, about 9-10%. (authors)

  17. A COMPLEX ADAPTIVE STATE SYSTEM: NETWORKS, ARMS RACES AND MORAL HAZARDS Un sistema adaptativo complejo: Redes, carreras armamentistas y peligros morales

    PABLO POLICZER

    2012-01-01

    Full Text Available Much of the debate over stateness in Latin America assumes that states should sustain basic levels of stability, and if they cannot, the question is why not. This article departs from the assumption of stability, by asking how the relationship between states and other actors has evolved over time. This departure requires a shift in focus: from stateness as referring to states and how they should operate, to stateness as referring to the relationships between states and other actors, and how they change over time. The article argues that such relationships can be understood as emergent complex adaptive systems (CAS, and considers three specific CAS mechanisms: networks, arms races, and moral hazards. This conceptual shift in how to think about states is especially challenging in a region historically accustomed to hierarchical governance.Buena parte del debate sobre la estatalidad en América Latina presupone que los estados deben mantener niveles básicos de estabilidad, y que si no pueden hacerlo, la pregunta es por qué no. Este artículo se aleja del supuesto de la estabilidad, al preguntar cómo la relación entre los estados y otros actores ha evolucionado con el tiempo. Esto requiere un cambio de enfoque: de estatalidad que se refiere a los estados y cómo debieran funcionar, a la estatalidad en referencia a las relaciones entre los estados y otros actores, y cómo éstas cambian con el tiempo. El artículo sostiene que este tipo de relaciones se puede entender como sistemas complejos adaptativos (SCA emergentes, y considera tres mecanismos específicos de SCA: redes, carreras armamentistas y peligros morales (moral hazards. Este cambio conceptual en laforma de pensar acerca de los estados es especialmente difícil en una región históricamente acostumbrada a la gobernanza jerárquica.

  18. Climate change and hazardous processes in high mountains Cambio climático y peligros naturales en altas montañas

    John J Clague

    2012-09-01

    Full Text Available The recent and continuing reduction in glacier ice cover in high mountains and thaw of alpine permafrost may have an impact on many potentially hazardous processes. As glaciers thin and retreat, existing ice- and moraine-dammed lakes can catastrophically empty, generating large and destructive downstream floods and debris flows. New ice-dammed lakes will form higher in mountain catchments, posing additional hazards in the future. The magnitude or frequency of shallow landslides and debris flows in some areas will increase because of the greater availability of unconsolidated sediment in new deglaciated terrain. Continued permafrost degradation and glacier retreat probably will decrease the stability of rock slopes.La reciente y continua reducción de la cobertura glaciaria en alta montaña y el deshielo del permafrost pueden tener un impacto negativo en muchos procesos potencialmente peligrosos. A medida que los glaciares reducen su espesor y retroceden, los lagos formados por diques de hielo o morenas pueden vaciarse catastróficamente, resultando en grandes y destructivas inundaciones o flujos detríticos río abajo. Nuevos diques de hielo van a formarse en zonas más altas de las cuencas montañosas, generando peligros adicionales en el futuro. La magnitud o frecuencia de movimientos en masa superficiales y flujos detríticos va a aumentar en algunas áreas debido a la mayor disponibilidad de materiales no consolidados en nuevos terrenos desglasados. La degradación continua del permafrost y el retiro de glaciares probablemente va a disminuir la estabilidad de laderas rocosas.

  19. Enhanced thyroid iodine metabolism in patients with triiodothyronine-predominant Graves' disease

    Takamatsu, J.; Hosoya, T.; Naito, N.; Yoshimura, H.; Kohno, Y.; Tarutani, O.; Kuma, K.; Sakane, S.; Takeda, K.; Mozai, T.

    1988-01-01

    Some patients with hyperthyroid Graves' disease have increased serum T3 and normal or even low serum T4 levels during treatment with antithyroid drugs. These patients with elevated serum T3 to T4 ratios rarely have a remission of their hyperthyroidism. The aim of this study was to investigate thyroid iodine metabolism in such patients, whom we termed T3-predominant Graves' disease. Mean thyroid radioactive iodine uptake was 51.0 +/- 18.1% ( +/- SD) at 3 h, and it decreased to 38.9 +/- 20.1% at 24 h in 31 patients with T3-predominant Graves' disease during treatment. It was 20.0 +/- 11.4% at 3 h and increased to 31.9 +/- 16.0% at 24 h in 17 other patients with hyperthyroid Graves' disease who had normal serum T3 and T4 levels and a normal serum T3 to T4 ratio during treatment (control Graves' disease). The activity of serum TSH receptor antibodies was significantly higher in the patients with T3-predominant Graves' disease than in control Graves' disease patients. From in vitro studies of thyroid tissue obtained at surgery, both thyroglobulin content and iodine content in thyroglobulin were significantly lower in patients with T3-predominant Graves' disease than in the control Graves' disease patients. Thyroid peroxidase (TPO) activity determined by a guaiacol assay was 0.411 +/- 0.212 g.u./mg protein in the T3-predominant Graves' disease patients, significantly higher than that in the control Graves' disease patients. Serum TPO autoantibody levels determined by immunoprecipitation also were greater in T3-predominant Graves' disease patients than in control Graves' disease patients. Binding of this antibody to TPO slightly inhibited the enzyme activity of TPO, but this effect of the antibody was similar in the two groups of patients.

  20. Experiments to Detect Clandestine Graves from Interpreted High Resolution Geophysical Anomalies

    Molina, C. M.; Hernandez, O.; Pringle, J.

    2013-05-01

    This project refers to the search for clandestine sites where possibly missing people have been buried based on interpreted near surface high resolution geophysical anomalies. Nowadays, there are thousands of missing people around the world that could have been tortured and killed and buried in clandestine graves. This is a huge problem for their families and governments that are responsible to warranty the human rights for everybody. These people need to be found and the related crime cases need to be resolved. This work proposes to construct a series of graves where all the conditions of the grave, human remains and related objects are known. It is expected to detect contrasting physical properties of soil to identify the known human remains and objects. The proposed geophysical methods will include electrical tomography, magnetic and ground penetrating radar, among others. Two geographical sites will be selected to located and build standard graves with contrasting weather, soil, vegetation, geographic and geologic conditions. Forward and inverse modeling will be applied to locate and enhance the geophysical response of the known graves and to validate the methodology. As a result, an integrated geophysical program will be provided to support the search for clandestine graves helping to find missing people that have been illegally buried. Optionally, the methodology will be tested to search for real clandestine graves.

  1. Aplicación del sistema de Análisis de Peligros y Puntos de Control Crítico (APPCC en la línea de envasado de aceite de oliva virgen

    Alvarruiz, A.

    2003-03-01

    Full Text Available The Hazard Analysis and Critical Control Point (HACCP is a preventive system which serves for ensuring consumer’s food safety by identifying the hazards associated to a food or drink. In this work, the specific hazards found in a bottling line of virgin olive oil are described, as well as the preventive measures which should be taken in the plant, the surveillance systems to implement, the corrective actions which eventually could be necessary to apply and the control records which should be registered. The implementation of this knowledge will provide any oil bottling line –specially those installed in the olive mill, complementing the processing line of virgin olive oil- with a self-control of their products based on the HACCP system.El Análisis de Peligros y Puntos de Control Crítico (APPCC es un sistema preventivo que trata de garantizar la seguridad e inocuidad alimentaria y que permite identificar los peligros específicos ligados a un alimento o bebida. En este trabajo se describen los peligros propios que se pueden encontrar en la línea de envasado de aceite de oliva virgen, las medidas preventivas que se pueden aplicar en la envasadora y los sistemas de vigilancia a implantar, así como las medidas correctoras previstas, en caso de ser necesarias, y los registros de control que deberán quedar en la industria. La puesta en práctica de estos conocimientos permitirá, a cualquier tipo de envasadora de aceites, en especial a aquellas situadas en la propia almazara, complementando la línea de elaboración de aceite de oliva virgen, un autocontrol de sus producciones basado en el sistema APPCC.

  2. Affective symptoms and cognitive functions in the acute phase of Graves' thyrotoxicosis

    Vogel, Asmus; Elberling, Tina V; Hørding, Merete;

    2007-01-01

    In the acute phase of Graves' thyrotoxicosis patients often have subjective cognitive complaints. Continuing controversy exists about the nature of these symptoms and whether they persist after treatment. This prospective study included 31 consecutively referred, newly diagnosed, and untreated...... of cognitive deficits) had decreased significantly, with further normalisation 1-year after treatment initiation. In conclusion, patients had subjective reports of cognitive deficits in the toxic phase of Graves' thyrotoxicosis but comprehensive neuropsychological testing revealed no cognitive impairment....... Reports of cognitive dysfunction may reflect affective and somatic manifestations of thyrotoxicosis and in most patients these symptoms disappear after treatment of Graves' thyrotoxicosis....

  3. Caracterização dos acidentes de trabalho graves no Estado do Paraná

    Scussiato, Louise Aracema

    2013-01-01

    Resumo: Os acidentes de trabalho graves, entendidos como aqueles que ocasionam lesões graves podem causar incapacidade física ou funcional, parcial, temporária ou permanente ou mesmo levar a morte, sendo considerado um problema de saúde pública no Brasil. Este estudo objetivou caracterizar os acidentes de trabalho graves ocorridos no Estado do Paraná entre 2007 e 2010; e caracterizar o perfil dos trabalhadores acidentados, segundo os ramos de atividade. Trata-se de um estudo epidemiológico de...

  4. Del compromiso a la desvinculación corporal. Un enfoque sociológico plural de las dinámicas, rupturas y permanencias identitarias ante la aceptación del peligro en los deportes en la naturaleza

    Guillaume Routier

    2013-01-01

    Desafiar o jugar con la gravedad, explorar las profundidades y poner su resistencia o simplemente su cuerpo a prueba, competir con los elementos naturales frecuentando un ambiente que es, a priori, hostil: tantas formas de exposición al peligro a través del deporte que fascinan e intrigan a la vez. Este trabajo es una exploración de los procesos de compromiso corporal y de la retirada, considerados en sus aspectos epistémicos y empíricos. Dos preguntas dirigen este análisis: 1) ¿cómo concebir...

  5. High-dose radioiodine therapy of Graves disease

    Full text of publication follows. Objectives: to estimate the effectiveness and safety of the disease treatment under different modes of applying RIT. Materials and methods: 67 patients with the thyrotoxicosis condition associated with Graves disease were researched. The patients were divided into 2 groups: a control group with 25 people (18 women and 7 men), who underwent a low-dose therapy of 150-500 MBq; and a main group of 42 people (32 women and 10 men), who underwent a high-dose therapy of 550 and 800 MBq. The volume of thyroid prior to the treatment made up 23.8 ± 20 ml in the main group and 30.2 ± 23 ml in the control one. The average age in the high-dose group was 44.6 ±23 years old and in the low-dose -47.2 ± 24 years old. In terms of the hormone level before the RIT, 52% of the main group patients experienced euthyroidism, while 48% - thyrotoxicosis. The corresponding indices in the control group were 42% and 58% respectively. The cessation of the thyreostatic therapy came on 5. to 21. day prior to the treatment, with the average of 14 ±7 days in both groups. The diagnosis of the disease was based on ultrasonography, planar scintigraphy, the hormone level and antibody titer. The performance was assessed through the attainment of hypo-thyrosis and the transition to a substitutive hormonal therapy with L-thyroxine in 6 months or more. The attainment of euthyroidism was seen as a partial effect due to a possibility of relapse. Results: in 6 months a positive result in the form of hypo-thyrosis was achieved for 39 patients in the main group, which accounted for 93%, and 3 patients (7%) experienced euthyroidism. No symptomatic thyrotoxicosis relapses were revealed. In the control group, hypo-thyrosis was achieved by 18 patients, which accounted for 72%; euthyroidism came up to 12%; 4 patients needed a refresher course of RIT, which made up 16% of the group. 93% of the main group patients tolerated the treatment favourably. 3 patients complained of the

  6. Development of Graves' ophthalmopathy and uveitis after radioiodine therapy for Graves' disease in a patient with HTLA-I associated myelopathy (HAM)

    Ozawa, Yasunori; Migita, Masayoshi; Watanabe, Tomoji; Okuda, Itsuko; Takeshita, Akira; Takagi, Akio; Shishiba, Yoshimasa (Toranomon Hospital, Tokyo (Japan))

    1994-09-01

    HTLV-I carriers or patients with HTLV-I associated myelopathy (HAM) are prone to immune-mediated inflammatory disorders. We present a 44-year-old female with HAM who developed Graves' disease. She developed severe Graves' ophthalmopathy shortly after [sup 131]I therapy, concurrently with a remarkable increase in TSH-receptor antibody titer. Ophthalmopathy was aggravated in spite of prednisolone therapy and euthyroidism being maintained by thyroxine replacement. Uveitis also developed after [sup 131]I therapy and iridocyclitis finally required trabeculotomy. This case suggests that HAM patients may have a higher risk of immune-mediated Graves' ophthalmopathy after [sup 131]I therapy.(author).

  7. Analysis of Graves' ophthalmopathy patients' tear protein spectrum

    JIANG Li-hong; WEI Rui-li

    2013-01-01

    Background Graves' ophthalmopathy/orbitopathy (GO) patients often suffer ocular surface damages and tear fluid proteins play a significant role in maintaining healthy ocular surfaces,while changes in tear protein components reflect the changes ocular surface abnormalities.In this study proteomics techniques were used to investigate tear protein compositions in GO patients.Methods We carried out a case-control study by comparing tear fluid contents of GO patients with that of healthy subjects.In the first step the tears were subjected to SDS-PAGE electrophoresis and then single protein bands were analyzed by to in-gel trypsin digestion and nano-flow liquid mass spectrometry (LC-MS/MS) using a MS software.Results In tear samples of GO subjects,the protein fractions of inflammation-related protein immunoglobulin kappa chain C region (IgKC) and serum albumin were essentially reduced,whereas a novel isoform of complement component 3 (C3),which we detected in control subjects,was completely absent in the GO patients' tears.Conclusions Reduced protein concentrations of particularly IgKC and complement C3 as well as albumin in the tears of GO patients may contribute to changes in their ocular surfaces via diminished reactive oxygen species (ROS) depletion and adaptive immune responses.The completely absent of C3 in the GO patients' tears,may imply that an important inflammatory signaling pathway is affected,which needs further investigation.

  8. Radioiodine therapy of benign thyroid diseases: Graves' disease - current aspects

    Radioiodine therapy is a reliable and cost-effective alternative to medical treatment of Graves' hyperthyroidism. Current recommendations favour a risk-adapted therapeutic procedure. Medical treatment is preferred in patients with a low risk of relapse which are characterised by the combination of female gender, age of onset above 40 years, thyroid volume below 40 ml and TSH-receptor antibodies below 10 U/l. Because of the poor remission rate with medical treatment in patients at less than 40 years of age, male gender, thyroid volume above 40 ml and TSH receptor antibodies above 10 U/l, it is suggested that definitive treatment with radioiodine or surgery should be considered soon after disease presentation. Analysis of cost-effectiveness clearly favour ablative radioiodine treatment. Ablative treatment is even more favourable in terms of early resumption of a normal life style of the hyperthyroid patient. Recent publications suggest further an adaptation of the tissue-absorbed dose to the pre-treatment thyroid volume using Marinelli's formula to achieve thyroid ablation with a single radioiodine treatment. (orig.)

  9. Optimal iodine-131 dose for eliminating hyperthyroidism in Graves' disease

    Since hypothyroidism is commonplace after treatment of Graves' disease with radioiodine, the goal should be cure of hyperthyroidism rather than avoidance of hypothyroidism. To find the optimal dose to accomplish cure, we treated 605 patients with stepwise increasing doses of 3, 4, 5, 6, 8, and 10 mCi, analyzing the relationship of dose, age, sex, gland weight, and thyroidal uptake to cure. Estimates of cure at doses above 10 mCi were made from the literature. Cure was directly related to dose between 5 and 10 mCi. There was no significant relationship between cure and age (chi-square, p = 0.74), sex (chi-square, p = 0.12), and 24-hr uptake if over 30% (chi-square for slope, p greater than 0.10). Cure and gland weight had an inverse relationship (chi-square for slope, 0.01 less than p less than 0.02). We concluded that the optimal 131I dose for curing hyperthyroidism is approximated by starting with 10 mCi and increasing it for unusually large glands or for special patient circumstances

  10. ¿Hay diferencias entre la violencia grave y la violencia menos grave contra la pareja?: un análisis comparativo

    Echeburúa, Enrique; Fernández Montalvo, Javier; Corral, Paz de

    2008-01-01

    En este estudio ex post facto se lleva a cabo una descripción de las características presentadas por 1.081 casos denunciados por violencia contra la mujer en las comisarías de la Ertzaintza del País Vasco. En primer lugar, se presentan las variables psicológicas y sociodemográficas del agresor y de la víctima, así como de la relación de pareja. Y en segundo lugar, se determinan las diferencias más significativas entre la violencia grave y la violencia menos grave en relación co...

  11. Early Christian Grave Monuments and the Eleventh-Century Context of the Monument Descriptor hvalf

    Cecilia Ljung

    2015-01-01

    This paper discusses the use of the term hvalf as a monument descriptor in Swedish runic inscriptions with special focus on its first appearance, connotations and historical context. The main emphasis lies on the word itself and its relationship to early Christian grave monuments (also known as Eskilstunacists). Evidence for the use of hvalf suggests that the term was employed to denote grave monuments as early as the first part of the eleventh century. Parallels in ornamentation and design l...

  12. Crystal Structure of a TSH Receptor Monoclonal Antibody: Insight Into Graves' Disease Pathogenesis

    Chen, Chun-Rong; Hubbard, Paul A.; Salazar, Larry M.; McLachlan, Sandra M.; Murali, Ramachandran; Rapoport, Basil

    2014-01-01

    The TSH receptor (TSHR) A-subunit is more effective than the holoreceptor in inducing thyroid-stimulating antibodies (TSAb) that cause Graves' disease. A puzzling phenomenon is that 2 recombinant, eukaryotic forms of A-subunits (residues 22–289), termed active and inactive, are recognized mutually exclusively by pathogenic TSAb and mouse monoclonal antibody 3BD10, respectively. Understanding the structural difference between these TSHR A-subunit forms could provide insight into Graves' diseas...

  13. Clinical applications of assays for thyrotropin-receptor antibodies in Graves' disease.

    Ginsberg, J; von Westarp, C

    1986-01-01

    Graves' disease is characterized by hyperthyroidism, diffuse goitre, infiltrative ophthalmopathy and, rarely, pretibial myxedema. In 1956 a substance capable of prolonged thyroid stimulation was discovered in the serum of some patients with Graves' disease and termed long-acting thyroid stimulator (LATS). It was shown to be an antibody that could interact with the receptor for thyroid-stimulating hormone (TSH). The term LATS is usually reserved for the activity measured in a laborious in-vivo...

  14. The Grave Goods of Roman Hierapolis: an analysis of the finds from four multiple burial tombs

    Indgjerd, Hallvard Rübner

    2014-01-01

    The Hellenistic and Roman city of Hierapolis in Phrygia, South-Western Asia Minor, boasts one of the largest necropoleis known from the Roman world. While the grave monuments have seen long-lasting interest, few funerary contexts have been subject to excavation and publication. The present study analyses the artefact finds from four tombs, investigating the context of grave gifts and funerary practices with focus on the Roman imperial period. It considers to what extent the finds influence an...

  15. Graves Disease with Exophtalmia in a Two-Year Old Child

    Hülya Yalçın; Bülent Akçora; Ali Balcı

    2011-01-01

    Thyrotoxicosis is one of the rare disorders diagnosed in childhood and adolescence. The most frequent cause is Graves disease. One of the Graves' disease complications is thyroid-associated orbitopathy. A 2-year-old girl was referred to our hospital for decreased weight gain. Her physical examination was normal except for a palpable thyroid tissue and exophtalmia. After laboratory examination, she was referred to the departments of nuclear medicine and radiology for the diagnosis of hyperthyr...

  16. Refractory Graves' Disease Successfully Cured by Adjunctive Cholestyramine and Subsequent Total Thyroidectomy.

    Yang, Yeoree; Hwang, Seawon; Kim, Minji; Lim, Yejee; Kim, Min Hee; Lee, Sohee; Lim, Dong Jun; Kang, Moo Il; Cha, Bong Yun

    2015-12-01

    The three major forms of treatment for Graves thyrotoxicosis are antithyroid drugs, radioactive iodine therapy and thyroidectomy. Surgery is the definitive treatment for Graves thyrotoxicosis that is generally recommended when other treatments have failed or are contraindicated. Generally, thyrotoxic patients should be euthyroid before surgery to minimize potential complications which usually requires preoperative management with thionamides or inorganic iodine. But several cases of refractory Graves' disease have shown resistance to conventional treatment. Here we report a 40-year-old female patient with Graves' disease who complained of thyrotoxic symptoms for 7 months. Her thyroid function test and thyroid autoantibody profiles were consistent with Graves' disease. One kind of thionamides and β-blocker were started to control her disease. However, she was resistant to nearly all conventional medical therapies, including β-blockers, inorganic iodine, and two thionamides. She experienced hepatotoxicity from the thionamides. What was worse is her past history of serious allergic reaction to corticosteroids, which are often used to help control symptoms. A 2-week regimen of high-dose cholestyramine improved her uncontrolled thyrotoxicosis and subsequent thyroidectomy was successfully performed. In conclusion, cholestyramine could be administered as an effective and safe adjunctive agent for preoperative preparation in patients with severe hyperthyroid Graves's disease that is resistant to conventional therapies. PMID:26394731

  17. Measurements of Actual Effective Half - Life in 131I Therapy for Graves' Hyperthyroidism

    Radioiodine[131I] has been used for the treatment of Graves' hyperthyroidism since the late 1940's and is now generally regarded as the treatment of choice for Graves' hyperthyroidism who does not remit following a course of antithyroid drugs. But for the dose given, several different protocols have been described by different centers, each attempting to reduce the incidence of long-term hypothyroidism while maintaining an acceptable rate control of Graves' hyperthyroidism. Our goals were to evaluate effective half-life and predict absorbed dose in Graves' hyperthyroidism patients, therefore, to calculate and read minister radioiodine activity needed to achieve aimed radiation dose. Our data showed that the mean effective 131I half-life for Graves' disease is 5.3 days(S.D=0.88) and mean biologic half-life is 21 days, range 9.5-67.2 days. The mean administered activity and the mean values of absorbed doses wet: 532 MBq(S.D.=254), 112 Gy (S.D.=50.9), respectively. The mean activity needed to achieve aimed radiation dose were 51 MBq and marked differences of 131I thyroidal uptake between tracer and therapy occurred in our study. We are sure that the dose calculation method that uses 5 days thyroidal 131I uptake measurements after tracer and therapy dose, provides sufficient data about the effective treatment in Graves' hyperthyroidism.

  18. Prognostic factors in the radiotherapy of Graves' ophthalmopathy

    Between April 1968 and February 1988, 311 patients with symptomatic and progressive Graves' ophthalmopathy were treated with megavoltage orbital radiotherapy. The patients were divided into three groups: I treated with 20 Gy/2 weeks; II treated with 30 Gy/3 weeks, and III received 20 Gy/2 weeks. The degree of eye involvement was evaluated numerically before and after therapy for each of five parameters: soft tissue signs, proptosis, eye muscle impairment, corneal involvement, and sight loss. Pre-treatment and current thyroid diagnosis and status were also noted. To evaluate the effects of radiotherapy alone, follow-up was terminated at the time any eye surgery was done; for those not treated surgically the minimum follow-up was 12 months. Because there were significant demographic differences between the patient groups, the results of each group were analyzed separately. A stepwise linear regression analysis was performed to determine if there were any significant variables affecting outcome. Based on these data formulae were derived which enable outcome to be predicted in any patient. Before therapy more than 90% of patients in all groups had soft tissue and eye muscle involvement, whereas 65-75% had proptosis and about half 50% had some degree of sight loss. Radiotherapy arrested progression of ophthalmic parameters in all but 1-6% of the patients. Objective and symptomatic improvement was noted for all parameters assessed, but there was marked individual variability. The best responses were noted for soft tissue, corneal involvement, and sight loss; however over half the patients had some improvement in eye muscle function and proptosis. Factors which resulted in less favorable outcome included male gender, advanced age, need for concurrent therapy for hyperthyroidism, and no history of hyperthyroidism. No complications have been observed

  19. Thyrotropin Receptor Epitope and Human Leukocyte Antigen in Graves' Disease.

    Inaba, Hidefumi; De Groot, Leslie J; Akamizu, Takashi

    2016-01-01

    Graves' disease (GD) is an organ-specific autoimmune disease, and thyrotropin (TSH) receptor (TSHR) is a major autoantigen in this condition. Since the extracellular domain of human TSHR (TSHR-ECD) is shed into the circulation, TSHR-ECD is a preferentially immunogenic portion of TSHR. Both genetic factors and environmental factors contribute to development of GD. Inheritance of human leukocyte antigen (HLA) genes, especially HLA-DR3, is associated with GD. TSHR-ECD protein is endocytosed into antigen-presenting cells (APCs), and processed to TSHR-ECD peptides. These peptide epitopes bind to HLA-class II molecules, and subsequently the complex of HLA-class II and TSHR-ECD epitope is presented to CD4+ T cells. The activated CD4+ T cells secrete cytokines/chemokines that stimulate B-cells to produce TSAb, and in turn hyperthyroidism occurs. Numerous studies have been done to identify T- and B-cell epitopes in TSHR-ECD, including (1) in silico, (2) in vitro, (3) in vivo, and (4) clinical experiments. Murine models of GD and HLA-transgenic mice have played a pivotal role in elucidating the immunological mechanisms. To date, linear or conformational epitopes of TSHR-ECD, as well as the molecular structure of the epitope-binding groove in HLA-DR, were reported to be related to the pathogenesis in GD. Dysfunction of central tolerance in the thymus, or in peripheral tolerance, such as regulatory T cells, could allow development of GD. Novel treatments using TSHR antagonists or mutated TSHR peptides have been reported to be effective. We review and update the role of immunogenic TSHR epitopes and HLA in GD, and offer perspectives on TSHR epitope specific treatments. PMID:27602020

  20. The interleukin-1 family gene polymorphisms and Graves' disease.

    Khalilzadeh, O; Anvari, M; Esteghamati, A; Momen-Heravi, F; Mahmoudi, M; Rashidi, A; Amiri, H M; Ranjbar, M; Tabataba-Vakili, S; Amirzargar, A

    2010-09-01

    Genetic factors, including cytokine gene polymorphisms, are potential contributors to the pathogenesis of the Graves' disease (GD). We attempted in this study to determine the association between GD and the following polymorphisms in the interleukin-1 (IL-1) family genes: IL-1alpha (-889C/T), IL-1ss (-511C/T), IL-1ss (+3962C/T), IL-1R (Pst-1 1970C/T) and IL-1RA (Mspa-I 11100C/T). We studied 107 patients with an established diagnosis of GD and 140 healthy controls. Cytokine typing was performed by the polymerase chain reaction with sequence-specific primers assay. Genotype distributions among patients were in Hardy-Weinberg equilibrium for all polymorphisms. The frequency of the IL-1alpha -889T allele was significantly higher in patients than in controls (51.9% vs. 31.6%, OR=2.33, 95% CI=1.61-3.38; p<0.0001). The IL-1RA Msp-I 11100C allele was significantly more frequent in patients than in controls (50.0% vs. 22.9%, OR=3.38, 95% CI=2.29-4.97, p<0.0001). No significant associations were found for other polymorphisms. Although the IL-1 family has well-known roles in GD pathogenesis, the contributions of their genetic variations to the disease are unclear. In this study, we documented a highly significant association between GD and polymorphism in IL-1alpha and IL-1RA genes. Further studies in other populations are necessary to confirm our results. PMID:20400062

  1. Current trends in the management of Graves' disease

    Members of the American Thyroid Association were invited to participate in a survey of the management of Graves' disease. One primary case and several variations were provided, which differed in respect to age, sex, goiter size, severity, etc. The questionnaire was based on the format used in a similar survey of members of the European Thyroid Association. The aim of the survey was to determine (1) how expert thyroidologist employ diagnostic procedures for this disorder, and (2) the choice of therapy of the three treatment options and its manner of implementation. Questionnaires were sent only to clinically active members. The overall response rate was 62%. Data analysis was possible on 52% of members surveyed and was performed using SPSS and a specific Fortran program. In the laboratory evaluation of the primary case a radioiodine uptake, scan, serum total T4, and basal TSH were requested by 92%, 47%, 83%, and 66%, respectively, with 84% of respondents using an ultrasensitive TSH assay. For management of the primary case, radioiodine treatment was the first choice of 69% of the respondents. Antithyroid drugs were used briefly (3-7 days) before 131I by 28%, whereas 41% said they would employ thioureas after 131I. Of those using 131I, 66% tailored the dose to achieve euthyroidism as the goal of therapy, while 34% aimed for hypothyroidism requiring T4 replacement. Only 30% of respondents chose thioureas as a first line of treatment (72% propylthiouracil; 28% tapazole). The duration of drug therapy was a predetermined fixed interval for 80% of the respondents, with 90% treating for 1-2 yr. Other specific trends in diagnostic approach and therapeutic preferences were identified for the eight variations on the primary case problem

  2. Radiotherapy for Graves' orbitopathy: results of a national survey

    Background: Graves' orbitopathy (GO) is a widely accepted indication for radiation therapy (RT). In conjunction with the German Cooperative Group on Radiotherapy for Benign Diseases (GCG-BD), a national survey was conducted in order to assess whether or not there is a consensus on the indication for RT and various treatment factors which were studied. Material and Methods: A questionnaire was circulated to 190 RT institutions to obtain relevant data concerning the patients' workload, stage-dependent indication, and diagnostic procedures, which were considered to be necessary. Further questions addressed details on radiation technique and dose-fractionation schedules, the combined use of corticoids, and salvage RT after previous treatment failure following RT. Results: With a response rate of 152/190 (80%), the survey is nationally representative. Based on the case workload, an estimated annual number of 1,600 GO cases are treated in German radiotherapy departments. With an 88% consensus, stages II-V are the typical indications. 85% considered imaging studies necessary for indication and only 48% for laboratory tests. 76% of the institutions used total doses in the range of 15-20 Gy, and conventional fractionation was most common (57%). 82% used a face mask fixation and 67% CT-based treatment planning. Approximately 50% would prescribe salvage RT, and total doses in the range of 20-40 Gy were considered to be acceptable. Conclusions: The survey revealed a consensus concerning most of the factors studied. We recommend to review the patterns of care for RT of other entities of benign diseases and to implement a quality assurance program both on national and international levels. (orig.)

  3. Prise en charge des traumatismes graves du rein

    Lakmichi, Mohamed Amine; Jarir, Redouane; Sadiki, Bader; Zehraoui; Bentani; Wakrim, Bader; Dahami, Zakaria; Moudouni; Sarf, Ismail

    2015-01-01

    Les traumatismes graves du rein de grade III, IV et V selon la classification de l'Amercan Society for Surgery For Trauma (ASST) sont plus rares et se retrouvent dans 5% des cas en moyenne. Leur prise en charge est souvent délicate, nécessitant alors des centres expérimentés dotés de moyen adéquats d'imagerie (scanner spiralé). Cependant, durant ces dernières années, la prise en charge de ces traumatismes a évolué vers une attitude de moins en moins chirurgicale grâce à l’évolution des techniques de la radiologie interventionnelle, de l'endourologie et des moyens de surveillance aux urgences et de réanimation. L'objectif de cette étude est d’évaluer notre expérience dans la prise en charge des traumatismes rénaux de haut grade. Notre étude rétrospective porte sur 25 cas de traumatismes grave du rein de grade III, IV et V selon la classification de l'ASST, colligés entre Janvier 2002 et Juin 2009 au service d'urologie du centre Hospitalier Universitaire Mohammed VI, Université Cadi Ayyad de Marrakech, Maroc. Nous avons étudié les données épidémiologiques, les signes cliniques et biologiques à l'admission (état de choc hémorragique, taux d'hémoglobine), les données radiologiques (échographie et scanner), les lésions associées, la prise en charge thérapeutique et les complications. L’âge moyen de nos patients était de 24,9 ans 15 et 58 ans, avec une prédominance masculine (sex-ratio = 7, 3). Le rein droit était intéressé dans 15 cas (60%). Le traumatisme rénal était fermé dans 15 cas, et ouvert par arme blanche dans 10 cas. Huit patients se sont présentés en état de choc hémorragique (32%). Une anémie inférieur à 10g /100ml a été observée dans 10 cas (40%). L'uroscanner fait systématiquement à l'admission a retrouvé un grade III (10 cas), grade IV (13 cas) et grade V (2 cas). La prise en charge a consisté en une exploration chirurgicale avec néphrectomie chez 2 cas de Grade IV pour une instabilité h

  4. Peligro de aluviones en el departamento Pocito, provincia de San Juan Alluvial hazard in the department of Pocito, province of San Juan

    L.P. Perucca

    2005-03-01

    Full Text Available Los aluviones repentinos representan uno de los principales peligros geológicos que afectan el departamento Pocito. Las aguas de lluvias torrenciales ocurridas durante los meses de verano, pueden dar lugar, en sólo algunas horas, a violentos aluviones caracterizados por su alta velocidad, poca profundidad, gran carga de sedimentos y detritos. El fenómeno se agrava cuando se reduce el índice de infiltración debido a lluvias previas. Estos torrentes se generan en la zona montañosa, con fuerte pendiente. La extensión del área de las unidades activas en el piedemonte de la sierra de Zonda se determinó a través del estudio de fotografías aéreas y de mapas con la topografía de la zona. Las áreas activas se ubicaron topográficamente por debajo de las unidades más antiguas del piedemonte. En la planicie aluvial pedemontana, donde se encuentra la zona urbana y rural, los aluviones se han restringido a las calles 13 y 15, orientadas paralelas a la dirección de flujo. Durante las lluvias torrenciales, estas calles se convierten en verdaderos cauce fluviales, mientras que en las calles orientadas perpendicularmente a las anteriores, los daños son mayores.En este trabajo se realiza la evaluación de los aspectos hidrológicos de una cuenca de régimen torrencial, como es la del arroyo La Lechuza, causante de la mayoría de los daños en el departamento. Los efectos de estos eventos pueden ser minimizados a través del establecimiento de un sistema de predicción y alerta, de la educación pública y toma de medidas estructurales.Torrential rains during summer can cause violent floods that are characterized by high speeds, relatively shallow depths and a great sediments and debris loading during a short time. The phenomenon is aggravated when the infiltration index reduce due to previous rains that saturate the area. These torrents are generated in the mountainous zone, with high gradient that erode the existing rocks and carried loose

  5. Morbidade Materna Grave e Near Misses em Hospital de Referência Regional

    Márcia Lait Morse

    2011-06-01

    Full Text Available OBJETIVO: Analisar perfil epidemiológico da morbidade materna grave/near miss em uma maternidade pública de referência regional, utilizando diferentes critérios identificadores. MÉTODOS: Trata-se de um estudo descritivo de corte transversal dos casos de morbidade materna grave/near miss realizado em Hospital de referência regional entre junho e outubro de 2009, identificados a partir dos livros de registro de internação da maternidade e análise dos prontuários clínicos. Foram estudadas mulheres que, durante a gestação, parto ou puerpério, apresentaram qualquer quadro clínico compatível com os critérios definidores de morbidade materna grave/near miss de Waterstone et al., Mantel et al. e Organização Mundial de Saúde. RESULTADOS: Entre as 1.544 internações foram identificadas 89 mulheres com morbidade materna grave, considerando os critérios adotados. As razões de morbidade materna grave/near miss variaram entre 81,4 a 9,4 por 1.000 NV, dependendo do critério utilizado. O índice de Mortalidade foi de 3,2%, chegando a 23% no critério da OMS. Das 89 mulheres, apenas 40% fizeram mais de seis consultas de pré-natal e 10% não realizaram qualquer consulta. Os marcadores mais encontrados foram a pré-eclâmpsia grave seguida de hemorragia grave, internação em UTI, Síndrome HELLP e eclâmpsia. Ocorreram três mortes maternas por causas obstétricas com RMM de 280/100.000 NV e uma morte tardia. O critério da OMS se mostrou mais específico, identificando os casos mais graves, enquanto o de Waterstone foi mais sensível. CONCLUSÃO: O estudo da morbidade materna grave/near miss em um hospital de referência regional pode contribuir para o conhecimento da magnitude deste evento, como também identificar suas características e condições clínicas mais frequentes, sendo extremamente importante para o enfrentamento da morbi-mortalidade materna.

  6. Induction of animal model of Graves' disease in BALB/c mice

    Zhu-fang Tian; Bing-yin Shi; Xiao-yan Wu; Li Xu

    2009-01-01

    Objective To construct an animal model of Graves' disease (GD) by immunizing BALB/c mice with hM12 cells co-expressing major histocompatibility complex (MHC) class Ⅱ molecules and human thyrotropin receptor (TSHR) molecules. Methods BALB/c mice in experimental group (H-2d) were immunized with hM12 cells Intraper-itoncally every 2 weeks for six times, while mice in control group were immunized with M12 cells. Five weeks later, the thyroids were histologically examined, and serum samples were tested for thyroid-stimulating antibodies (TSAb) and thyroid hormone levels. Results One BALB/c mouse in experimental group developed Graves'-like disease. Total T4 and T3 levels in this mouse were above the upper limit of normal, TSAb activity was displayed in its serum. The thyroid histologically showed the features of thyroid hyperactivity including thyrocyte hypercellularity and colloid absorption.None of control mice developed Graves'-like disease. Conclusion An animal model with some characteristics of human Graves' disease was successfully induced and the model will facilitate studies aimed directly at understanding the patho-genesis of autoimmunity in Graves' disease.

  7. Change in Practice over Four Decades in the Management of Graves' Disease in Scotland

    Smith, D. M.; Dutta, S.; Ahmed, F.; Thaha, M. A.

    2016-01-01

    There is continuing debate on the optimal treatment for Grave's thyrotoxicosis with a resultant variation in clinical practice. The present study aimed to ascertain changes in practice in the treatment of Grave's thyrotoxicosis in Tayside, Scotland, over the past four decades. Methods. The “Scottish automated follow-up register” (SAFUR) was queried to identify all patients treated for Grave's thyrotoxicosis from 1968 to 2007 inclusive. Patients were divided into 4 groups (Groups A to D) according to the decades. Demographic profile, treatment modalities, radioactive iodine (RAI) dose, and recurrence rates were studied and outcomes were compared by χ2 test and ANOVA using SPSS v15.0. A p value of < 0.05 was considered significant. Results. Altogether, 3737 patients were diagnosed with Grave's thyrotoxicosis over the 4 decades. Use of RAI has increased from 43.1% in Group A to 68% in Group D (p < 0.001). The dose of RAI has increased (p < 0.001) and there has been a reduction in recurrence rate with higher dose of RAI. Surgical intervention rates decreased from 55.3% to 12.3% (p < 0.001) over time. Conclusions. Analysis of a large dataset of patients with Grave's thyrotoxicosis suggests increasing use of RAI as the preferred first line of treatment. Furthermore, using a single higher dose of RAI and adoption of total thyroidectomy have decreased recurrence rates. PMID:27313946

  8. Magnetic Ghosts: Mineral Magnetic Measurements On Roman and Anglo-saxon Graves

    Linford, N.

    The location of inhumations, in the absence of ferrous grave goods, often presents a considerable challenge to archaeological geophysics given the small physical size of the features and the slight contrast between the fill of the grave and the surround- ing subsoil. Even during excavation, the identification of graves may be complicated where site conditions do not favour the preservation of human skeletal remains and often only a subtle soil stain is likely to survive. A recent initiative in the United King- dom has seen the formation of the Buried Organic Matter Decomposition Integrated with Elemental Status (BODIES) research group, to examine the decomposition of organic artefacts in ancient graves with respect to localised changes in pH, redox po- tential and nutrient status. This paper presents initial results from a limited mineral magnetic study of two grave sites in an attempt to ascertain whether the decomposi- tion of organic remains may lead to a detectable magnetic signature within the soil. Results from a series of isothermal, hysteresis and magneto-thermal experiments will be presented together with surface magnetometer and topsoil susceptibility surveys.

  9. Two adolescent patients with coexistent Graves' disease and Moyamoya disease in Korea.

    Cheon, Chong Kun; Kim, Su Yung; Yoo, Jae-Ho

    2014-06-01

    Moyamoya disease is a cerebrovascular condition that results in the narrowing of the vessels of the circle of Willis and collateral vessel formation at the base of the brain. Although relationships between Graves' disease and cerebrovascular accidents in Moyamoya disease are obscure, the coexistence of the two diseases is noteworthy. Moyamoya disease has been rarely reported in adolescent patients with thyrotoxicosis. Recently, we encountered two adolescent Korean patients with Moyamoya disease associated with Graves' disease who presented with episodic right-sided hemiparesis and syncope. These two girls who had Graves' disease had no history of other diseases or head trauma. A thyroid function test revealed a euthyroid state and a high thyroid-stimulating hormone (TSH) receptor antibody titer at that time. The patients were diagnosed with Moyamoya disease based on brain magnetic resonance angiography and cerebral four-vessel angiography. The patients underwent cranial revascularization by encephalo-duroarterio-synangiosis as soon as a diagnosis was made, which resulted in successful symptom resolution. They fared well and had no additional neurological symptoms as of their last follow-up visits. Here, we report these two cases of confirmed Moyamoya disease complicated by Graves' disease with a review of the literature, and discuss the possible association between the two diseases. To our knowledge, this is the first report in South Korea on Moyamoya disease associated with Graves' disease in adolescents with a euthyroid. PMID:25076974

  10. The change of serum TRAb after 131I radiotherapy in patients of Graves' hyperthyroidism

    Objective: The clinical value of thyrotrophin receptor antibody (TRAb) in patients with Graves' hyperthyroidism was investigated during 131I radiotherapy. Methods: A total of 130 patients with Graves' hyperthyroidism and 50 normal controls were included in the study. Serum concentration of TRAb was measured by radioreceptor assay (RRA) before and at 3, 6, 12 and 24 months after 131I radiotherapy. Results: Abnormally higher TRAb level [(92.93±68.99)U/L] was noted in patients before treatment(P131I radiotherapy, the TRAb [(12.99±5.52) U/L] was back to normal with no difference to that of controls (P>0.05). Conclusion: Serum concentration of TRAb was of clinical significance in the diagnosis of Graves' hyperthyroidism and in the monitoring of 131I radiotherapy. (authors)

  11. La nutrición enteral precoz en el enfermo grave

    B. García Vila; Grau, T

    2005-01-01

    La nutrición enteral se ha demostrado como un método eficaz y seguro de nutrir a los enfermos graves ingresados en una Unidad de Cuidados Intensivos. Aunque se desconoce cuánto tiempo puede estar un enfermo grave sin nutrición, el catabolismo acelerado y el ayuno pueden ser deletéreos en el enfermo grave y la recomendación más frecuente es la de empezar la nutrición artificial cuando se prevea un período de ayuno superior a los siete días. Las ventajas de la nutrición enteral sobre la nutrici...

  12. Graves, Ancestors and Cement in Land disputes in Acholi and Ikland, Uganda

    Meinert, Lotte; Willerslev, Rane; Seebach, Sophie Hooge

    2016-01-01

    The paper explores the roles of graves, ancestors and concrete pillars in disputes over land across different land-systems, -conflicts, and territory making in northern Uganda by comparing extended cases between Acholi in Gulu district and Ik in Kaabong district . In the post-conflict Acholi region...... land can be a strategy in land disputes. In Ikland graves have traditionally not marked land claims and boundaries have been highly fluid, but the placing of the dead in valleys between the mountains has marked belonging to the larger landscape and territory. Due to inter-ethnic conflicts as well as...... ownership of land in attempts to create permanence. Both new and old authorities use material tokens and spiritual principles concerning the dead to establish evidence and trust in their authority to govern. The perceived material qualities of cement for graves and land markers as endurable and modern play...

  13. Acute effects of radioiodine therapy on the voice and larynx of basedow-Graves patients

    Graves's disease is the most common cause of hyperthyroidism. There are three current therapeutic options: anti-thyroid medication, surgery, and radioactive iodine (I 131). There are few data in the literature regarding the effects of radioiodine therapy on the larynx and voice. The aim of this study was: to assess the effect of radioiodine therapy on the voice of Basedow-Graves patients. Material and method: A prospective study was done. Following the diagnosis of Grave's disease, patients underwent investigation of their voice, measurement of maximum phonatory time (/a/) and the s/z ratio, fundamental frequency analysis (Praat software), laryngoscopy and (perceptive-auditory) analysis in three different conditions: pre-treatment, 4 days, and 20 days post-radioiodine therapy. Conditions are based on the inflammatory pattern of thyroid tissue (Jones et al. 1999). Results: No statistically significant differences were found in voice characteristics in these three conditions. Conclusion: Radioiodine therapy does not affect voice quality. (author)

  14. Del compromiso a la desvinculación corporal. Un enfoque sociológico plural de las dinámicas, rupturas y permanencias identitarias ante la aceptación del peligro en los deportes en la naturaleza

    Guillaume Routier

    2013-12-01

    Full Text Available Desafiar o jugar con la gravedad, explorar las profundidades y poner su resistencia o simplemente su cuerpo a prueba, competir con los elementos naturales frecuentando un ambiente que es, a priori, hostil: tantas formas de exposición al peligro a través del deporte que fascinan e intrigan a la vez. Este trabajo es una exploración de los procesos de compromiso corporal y de la retirada, considerados en sus aspectos epistémicos y empíricos. Dos preguntas dirigen este análisis: 1 ¿cómo concebir el compromiso corporal, a través del diálogo y la complementariedad entre los patrones de inteligibilidad; 2 más específicamente, ¿cómo se convierte uno en practicante de estas actividades y, por qué de repente, una persona se decide a abandonar?

  15. Aplicación del sistema de análisis de peligros y puntos de control crítico (APPCC en la línea de elaboración de aceite de oliva virgen

    Alvarruiz, A.

    2002-09-01

    Full Text Available The Hazard Analysis and Critical Control Point (HACCP is a preventive system which tries to ensure the food safety and wholesomeness and allows us product protection and flaw correction. Quality control costs are therefore reduced, since final super-control becomes almost unnecessary. In this work the hazards that can be found in a processing line of virgin olive oil are described, as well as the preventive actions which can be taken in the oil mill, the surveillance systems to be implemented, the eventual corrective actions and the records to be kept by the plant. The implementation of these principles would make possible, for any oil mill (regardless of the system used for solid-liquid separation, a production self-control based on the HACCP system.El Análisis de Peligros y Puntos de Control Crítico (APPCC es un sistema preventivo que trata de garantizar la seguridad e inocuidad alimentaria, y que permite la protección del producto y la corrección de fallos, mejorando los costes de calidad por defectos y ahorrando casi el supercontrol final. En este trabajo se describen los peligros propios que se pueden encontrar en la línea de elaboración de aceite de oliva virgen, las medidas preventivas que se pueden aplicar en la almazara y los sistemas de vigilancia a implantar, así como las medidas correctoras previstas, en caso de ser necesarias, y los registros de control que deberán quedar en la industria. La puesta en práctica de estos conocimientos permitirá, a cualquier tipo de almazara (con independencia del sistema de separación sólido - líquido utilizado, un autocontrol de sus producciones basado en el sistema APPCC.

  16. ¿Hay diferencias entre la violencia grave y la violencia menos grave contra la pareja?: un análisis comparativo

    Enrique Echeburúa; Javier Fernández-Montalvo; Paz de Corral

    2008-01-01

    En este estudio ex post facto se lleva a cabo una descripción de las características presentadas por 1.081 casos denunciados por violencia contra la mujer en las comisarías de la Ertzaintza del País Vasco. En primer lugar, se presentan las variables psicológicas y sociodemográficas del agresor y de la víctima, así como de la relación de pareja. Y en segundo lugar, se determinan las diferencias más significativas entre la violencia grave y la violencia menos grave en relación con esas mismas v...

  17. Radioreceptor assay study of thyrotropin receptor antibody (TRAb) in Grave's diseases

    Here was reported the assay system using pig thyroid TSH receptor and 125I-bTSH purified by receptor of thyroid cell membrane for the study of TRAb activity. The binding rate of ASH soluble receptor with 125I-bTSH was 22.2 ∼ 37.4%, while as the control was only 1.0 ∼ 2.1%. TRAb was measured clinically in 48 cases of Grave's diseases and 25 normal persons. The TSH binding inhabitory index(TRII) was introduced for reflection of TRAb activity. The results showed that TBII was positure in 30 of 48 patients of Grave's diseases, the detctactibility was 79.2%

  18. Dual thyroid ectopia with Graves' disease: a Case Report and a review of the literature

    Ectopic thyroid of thyroid ectopia is a rare developmental anomaly with the prevalence of 1 per 100,000 300,000 population. Even rarer, such an anomaly manifests as dual thyroid ectopia. To our best knowledge, only one case has been reported on dual thyroid ectopia with graves' disease in the Eglish literature. We present here a case of dual thyroid ectopia complicated by graves' disease, where by the diagnosis was rendered through judicious use of various diagnostic modalities coupled with a close clinical follow up. In this case, therapeutic consideration should be personalized with proper informed consent of the patient

  19. La libertad condicional en el caso de enfermos graves de cáncer

    de las Heras Vives, Luis

    2015-01-01

    El presente trabajo tiene como objetivo ofrecer una visión práctica sobre el instituto de la libertad condicional en el caso de enfermos graves de cáncer. En primer lugar, se realiza un análisis de la normativa aplicable y delimita el concepto de 'enfermedad muy grave'. En segundo lugar, se exponen los argumentos jurídico-éticos que la justifican, así como los criterios utilizados por la jurisprudencia a la hora de ponderar los bienes y derechos en conflicto, a saber; el derecho a la vida del...

  20. Hipertrigliceridemia familiar grave durante a gestação Severe familial hypertriglyceridemia during pregnancy

    Luiz Augusto Casulari; Myrian Wesgueber; Ricardo Cassiano B. Silva; Henrique F. Soares; Lucilia Domingues

    2001-01-01

    A presença de hipertrigliceridemia grave durante a gravidez é rara, mas comporta grande possibilidade de desenvolver complicações, como a pancreatite aguda, que coloca em risco a mãe e o feto. Apresentamos o relato da evolução da gestação de uma paciente portadora de hipertrigliceridemia grave que havia apresentado pancreatite aguda dois meses antes da fecundação. Foi tratada durante o pré-natal com dieta e 3,0 g de ácidos graxos de cadeia ômega-3 (ácidos eicosapentaenóico 14% e docosahexaenó...

  1. The Roma: People without a Home or Grave

    Vera Klopčič

    2010-12-01

    Full Text Available Although the Roma have been living in Europe for centuries, they still face rejection by majority populations, being treated as undesirable strangers in almost all European countries. Written evidence of their arrival can be traced back to the fourteenth and fifteenth centuries. There are many legends and myths about their origins and reasons for emigrating from their country of origin. Until recently, the Roma transmitted their own history only as oral tradition. One of the best-known contemporary Roma intellectuals, journalist and writer Rajko Djurić, picturesquely explains the importance of the Romany language for further exploration of Roma culture and their origin: “Romany is the only book they brought from India; it constitutes their collective memory and reflects the views of this people, to themselves, to the world, and to other peoples. Their language is an inventory of the material and spiritual culture to which they once belonged, and contains elements of culture of other peoples that they came into contact with during their long and yet insufficiently studied journey.” When the Roma arrived in Europe, their lifestyle differed significantly from that of other European peoples. As a result, majorities and other groups in Europe intervened in their lives for centuries. They were forced to abandon their nomadic way of life. In the past, authorities often expelled them from their territory and they did not enjoy legal protection when violence or crimes were committed against them. Living in isolated settlements, excluded from social life, segregated, and discriminated against by others, they lived on the margins as a people without a home or a grave. At the same time, they established their parallel world as a system of social norms valid within their community, and within it all non-Roma were perceived as gadje ‘outsiders’. Roma legends explain the reasons for their nomadic way of life: they contain stories of persecution and

  2. TSH receptor antibody titers measured with a third-generation assay did not reflect the activity of Graves' ophthalmopathy in untreated Japanese Graves' disease patients.

    Mukasa, Koji; Yoshimura Noh, Jaeduk; Kouzaki, Ai; Ohye, Hidemi; Kunii, Yo; Watanabe, Natsuko; Yoshihara, Ai; Matsumoto, Masako; Suzuki, Miho; Ito, Koichi

    2016-02-29

    TSH receptor antibody (TRAb) titer has been reported to be correlated with Graves' ophthalmopathy (GO). However, the correlation between GO activity and TRAb titer assessed with a third-generation assay has not been reported. We enrolled 238 untreated Graves' disease patients who came to the outpatient clinic of Ito Hospital and 28 patients who were euthyroid. All of the patients were assessed for GO by an ophthalmologist within 3 months of their initial visit to Ito Hospital. Clinical activity score (CAS), short inversion time inversion recovery (STIR), and sum of the maximum external orbital muscle areas (SEOMA) on a frontal sectional magnetic resonance imaging (MRI). The TRAb titer was significantly higher in patients with inactive ophthalmopathy (the inactive-GO group) than in patients with active ophthalmopathy (the active-GO group) (17.7 ± 13.5 IU/L vs 13.0 ± 13.1 IU/L, p=0.0082). The SEOMA values were not correlated with TRAb titer. The prevalence of active-GO was higher in euthyroid patients than in hyperthyroid patients although the difference was not significant. In conclusion, TRAb titer measured with a third-generation assay dose not correlate with GO activity based on MRI findings in untreated Graves' disease patients, and the prevalence of active-GO is higher in euthyroid patients with lower TRAb titers than in hyperthyroid patients. PMID:26581710

  3. Role of insulin-like growth factor-1 (IGF-1) pathway in the pathogenesis of Graves' orbitopathy

    Smith, Terry J; Hegedüs, Laszlo; Douglas, Raymond S

    2012-01-01

    The etiology of Graves' orbitopathy (GO) remains enigmatic and thus controversy surrounds its pathogenesis. The role of the thyroid stimulating hormone receptor (TSHR) and activating antibodies directed against it in the hyperthyroidism of Graves' disease (GD) is firmly established. Less well elu...

  4. Application of new therapies in Graves' disease and thyroid-associated ophthalmopathy: animal models and translation to human clinical trials

    Banga, J Paul; Nielsen, Claus H; Gilbert, Jacqueline A;

    2008-01-01

    immunosuppression. The recent development of an induced model of experimental Graves' disease, although incomplete as it lacks the extrathyroidal manifestations, provided opportunities to investigate immune intervention strategies, including influence upon the autoreactive B and T cell players in the autoimmune...... process. These major advances are generating new possibilities for therapeutic interventions for patients with Graves' disease and TAO....

  5. Anxiety and Depression Are More Prevalent in Patients with Graves' Disease than in Patients with Nodular Goitre

    Bové, Kira Bang; Watt, Torquil; Vogel, Asmus Mejling;

    2014-01-01

    BACKGROUND AND OBJECTIVE: Graves' disease has been associated with an increased psychiatric morbidity. It is unclarified whether this relates to Graves' disease or chronic disease per se. The aim of our study was to estimate the prevalence of anxiety and depression symptoms in patients with Graves......' disease compared to patients with another chronic thyroid disease, nodular goitre, and to investigate determinants of anxiety and depression in Graves' disease.METHODS: 157 cross-sectionally sampled patients with Graves' disease, 17 newly diagnosed, 140 treated, and 251 controls with nodular goitre...... completed the Hospital Anxiety and Depression Scale (HADS). The differences in the mean HADS scores between the groups were analysed using multiple linear regression, controlling for socio-demographic variables. HADS scores were also analysed dichotomized: a score >10 indicating probable 'anxiety...

  6. Accidentes, decisiones y sorpresas: Un relato acerca de cómo es posible abordar las transformaciones de urbanizaciones populares en el Área Metropolitana de Buenos Aires

    María Mercedes Di Virgilio

    2012-04-01

    Full Text Available El objetivo de este artículo es presentar la trastienda de una investigación que se propuso describir y comprender cómo se han transformado las urbanizaciones de origen informal, sus viviendas y sus habitantes, en el Área Metropolitana de Buenos Aires. Esta investigación se inserta en el marco de un estudio multicéntrico, del que forman parte diferentes ciudades de América Latina, bajo el proyecto: “The rehabilitation of consolidated irregular settlements in Latin American Cities: Towards a ‘third generation’ of public policy analysis and development”, desarrollado por la Latin American Housing Network, Universidad de Texas (Austin. Aquí presentamos la estrategia metodológica adoptada, las técnicas y los pasos definidos para abordar nuestro objeto de estudio a nivel local y su articulación con un proyecto de carácter colectivo que involucra no sólo investigadores de distintas ciudades sino también de diferentes disciplinas. Nuestro propósito es mostrar la realidad de este proceso investigativo, con sus accidentes e imprevistos y las decisiones adoptadas para superarlos

  7. The natural history and prognostic factors of Graves' disease in Korean children and adolescents

    Seung Min Song

    2010-04-01

    Full Text Available Purpose : Graves' disease is the most common cause of hyperthyroidism in children and adolescents. In this study, we investigated the natural course and the prognostic factors of Graves' disease in Korean children and adolescents. Methods : One-hundred thirteen (88 girls and 25 boys patients were included in this study. A retrospective analysis was made of all patients who were diagnosed with Graves' disease. The following parameters were recorded and analyzed: patient's sex, age at diagnosis, duration of disease, laboratory findings, symptoms and signs, and family history of autoimmune thyroid disease. Results : All patients were initially treated with antithyroid drugs, either methimazole (93.8% or propylthiouracil (6.2%. Antithyroid drugs had been discontinued in 75 (66.4% of 113 patients. Of these 75 patients, 23 (20.4% relapsed after 25.5¡?#?3.7; months. Thirteen (11.5% of 23 patients, who experienced the first relapse, showed a second remission. However, 2 (1.8% of 13 patients relapsed again. Euthyroid state could not be achieved by antithyroid drugs in 1 patient, and radioactive iodine therapy was performed. The older the patient at diagnosis, the greater the likelihood of remission (P =0.034. Conclusion : Age at diagnosis seems to be a prognostic factor in Korean children and adolescents with Graves' disease, and should be taken into account in treatment plan determination.

  8. Regulation mechanisms of pituitary-thyroid axis in normal subjects and patients with Graves' disease

    The regulatory mechanism of the pituitary-thyroid axis in normal subjects and patients with Graves' disease was investigated using a highly sensitive TSH assay based on the immunoradiometric assay. All of the normal subjects had detectable TSH values within the range 0.35 to 6.0 μU/ml. No negative correlations between TSH and free thyroid hormones existed in normal subjects. Patients with thyroid carcinoma who seemed to have normal pituitary-thyroid function showed a rapid increase of TSH after total thyroidectomy. On the other hand, while untreated patients with Graves' disease all had undetectable TSH values, these patients took 1 to 3.5 months longer to normalize their TSH values than to normalize free thyroid hormones on antithyroid drug therapy. During the recovery phase by the treatment with decrease of antithyroid drug or supplement of T4 from iatrogenic hypothyroid state after treatment for Graves' disease and thyroid carcinoma, normalization of TSH levels was delayed than that of free thyroid hormones. Patients with Graves' disease in remission showed an extremely positive correlation between basal and peak TSH levels in TRH test, and a negative correlation between basal TSH and FT4. In conclusion, an individual patient may have a different set point concerning the regulatory mechanism of the pituitary-thyroid axis, and the persistence of the hyperthyroid state would seem to have caused some reversible dysfunction of the pituitary gland. (author)

  9. B lymphocyte depletion with the monoclonal antibody rituximab in Graves' disease: a controlled pilot study

    El Fassi, Daniel; Nielsen, Claus H; Bonnema, Steen J; Hasselbalch, Hans K; Hegedüs, Laszlo

    2007-01-01

    Graves' disease (GD) is a common TSH receptor autoantibody (TRAb)-mediated disorder. Because B lymphocytes are important self-antigen presenting cells and precursors for antibody-secreting plasma cells, temporary B-lymphocyte depletion with the monoclonal antibody rituximab (RTX) might be of...

  10. Multiple Fractures in Patient with Graves' Disease Accompanied by Isolated Hypogonadotropic Hypogonadism.

    Yi, Hyon-Seung; Kim, Ji Min; Ju, Sang Hyeon; Lee, Younghak; Kim, Hyun Jin; Kim, Koon Soon

    2016-02-01

    Isolated hypogonadotropic hypogonadism (IHH) is known to decrease bone mineral density due to deficiency of sex steroid hormone. Graves' disease is also an important cause of secondary osteoporosis. However, IHH does not preclude the development of primary hyperthyroidism caused by Graves' disease, leading to more severe osteoporosis rapidly. Here, we describe the first case of 35-year-old Asian female patient with IHH accompanied by Graves' disease and osteoporosis-induced multiple fractures. Endocrine laboratory findings revealed preserved anterior pituitary functions except for secretion of gonadotropins and showed primary hyperthyroidism with positive autoantibodies. Sella magnetic resonance imaging showed slightly small sized pituitary gland without mass lesion. Dual energy X-ray absorptiometry revealed severe osteoporosis in lumbar spine and femur neck of the patient. Plain film radiography of the pelvis and shoulder revealed a displaced and nondisplaced fracture, respectively. After surgical fixation with screws for the femoral fracture, the patient was treated with antithyroid medication, calcium, and vitamin D until now and has been recovering fairly well. We report a patient of IHH with Graves' disease and multiple fractures that is a first case in Korea. PMID:26981520

  11. 77 FR 23196 - Native American Graves Protection and Repatriation Act Regulations

    2012-04-18

    ... American Tribal Governments'' (59 FR 22951, April 29, 1994); Executive Order 13175, ``Consultation and... Office of the Secretary 43 CFR Part 10 RIN 1024-AD99 Native American Graves Protection and Repatriation... Secretary of the Interior (Secretary) is responsible for implementation of the Native American...

  12. 77 FR 74874 - Native American Graves Protection and Repatriation Review Committee: Meeting

    2012-12-18

    ... National Park Service Native American Graves Protection and Repatriation Review Committee: Meeting AGENCY... Federal Advisory Committee Act, 5 U.S.C. Appendix (1988), of a telephonic meeting of the Native American... Advisory Committee Act, 5 U.S.C. Appendix (1988), of a telephonic meeting of the Native American...

  13. 78 FR 16295 - Native American Graves Protection and Repatriation Review Committee: Meeting

    2013-03-14

    ... National Park Service Native American Graves Protection and Repatriation Review Committee: Meeting AGENCY... the Federal Advisory Committee Act, 5 U.S.C. Appendix (1988), of a meeting of the Native American... previously noticed in the Federal Register (77 FR 53228-53229, August 31, 2012), to occur on May 22-23,...

  14. 48 CFR 352.242-72 - Native American Graves Protection and Repatriation Act.

    2010-10-01

    ... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Native American Graves Protection and Repatriation Act. 352.242-72 Section 352.242-72 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CLAUSES AND FORMS SOLICITATION PROVISIONS AND CONTRACT CLAUSES Texts of Provisions and Clauses 352.242-72 Native...

  15. Clinical value of serum TRAb levels determination in diagnosis of Graves's disease

    Objective: To investigate the clinical diagnostic value of serum TRAb levels determination in patients with Graves' disease. Methods: Serum TRAb (with RRA), FT3, FT4, TSH (with CLIA) levels were measured in 223 patients with Graves' disease both before and 6, 12, 36 months after treatment with antithyroid drugs (ATD) as well as in 50 controls. Results: Positive rate of serum TRAb was 93.3% in patients with Graves' disease before treatment. Six months after ATD therapy the positive rate dropped to 41.3%, being still significantly higher than that in controls (P<0.05). The TRAb positive rate dropped steadily with 12 (18.3% ), 24 (8.9% ) and 36 months (4.9%) of ATD treatment. In the 21 patients who had hyperthyroidism recurred after the course of treatment, TRAb remained positive in 18 of them (80.7%). Conclusion: Persistent positive TRAb despite euthyroid status in patients with Graves' disease after seemingly successful ATD treatment donates persistent immunodysfunction and possible recurrence. It is mandatory to continue ATD treatment until TRAb negative. (authors)

  16. Metastatic papillary carcinoma of the thyroid in a patient previously treated for Graves' disease.

    Yunusa, Garba H; Kotze, Tessa; Brink, Anita

    2014-01-01

    Incidental papillary carcinoma of the thyroid in patients treated surgically for benign thyroid diseases including Graves' disease is a known phenomenon. However, the management of these patients remains an issue of concern and controversy for those who care for them. We report a case of metastatic papillary carcinoma of the thyroid in a patient previously treated for Graves' disease. The subject of this presentation is a 50-year-old lady who was diagnosed with Graves' disease at the age of 29, for which she had a subtotal thyroidectomy following failure of medical and radioactive iodine treatment. Three years later, the patient was referred to our nuclear medicine department with a clinical diagnosis of suspected metastatic lymph nodes presumably from a thyroid malignancy.She had an 123I diagnostic whole body scan that showed 123I avid areas in the thyroid bed as well as left cervical lymph nodes, which later turned out to be metastatic papillary carcinoma of the thyroid on histology. She was treated with therapeutic doses of 131I. Follow-up radioactive iodine scans and serum thyroglobulin assays showed no evidence of malignant thyroid tissue. The occurrence of papillary carcinoma of the thyroid after a subtotal thyroidectomy for Graves' disease is hereby reported. The need for vigilance and regular follow-up in patients who receive all forms of treatment for benign thyroid diseases is emphasized. PMID:24705115

  17. Heterotopic relation between media and materiality in children's online memorials and on children's graves

    Sandvik, Kjetil; Christensen, Dorthe Refslund

    In this paper we analyze how bereaved parents make use of various media-strategies on online memorial sites and on children’s graves when performing processes of grief and commemoration for their stillborns and infants, and how these processes are not just linked to one particular media but take...

  18. Euthyroid and primarily hypothyroid patients develop milder and significantly more asymmetric Graves ophthalmopathy

    Eckstein, Anja; Loesch, Christian; Glowacka, Diana; Schott, Matthias; Mann, Klaus; Esser, Joachim; Morgenthaler, Nils G

    2009-01-01

    Abstract Background and aims: Retrospective, observational study to compare clinical symptoms and TSH-receptor antibodies (TRAb) in Graves' ophthalmopathy (GO) in euthyroid and primarily hypothyroid patients to those in hyperthyroid patients. Methods: Clinical symptoms (NOSPECS [severity] and CAS [activity] score), prevalence and levels of thyroid specific antibodies and the course of the disease were evaluated in 143 primarily hyperthyroid, 28 primarily euthyroid an...

  19. B lymphocyte depletion with the monoclonal antibody rituximab in Graves' disease: a controlled pilot study

    El Fassi, Daniel; Nielsen, Claus H; Bonnema, Steen J; Hasselbalch, Hans C; Hegedüs, Laszlo

    2007-01-01

    CONTEXT: Graves' disease (GD) is a common TSH receptor autoantibody (TRAb)-mediated disorder. Because B lymphocytes are important self-antigen presenting cells and precursors for antibody-secreting plasma cells, temporary B-lymphocyte depletion with the monoclonal antibody rituximab (RTX) might b...

  20. The role of TSH receptor antibodies in the management of Graves' disease.

    Matthews, David C; Syed, Akheel A

    2011-06-01

    The central role of thyrotropin receptor antibodies (TRAbs) in the pathogenesis of Graves' disease has been recognised for several decades. However, the practical application of testing for TRAbs in clinical decision making remains the subject of controversy. The diagnosis of Graves' disease can be made in most cases simply based on a patient's clinical presentation. The TRAb test is therefore of most value in ambiguous clinical scenarios such as in the differential diagnosis of unilateral exophthalmos, euthyroid Graves' ophthalmopathy, subclinical hyperthyroidism, thyrotoxicosis associated with hyperemesis gravidarum, amiodarone-induced thyrotoxicosis and painless thyroiditis. It may also have a role in predicting the risk of a recurrence of Graves' disease following a course of antithyroid drug treatment. One further clinical utility of the TRAb test is in pregnancy where antibody titre measured during the third trimester is used to predict the risk of neonatal thyroid dysfunction. The TRAb titre not only aids in clinching a difficult diagnosis but can also help guide treatment in some patients. Although the TRAb assay has become more affordable in recent years, cost remains an important factor when considering its use routinely. Nonetheless, this is an underutilised blood test that could augment standard endocrine investigations in the differential diagnosis of hyperthyroidism. PMID:21570635

  1. Miastenia grave induzida por D-penicilamina em paciente com esclerose sistêmica progressiva

    Paulo E. Marchiori; Milberto Scaff; Wilson Cossermelli; J. Lamartine de Assis

    1984-01-01

    Relato de caso de miastenia grave induzida por D-penicilamina. São descutidos os possíveis mecanismos etiopatogênicos envolvidos no desencadeamento da doença e é salientada a presença de anticorpo anti-receptor de acetilcolina e hiperplasia tímica na DPA-MG.

  2. Miastenia grave induzida por D-penicilamina em paciente com esclerose sistêmica progressiva

    Paulo E. Marchiori

    1984-12-01

    Full Text Available Relato de caso de miastenia grave induzida por D-penicilamina. São descutidos os possíveis mecanismos etiopatogênicos envolvidos no desencadeamento da doença e é salientada a presença de anticorpo anti-receptor de acetilcolina e hiperplasia tímica na DPA-MG.

  3. A Danish Early Germanic Iron Age Grave with Tablet Woven Cuffs

    Mannering, Ulla; Knudsen, Lise Ræder

    This article presents exciting new textile information from a Danish Early Germanic Iron Age grave at Broedbaek, North West Jutland, where tiny little fragments of textiles were found on metal clasps and brooches. Some of the textiles appeared to be made in a so far unknown tablet weaving technique....

  4. Clinical significance of monitoring of serum TRAb in pregnant women with graves' disease treated by propylthiouracil

    Objective: To discuss the change of serum TRAb and changeable regularity of thyroid function and clinical significance of pregnant women with Graves' diease treated by propylthiouracil. Methods: Detecting the serum TRAb, FT3, FT4, TSH levels of pregnant women with Graves' disease treated by propylthiouracil using radioreceptor assay and electro chemiluminescence. Results: The serum TRAb level of the pregnant women with Graves' disease in early gestation treated by propylthiouracil descended much more than that in the initial diagnosis (P<0.01). The positive rates of TRAb in the women before treated by propylthiouracil and treated 3 months, 6 months, 8 months were 90.2%, 82.9%, 68.2% and 21.9% separately. The activity of TRAb descended slightly 3 months latter after treated. The activity of TRAb descend obviously and the positive rates changed largely 8 months after treated. Conclusion: There is very important clinical significance of monitoring of serum TRAb in pregnant women with Graves' disease in diagnosis and differential diagnosis and observation of therapeutic effects. Also, a favourable prognosis judgement. Meanwhile, provides significant reference index of pathogenetic condition judgement and drug discontinuance whether or not for the clinician. (authors)

  5. The archaeology of early medieval violence: the mass grave at Budeč, Czech Republic

    Štefan, I.; Stránská, Petra; Vondrová, H.

    2016-01-01

    Roč. 90, č. 351 (2016), s. 759-776. ISSN 0003-598X Institutional support: RVO:67985912 Keywords : Czech Republic * Bohemia * Budeč * tenth-eleventh centuries * early medieval * mass grave * violence * warfare Subject RIV: AC - Archeology, Anthropology, Ethnology Impact factor: 1.717, year: 2014

  6. Subclinical Hypothyroidism after 131I-Treatment of Graves' Disease: A Risk Factor for Depression?

    Jing Yu

    Full Text Available Although it is well accepted that there is a close relationship between hypothyroidism and depression, previous studies provided inconsistent or even opposite results in whether subclinical hypothyroidism (SCH increased the risk of depression. One possible reason is that the etiology of SCH in these studies was not clearly distinguished. We therefore investigated the relationship between SCH resulting from 131I treatment of Graves' disease and depression.The incidence of depression among 95 patients with SCH and 121 euthyroid patients following 131I treatment of Graves' disease was studied. The risk factors of depression were determined with multivariate logistic regression analysis. Thyroid hormone replacement therapy was performed in patients with thyroid-stimulating hormone (TSH levels exceeding 10 mIU/L.Patients with SCH had significantly higher Hamilton Depression Scale scores, serum TSH and thyroid peroxidase antibody (TPOAb levels compared with euthyroid patients. Multivariate logistic regression analysis revealed SCH, Graves' eye syndrome and high serum TPO antibody level as risk factors for depression. L-thyroxine treatment is beneficial for SCH patients with serum TSH levels exceeding 10 mIU/L.The results of the present study demonstrated that SCH is prevalent among 131I treated Graves' patients. SCH might increase the risk of developing depression. L-thyroxine replacement therapy helps to resolve depressive disorders in SCH patients with TSH > 10mIU/L. These data provide insight into the relationship between SCH and depression.

  7. Uso de albumina humana em pacientes graves: controvérsias e recomendações Albumin in critically ill patients: controversies and recommendations

    Haroldo Falcão

    2011-03-01

    Full Text Available O uso de albumina humana como terapêutica nas unidades de terapia intensiva é tradicional há mais de 50 anos. No entanto, estudos no final dos anos 90 apontaram um possível malefício em relação ao seu uso em pacientes graves. O efeito da controvérsia causado por esta publicação perdurou mesmo após a publicação de outras meta-análises e estudos randomizados e controlados, que não encontraram relação de prejuízo para o uso desta solução coloide. No Brasil, vários serviços públicos e privados seguiram recomendações da Agência Nacional de Vigilância Sanitária sobre usos adequados ou não da albumina venosa. Nesta revisão, procuramos abordar as razões da administração de albumina, assim como reunir evidências metabólicas e imunomoduladoras de possíveis efeitos deste coloide no paciente grave. Os estudos de maior impacto desde 1998 até os dias atuais foram pormenorizados, demonstrando que não parece existir aumento de mortalidade com o uso de albumina venosa, em relação às soluções cristaloides. As indicações da Agência Nacional de Vigilância Sanitária foram discutidas diante das evidências atuais sobre o uso de albumina no doente crítico.Human albumin has been used as a therapeutic agent in intensive care units for more than 50 years. However, clinical studies from the late 1990s described possible harmful effects in critically ill patients. These studies' controversial results followed other randomized controlled studies and meta-analyses that showed no harmful effects of this colloid solution. In Brazil, several public and private hospitals comply with the Agência Nacional de Vigilância Sanitária (the Brazilian Health Surveillance Agency recommendations for appropriate administration of intravenous albumin. This review discusses indications for albumin administration in critically ill patients and analyzes the evidence for metabolic and immunomodulatory effects of this colloid solution. We also

  8. Efficiency of radioiodine therapy in Graves disease and adenoma toxicum and incidence of hypothyroidism

    The aim of the this study was to evaluate different states in hyperthyroid patients and incidence of hypothyroidism after I-131 therapy.We observed a total of 184 hyperthyroid pts, from which 108(58,7%)pts with Graves' disease,65(35,3%)pts with single toxicum nodule and 11(6%)pts with toxicum multinodular goitre,treated with radioiodine therapy during the period 1986-2001.Dose of I-131 orally administered ranged 150-1100MBq and was calculated according to the 'MBq/gram' method.The radioiodine-131 therapy was performed once in 69,5%(128/184)pts,twice in 21,2%(39/184)pts and in 9,3%(17/184)pts more than two doses. Completely cured of hyperthyroidism occurred in 61%(66/108)pts with Graves' disease,81,8%(9/11)pts with toxic multinodular goiter and 90,7%(59/65)pts with single toxic nodule. The patients in our study were evaluated 6 months to 15 years after received J-131 therapy. Incidence of early hypothyroidism within one year was 23,1%(25/108) in Graves' disease,9%(1/11) in toxic multinodular goiter and 4,6%(3/65) with single toxicum nodule.Overall incidence of hypothyroidism within one year was 17,6% and had cumulative increase of Graves' disease every following year approximately for 3%,while for adenoma toxicum there was no any significant changes. We concluded that radioiodine therapy is simple,comfortable radical method for medical treatment of hyperthyroidism and indicate higher incidence of hypothyroidism in patients treated with I-131 for Graves' disease than that of patients treated for toxicum multinodular goiters and single toxic nodule

  9. Stressful life events and Graves' disease: Results of a case control study

    Prolonged worry has generally been acknowledged as one of the main precipitating factors of the onset of Graves' disease. A review of literature reveals that emotional stresses of considerable severity precede the onset of hyperthyroidism in about 90% of cases. However, not everyone subscribes to the Stress/Graves' disease hypothesis. Attempts to resolve this issue have tended to focus on whether a correlation can be shown between the magnitude of antecedent life events and the disease. Hence the main objective of the present study was to identify the possible association between stressful life events and Graves' disease. This paper presents the results of a case-control study, involving patents and subjects from the Veterans Memorial Medical Centre of Manila. A total of 224 patients of Graves' disease, newly or previously diagnosed, representing the 'patient's' arm were interviewed. All patients were questioned regarding various stresses, which greatly affected their life style spanning over a 12-month period prior to the onset of the disease. Simultaneously, 224 control subjects were also interviewed, and their stresses spanning over a similar period preceding the dates of interviews were recorded in quantifiable terms. Different stresses were given different intensity scores based on a social readjustment scale taking into consideration the life situations, emotions and diseases. In cases of multiple stresses, intensity scores were added to obtain the total stress intensity. Results were expressed as mean, standard deviation, median, frequency and percent distribution. Scatter plot was also constructed for intensity of stressful life events. To determine association of different factors with Graves' disease, Students t-test and chi-square tests were applied to the data. Odds ratio (OR) was also computed to determine risk attributed to each factor. Since there was significant difference in gender distribution between the patients and controls, stratified Mantel

  10. B-cell depletion with rituximab in the treatment of autoimmune diseases. Graves' ophthalmopathy the latest addition to an expanding family

    Nielsen, Claus H; El Fassi, Daniel; Hasselbalch, Hans K;

    2007-01-01

    In this review, the authors summarise the clinical results obtained after therapy with rituximab in autoimmune diseases, including Graves' disease and Graves' ophthalmopathy. On the basis of qualitative and quantitative analyses of B- and T-cell subsets, and autoantibody levels obtained in other...... diseases before and after rituximab therapy, the authors interpret the results of the only two clinical investigations of the efficacy of rituximab in the treatment of Graves' disease and Graves' opthalmopathy reported so far. No significant effect on autoantibody levels was observed. Nonetheless, 4 out of...... 10 Graves' disease patients remained in remission 400 days after rituximab treatment versus none in the control group, and remarkable improvements in the eye symptoms of patients with Graves' ophthalmopathy were observed. This supports a role for B cells in the pathogenesis of Graves' ophthalmopathy...

  11. Review of Novum Inventorium Sepulchrale: Kentish Anglo-Saxon Graves and Grave Goods in the Sonia Chadwick Hawkes Archive (Online Digital Corpus

    Tara-Jane Sutcliffe

    2008-02-01

    Full Text Available In 2007, the year in which the Society of Antiquaries of London celebrated its tercentenary, what more fitting tribute to those industrious individuals than that their work be made accessible to a new generation of students. One means was by a celebratory exhibition hosted by the Royal Academy, Making History: Antiquaries in Britain, 1707-2007, which showcased a treasure-trove of art, antiquities and manuscripts (for review, see Mount 2007. Structured display is one thing: scholarly use or re-use of antiquarian data is, however, quite another matter. Indeed, therein arguably lays one of the more pressing challenges facing the practice of 'modern' archaeology (see Jones et al. 2001. A timely response was the online publication in October 2007 of the Novum Inventorium Sepulchrale (NIS, a digital corpus of Kentish Anglo-Saxon graves and grave goods. Through this project a wealth of primary data has been made accessible as never before. This resource will be of interest to all those researching Anglo-Saxon Archaeology, particularly material culture and mortuary practices. Whilst the editors express the hope that the NIS will 'enable future generations of researchers to gain a better understanding of the origins of the Anglo-Saxon kingdoms', users will find themselves both delighted and frustrated by the quantity and format of the data presented in it.

  12. Facts and fallacies about radioactive iodine therapy for Graves' disease

    Miller, J.L.

    1982-08-07

    The therapeutic options available in the hyerthyroidism of Graves' disease are two basic treatments. Firstly antithyroid drugs and secondly one can 'ablate' the thyroid gland by means of thyroidectomy or radioactive iodine (/sup 131/I). At present /sup 131/I is the current treatment of chioce for Graves' disease. In a follow-up study of 21 714 patients who were treated with /sup 131/I and observed for a period of 8 years, there was no increase in the incidence of thyriod carcinoma. A possible explanation for this is that the dose of /sup 131/I used destroys the ability of the thyroid cells to replicate and thus transmit genetically damaged material.

  13. Scientific studies on pottery and pro-porcelain from group of graves in Henglingshan, Guangdong Province

    2009-01-01

    The findings of the Henglingshan group of graves, Guangdong Province, were appraised as one of the ten major archaeological excavations in 2000. The pottery and proto-porcelain samples excavated from the group of graves in Henglingshan are very important for studying the development history of Guang-dong ceramics. In this paper, the chemical compositions, micro-structure and physical properties of the samples were systematically analyzed. The results were subjected to multivariate statistical analysis. Different compositional patterns were found for specimens from different periods. The reasons for these variations were discussed. In addition, compared with the pottery and proto-porcelain samples from different production sites in other provinces of China, the obvious regional characters and unique law of the development for ancient ceramics of Guangdong were also discussed.

  14. The role of nuclear medicine in the management of Graves' disease

    131I therapy is safe and effective for most Graves' disease patients. It is being used more frequently in previously restricted populations such as children, adolescents, and women of childbearing age. It affords prompt, consistent relief of hyperthyroidism, but permanent hypothyroidism ensues in almost all patients. This complication is readily diagnosed with modern in vitro assays and inexpensive, life-long replacement therapy renders the patient asymptomatic and able to resume a normal lifestyle. Recent changes in NRC requirements have further liberalized the use of 131I for Graves' disease in the USA, permitting more patients to be treated with effective outpatient therapy. The controversial role of 131I in exacerbation of GO has been further clarified and preventive measures are available

  15. Breaking the glass ceiling: an interview with Dr. Shirley Graves, a pioneering woman in medicine.

    Ahmed, Zulfiqar; Mai, Christine L; Elder, Badrea; Rodriguez, Samuel; Yaster, Myron

    2014-04-01

    Shirley Graves M.D., D.Sc. (honorary) (1936), Professor Emeritus of Anesthesiology and Pediatrics at the University of Florida, was one of the most influential women in medicine in the 1960 and 1970s, a time when the medical profession was overwhelmingly male-dominated. In today's society, it is hard to believe that only 50 years ago, women were scarce in the field of medicine. Yet Dr. Graves was a pioneer in the fields of pediatric anesthesia and pediatric critical care medicine. She identifies her development of the pediatric intensive care unit and her leadership in the Division of Pediatric Anesthesia at the University of Florida as her defining contributions. Through her journal articles, book chapters, national and international lectures, and leadership in the American Society of Anesthesiology and the Florida Society of Anesthesiology, she inspired a generation of men and women physicians to conquer the unthinkable and break through the glass ceiling. PMID:24571660

  16. The influence of position deviation on RAIU and,the corresponding therapeutic dose calculations in patients with Graves hyperthyroidism

    李从心

    2013-01-01

    Objective To evaluate the influence of inappropriate position deviation on radioactive iodine uptake(RAIU),effective half-life(Teff)and the corresponding dose variances in patients suffering from Graves hyperthyroidism.Methods RAIU was examined in 20 patients with

  17. Predicting the Risk of Recurrence Before the Start of Antithyroid Drug Therapy in Patients With Graves' Hyperthyroidism.

    Vos, Xander G; Endert, Erik; Zwinderman, A H; Tijssen, Jan G P; Wiersinga, Wilmar M

    2016-04-01

    Genotyping increases the accuracy of a clinical score (based on pretreatment age, goiter size, FT4, TBII) for predicting recurrence of Graves' hyperthyroidism after a course of antithyroid drugs: a prospective study. PMID:26863422

  18. The Veneration and Visitation of the Graves of Saints in Soviet Central Asia. Insights from the Southern Ferghana Valley, Uzbekistan

    Exnerová, Věra

    2015-01-01

    Roč. 83, č. 3 (2015), s. 501-536. ISSN 0044-8699 Institutional support: RVO:68378009 Keywords : graves of saints * Uzbekistan * Ferghana Valley * Soviet period * oral history * local practices Subject RIV: AB - History

  19. Application of new therapies in Graves' disease and thyroid-associated ophthalmopathy: animal models and translation to human clinical trials

    Banga, J Paul; Nielsen, Claus H; Gilbert, Jacqueline A; El Fassi, Daniel; Hegedus, Laszlo

    2008-01-01

    Most current approaches for treating Graves' disease are based essentially upon regimes developed nearly 50 years ago. Moreover, therapeutic approaches for complications such as thyroid-associated ophthalmopathy (TAO) and dermopathy are singularly dependent on conventional approaches of nonspecif...

  20. Thyroid storm following radioactive iodine (RAI) therapy for pediatric graves disease

    Rohrs, Henry J.; Silverstein, Janet H.; Weinstein, David A.; Amdur, Robert J.; Haller, Michael J.

    2014-01-01

    Patient: Female, 11 Final Diagnosis: Thyroid storm Symptoms: Diarrhea • tachycardia • tachypnea • tremor • wheezing Medication: — Clinical Procedure: — Specialty: — Objective: Rare disease Background: A growing number of pediatric endocrinologists treat Graves disease with radioactive iodine (RAI) therapy due to the typically definitive nature of I-131 therapy. Given the published benefits and perceived low risks of RAI when compared to surgery or long-term anti-thyroid medication, the trend ...

  1. Clinical experience with radioactive iodine in the treatment of childhood and adolescent Graves' disease

    Cury, Adriano N; Meira, Verônica T; Monte, Osmar; Marone, Marília; Scalissi, Nilza M; Kochi, Cristiane; Calliari, Luís E P; Carlos A. Longui

    2012-01-01

    Background/aims Treatments for Graves' disease (GD) in children and adolescents include oral antithyroid drugs (ATDs), near total thyroidectomy, and radioactive iodine (RAI). ATDs remain the preferred choice in this age group, but because persistent remission occurs in 30% of cases, RAI is becoming a common option for definitive therapy. Methods We performed a review of 65 medical records of GD patients under age 19 years who were followed between 1985 and 2005. Results The prevalence of GD w...

  2. A note on Robinson-Ursescu and Lyusternik-Graves theorem

    Cibulka, R.; Fabian, Marián

    2013-01-01

    Roč. 139, 1-2 (2013), s. 89-101. ISSN 0025-5610 R&D Projects: GA ČR(CZ) GAP201/11/0345 Institutional research plan: CEZ:AV0Z10190503 Keywords : open mapping * restrictive metricregularity * graves theorem Subject RIV: BA - General Mathematics Impact factor: 1.984, year: 2013 http://link.springer.com/article/10.1007%2Fs10107-013-0662-z

  3. Precipitation of the thyrotropin receptor and identification of thyroid autoantigens using Graves' disease immunoglobulins.

    Heyma, P; Harrison, L C

    1984-01-01

    The thyrotropin (TSH) receptor is a putative target for autoantibodies in Graves' hyperthyroidism and therefore, should be capable of being identified, isolated, and structurally characterized by immunological means. To this end, four sera from patients with hyperthyroidism, three of which inhibited the binding of 125I-TSH to Triton-solubilized human thyroid membranes, were used to isolate TSH receptors by immunoprecipitation. To account for an effect of TSH binding or receptor occupancy on t...

  4. Espessamento do tendão muscular na oftalmopatia de Graves

    Elvira Barbosa Abreu

    2011-12-01

    Full Text Available OBJETIVO: Estudar a frequência do espessamento do tendão muscular em pacientes com oftalmopatia de Graves buscando estabelecer correlações com as diferentes formas clínicas da doença. A diversidade clínica e laboratorial na oftalmopatia de Graves pode levar à confusão quanto ao diagnóstico, conduta e prognóstico. Os achados radiológicos variam desde o aumento isolado do tecido adiposo até o espessamento da musculatura extraocular, caracteristicamente poupando os tendões. Em 2004,no entanto, Ben Simon descreveu o espessamento do tendão muscular na oftalmopatia de Graves. MÉTODOS: Foram avaliados 20 pacientes, de ambos os sexos, com idades entre 20 e 80 anos, com formas clínicas designadas como :forma benigna (retração palpebral,forma intermediária (diplopia na posição primária do olhar e forma maligna ou infiltrativa (sinais de comprometimento do nervo óptico.Todos os pacientes foram submetidos à tomografias computadorizadas de órbita. Os pacientes estavam eutiroideanos, há pelo menos um ano. Os padrões tomográficos foram estudados e divididos em dois grupos: com e sem espessamento dos tendões da musculatura extraocular. RESULTADOS: Uma relação estatisticamente significativa entre espessamento do tendão e a forma clínica intermediária foi encontrada (p <0,012. CONCLUSÃO: O espessamento do tendão extraocular, encontrado em 30% dos pacientes com oftalmopatia de Graves, relaciona-se positivamente com a forma intermediária da doença, caracterizada pela presença de diplopia e que constitui um achado de grande valor clínico.

  5. Correlation between TSH Receptor Antibody Assays and Clinical Manifestations of Graves' Orbitopathy

    Jang, Sun Young; Shin, Dong Yeob; Lee, Eun Jig; Choi, Young Joon; Lee, Sang Yeul; Yoon, Jin Sook

    2013-01-01

    Purpose To investigate an association between the levels of serum thyroid-stimulating hormone (TSH)-receptor autoantibodies (TRAbs) and Graves' orbitopathy (GO) activity/severity scores, and compare the performance of three different TRAb assays in assessing the clinical manifestations of GO. Materials and Methods Cross-sectional study. Medical records of 155 patients diagnosed with GO between January 2008 and December 2010 were reviewed. GO activity was assessed by clinical activity score (C...

  6. A change from stimulatory to blocking antibody activity in Graves' disease during pregnancy

    Jones, BM; Kung, AWC

    1998-01-01

    Remission of Graves' disease (GD) during pregnancy with recrudescence after delivery is commonly observed. However, as pregnancy is associated with type 2 rather than type 1 cytokine production, a decrease in thyroid- stimulating antibody (TSAb) activity alone is unlikely to account for the remission during pregnancy. We hypothesized that a change in the antibody characteristics may occur as pregnancy advances. Fifteen women were studied in the first, second, and third trimesters of pregnancy...

  7. A Case of Hyperglycemic Hyperosmolar State Associated with Graves' Hyperthyroidism: A Case Report

    Moon, Sung Won; Hahm, Jong Ryeal; LEE, GYEONG-WON; Kang, Mi Yeon; Jung, Jung Hwa; Jung, Tae Sik; Lee, Kang Wan; Jung, Kyoung Ah; Ahn, Yong Jun; Kim, Sunjoo; Kim, Me Ae; Kim, Deok Ryong; Chung, Soon Il; Park, Myoung Hee

    2006-01-01

    Hyperglycemic hyperosmolar state (HHS) is an acute complication mostly occurring in elderly type 2 diabetes mellitus (DM). Thyrotoxicosis causes dramatic increase of glycogen degradation and/or gluconeogenesis and enhances breakdown of triglycerides. Thus, in general, it augments glucose intolerance in diabetic patients. A 23-yr-old female patient with Graves' disease and type 2 DM, complying with methimazole and insulin injection, had symptoms of nausea, polyuria and generalized weakness. He...

  8. Carbon Footprint Calculation of an AEH-technology Residential House from Cradle to Grave

    Gerasimenko, Olga

    2015-01-01

    This thesis presents the carbon footprint calculation of a Finnish active energy house (AEH), which uses a range of innovative energy saving technologies. The calculation is made for all the stages of the 50-year life-cycle from cradle to grave. The results of the study take into account footprints of all materials production, materials transportation to the site, commissioning and demolition phases with all the waste and its transportation to waste treatment facilities and also the 50-yea...

  9. Two adolescent patients with coexistent Graves' disease and Moyamoya disease in Korea

    Cheon, Chong Kun; Kim, Su Yung; Yoo, Jae-Ho

    2014-01-01

    Moyamoya disease is a cerebrovascular condition that results in the narrowing of the vessels of the circle of Willis and collateral vessel formation at the base of the brain. Although relationships between Graves' disease and cerebrovascular accidents in Moyamoya disease are obscure, the coexistence of the two diseases is noteworthy. Moyamoya disease has been rarely reported in adolescent patients with thyrotoxicosis. Recently, we encountered two adolescent Korean patients with Moyamoya disea...

  10. Incidental Visualization of Thyroid Gland on Bone Scan Caused by Graves' Hyperthyroidism

    Sohn, Myung Hee; Jeong, Hwan Jeong; Kim, Dong Wook; Lim, Seok Tae [Chonbuk National University Medical School, Jeonju (Korea, Republic of)

    2009-04-15

    A 45-year-old man presented with fatigue and weight loss underwent a Tc-99m MDP bone scan because of increased serum alkaline phosphatase. Delayed images at 4 hours demonstrated diffuse increased activity throughout both lobes of the thyroid in the absence of activity of the stomach and salivary glands. Thyroid laboratory indices and a Tc-99m pertechnetate thyroid scan suggested Graves' hyperthyroidism

  11. Clinical study of hepatic dysfunction and its correlative factors in newly diagnosed patients with Graves hyperthyroidism

    Objective: To investigate the incidence,clinical features and the possible risk factors of hepatic dysfunction in the newly diagnosed patients with Graves hyperthyroidism. Methods: A retrospective analysis about total 204 newly diagnosed patients with Graves hyperthyroidism was studied. All the patients were divided into two groups by liver function:the hepatic dysfunction group (146 cases)and the normal group (58 cases). The gender composition, age, thyroid weight, 24 h-131I intake rate,free triiodothyronine (FT3), free thyronine (FT4), thyroid-stimulating hormone receptor antibody (TRAb), thyroid peroxidase antibodies (TPOAb) and thyroglobulin antibody (TGAb)were compared between the two groups. A correlation analysis was progressed between the indicators of liver function and thyroid hormone. Results: (1) The incidence of hepatic dysfunction (at least one abnormal parameter) in the newly diagnosed patients with Graves hyperthyroidism was 71.6% and the most familiar abnormal parameter was alanine transaminase (ALT) (37.7 %). Altogether 61 patients (41.8 %) had only one abnormal parameter in the hepatic dysfunction group and the most common abnormal parameter was alkaline phosphatase (ALP) (50.8%). (2) Compared with the normal group, hepatic dysfunction group had longer disease duration, higher serum FT3, FT4 and TRAb levels,but there were no significant differences in gender composition, age, thyroid weight, 24 h-131I intake rate, TPOAb, TGAb between the two groups. (3) A significantly positive correlation was found between the aspartate aminotransferase and FT3, the ALP and FT3, FT4, the total bilirubin and FT4, the direct bilirubin and FT3, FT4, respectively. Conclusions: Hepatic dysfunction in newly diagnosed patients with Graves hyperthyroidism is very common and the most common abnormal parameters include ALT and ALP. The hepatic dysfunction is closely correlated with patients' disease duration, thyroid hormone and TRAb levels. (authors)

  12. The Interpretation of Istighotsah Tradition Post Ndoro Purbo’s Grave Destruction in Yogyakarta

    Dandung Budi Yuwono

    2015-12-01

    Full Text Available Yogyakarta is known as a tolerans society, suddenly shocked by an incidence of thedestruction of the Ndoro Purbo’s grave, the 6th Sultan Hamengku Buwono’s grandchild, by irresponsible persons. In response to this incidence, a Nahdliyin (NU community in Yogyakarta performs sacred rituals called an ‘istighotsah’. This is a qualitative research (case study that aims to answer three problems: (1 how does NU in Yogyakarta look at the figure of Ndoro Purbo?  (2 How do they interpret the acts of  Ndoro Purbo’s grave destruction? And (3 Why does NU Yogyakarta perform a ritual ‘istighotsah’, and how do they interpret ‘istighotsah’? This study aims to explain the interpretation of NU members on the acts of Ndoro Purbo’s grave destruction, to understand the reasons of NU do ‘istighotsah’,   and tofind the meaning of ‘istighotsah’ for NU members. Data was collected through observation, participant observation and in-depth interviews, while the interpretive data analysis is done using emic and ethical perspective. The study’s findings indicate that Ndoro Purbo was imaged as a figure of saint and known as a person with supernatural power. The Ndoro Purbo’s grave destruction was considered as a form of rudeness to the Javanese value, which is interpreted as violation of the Islamic values and a game of symbol, and it was considered as an act of wrongdoers. To fight such injustice among the NU members, they perform ritual‘istighotsah’ as an expression of  a protest to God and a form of spiritual resistance during the difficult situation in facing disobedient or ‘visible sin’.

  13. Graves hyperthyroidism 131I treatment the clinical curative effect of observation

    Objective: to study the clinical treatment of 131I Graves hyperthyroidism curative effect. Methods: the clinical data of Graves hyperthyroidism patients were retrospectively analyzed. Results: 258 cases of patients with hyperthyroidism Graves. 131I treatment 1∼2 times after healed 200 cases, improvement of 38 patients, a low, 10 cases were invalid 10 cases failure; the total effective 96.12%. 1 year after treatment 131I thyroid quality by before treatment 43.6 + 20.9 grams shrinks to 1.98 + 18.5 grams (p131I before treatment with prominent eyes 68 cases (26.4%) 131I after treatment, the prominent eyes healed 24 cases (34.8%), improvement 30 patients (43.5%), invalid in 12 cases (17.4%), aggravating in 2 cases (2.9%), efficient for 79.7%. Concurrent hyperthyroidism 131I before treatment in patients with 31 patients (heart), after the treatment of 131I 12.0% in 25 patients recovered, 6 patients get better, efficient 100%. After the treatment of 131I temporary armor low in 25 patients (9.7%) , permanent armour low 27 cases (10.5%). After the treatment of 131I 15 cases have been reduced to a sex WBC (5.8%), 8 cases of liver function mild damage (3.1%), 13 cases itchy skin (1 case), cholesterol by 5.0% compared appear suspected hyperthyroidism crises (0.4%). 258 patients with thyroid type micronodular 41 cases, treatment cured after 131I in 25 patients (61.0%), improvement in 16 (39.0%), laseris 100%, Diffuse 217 example, cure 175 cases (80.6%), improvement 22 patients (10%), a low 10 (4.6%), invalid 10 (4.6%), laseris 95.4 percent. Conclusion: 131I treatment Graves hyperthyroidism is simple, safe, effective, and can be used as the preferred treatment method outperforms that of anti-thyroid drugs. (authors)

  14. Affective symptoms and cognitive functions in the acute phase of Graves' thyrotoxicosis

    Vogel, Asmus; Elberling, Tina V; Hørding, Merete;

    2007-01-01

    problems. No significant differences between the patient and the control group on neuropsychological test performances were found. Thyroid levels did not correlate with the neuropsychological test performances or psychiatric ratings. After reaching euthyroidism the level of affective symptoms (including......In the acute phase of Graves' thyrotoxicosis patients often have subjective cognitive complaints. Continuing controversy exists about the nature of these symptoms and whether they persist after treatment. This prospective study included 31 consecutively referred, newly diagnosed, and untreated...

  15. Predictor factors in the effectiveness of the therapeutic dose in the Graves diseases

    The treatment of the Graves diseases includes different options, between which are the antithyroid drugs, 131I and/or the surgery. Of all of them, the 131I, it has been increasing the use through the years, going to constitute the treatment of election for many authors, due to the big effectiveness to obtain a rapid healing of this illness. On the other hand, controversies exist about this use, related about the administration doses of 131I

  16. Coincidence of remission of postpartum Graves' disease and use of omega-3 fatty acid supplements

    Breese McCoy Sarah J

    2011-01-01

    Abstract I developed Graves' Disease four months postpartum. After one year on propylthiouracil, I learned that omega-3 fatty acids may reduce inflammation associated with certain autoimmune disorders, although no investigations for thyroiditis have been reported. Within eight weeks of beginning flaxseed oil supplements, TSH levels normalized, but fell somewhat when flaxseed was decreased and PTU discontinued. During another pregnancy, plasma TSH normalized, but was again suppressed by four w...

  17. The incidence of ophthalmopathy after radioiodine therapy for Graves' disease: Prognostic factors and the role of methimazole

    Kung, AWC; Yau, CC; Cheng, A

    1994-01-01

    Radioactive iodine-131 (RAI) has been reported to be associated with a high incidence of development or exacerbation of Graves' ophthalmopathy (GO). This is thought to be associated with a surge of autoantibodies after RAI therapy. The role of methimazole (MMI), which possesses immunomodulatory action, in the prevention of GO was explored by studying 114 patients with Graves' disease. They were assigned randomly to receive either RAI alone or adjunctive antithyroid drugs, which consisted of M...

  18. Remission of anorexia nervosa after thyroidectomy: A report of two cases with Graves' disease and anorexia nervosa

    Noguchi Hitoshi; Murakami Tsukasa; Uchino Shinya; Yamashita Hiroto; Noguchi Shiro

    2011-01-01

    Abstract We report two patients with anorexia nervosa and Graves' disease who received subtotal thyroidectomy for Graves' disease and concomitantly experienced remission from anorexia nervosa. Both were young women (aged 20 and 26) at the time of surgery. Both had well controlled thyroid function and eating behavior at the time of surgery. Both were followed for over five years without relapse of anorexia nervosa or hyperthyroidism. These cases suggest the existence of an endocrine factor ori...

  19. Related factors of thyroid-associated ophthalmopathy in patents with Graves' disease after 131I treatment

    Objective: To analysis the related factors of thyroid-associated ophthalmopathy(TAO) in patients with Graves' disease after 131I treatment. Methods: Five hundred and sixty two patients with Graves' disease were followed up after 131I treatment, included 243 cases with TAO and 319 cases without TAO. Logistic multivariate regression analysis was used to analyse the data of the improvement of the TAO, stability and progression. Results: Of the patients without TAO, 10 new cases of TAO were diagnosed (3.13%). Of the patients with TAO, 134 (55.14%) had experienced improvement, 99 (40.74%) cases with stable disease and 10 (4.12%) cases with progressed disease. The progression rate were no difference between the part of patients with and without TAO (χ2=0.576, P>0.05), and were difference between simple and invasive prominent eyes groups (χ2=11.893, P2=10.621, P131I therapy had no obviously influence between Graves' disease with and without TAO, and early controling the risk factors and treatment with glucocorticoid could prevent aggravation of TAO. (authors)

  20. Acute effects of radioiodine therapy on the voice and larynx of basedow-Graves patients

    Isolan-Cury, Roberta Werlang; Cury, Adriano Namo [Sao Paulo Santa Casa de Misericordia, SP (Brazil). Medical Science School (FCMSCSP); Monte, Osmar [Sao Paulo Santa Casa de Misericordia, SP (Brazil). Physiology Department; Silva, Marta Assumpcao de Andrada e [Sao Paulo Santa Casa de Misericordia, SP (Brazil). Medical Science School (FCMSCSP). Speech Therapy School; Duprat, Andre [Sao Paulo Santa Casa de Misericordia, SP (Brazil). Medical Science School (FCMSCSP). Otorhinolaryngology Department; Marone, Marilia [Nuclimagem - Irmanity of the Sao Paulo Santa Casa de Misericordia, SP (Brazil). Nuclear Medicine Unit; Almeida, Renata de; Iglesias, Alexandre [Sao Paulo Santa Casa de Misericordia, SP (Brazil). Medical Science School (FCMSCSP). Otorhinolaryngology Department. Endocrinology and Metabology Unit

    2008-07-01

    Graves's disease is the most common cause of hyperthyroidism. There are three current therapeutic options: anti-thyroid medication, surgery, and radioactive iodine (I 131). There are few data in the literature regarding the effects of radioiodine therapy on the larynx and voice. The aim of this study was: to assess the effect of radioiodine therapy on the voice of Basedow-Graves patients. Material and method: A prospective study was done. Following the diagnosis of Grave's disease, patients underwent investigation of their voice, measurement of maximum phonatory time (/a/) and the s/z ratio, fundamental frequency analysis (Praat software), laryngoscopy and (perceptive-auditory) analysis in three different conditions: pre-treatment, 4 days, and 20 days post-radioiodine therapy. Conditions are based on the inflammatory pattern of thyroid tissue (Jones et al. 1999). Results: No statistically significant differences were found in voice characteristics in these three conditions. Conclusion: Radioiodine therapy does not affect voice quality. (author)

  1. Hyperparathyroidism after radioactive iodine therapy for Graves' disease. A case report

    Kawamura, Juichi; Tobisu, Kenichi; Sanada, Shingo (Kyoto Univ. (Japan). Faculty of Medicine)

    1983-11-01

    Herein we report a 36-year-old man with hyperparathyroidism and a past history of internal irradiation to the thyroid. Twelve years previously at age 24 years he had received 8 mCi of radioactive iodine for Graves' disease. An additional dose of 4 mCi was required 3 years later. A right lower parathyroid adenoma (28 x 23 x 20 mm, 5.7 g) was found at neck exploration. Although the association of external ionizing radiation to the head and neck and the subsequent development of hyperfunctioning parathyroid glands has been described in recent years, there are only 4 cases in the literature of parathyroid surgery for hyperparathyroidism secondary to earlier treatment with radioactive iodine for Graves' disease. In a long-term follow-up of 180 patients treated with radioactive iodine for Graves' disease, neither hypercalcemia nor hypophosphatemia was found. Whether internal radiation therapy can be a causative factor in the development of hyperparathyroidism should be elucidated in future. However, it seems reasonable to suggest that patients whose hyper-thyroidism has been treated with radioactive iodine should have their serum calcium levels examined at 5-year intervals.

  2. GRAVE: An Interactive Geometry Construction and Visualization Software System for the TORT Nuclear Radiation Transport Code

    A software system, GRAVE (Geometry Rendering and Visual Editor), has been developed at the Oak Ridge National Laboratory (ORNL) to perform interactive visualization and development of models used as input to the TORT three-dimensional discrete ordinates radiation transport code. Three-dimensional and two-dimensional visualization displays are included. Display capabilities include image rotation, zoom, translation, wire-frame and translucent display, geometry cuts and slices, and display of individual component bodies and material zones. The geometry can be interactively edited and saved in TORT input file format. This system is an advancement over the current, non-interactive, two-dimensional display software. GRAVE is programmed in the Java programming language and can be implemented on a variety of computer platforms. Three- dimensional visualization is enabled through the Visualization Toolkit (VTK), a free-ware C++ software library developed for geometric and data visual display. Future plans include an extension of the system to read inputs using binary zone maps and combinatorial geometry models containing curved surfaces, such as those used for Monte Carlo code inputs. Also GRAVE will be extended to geometry visualization/editing for the DORT two-dimensional transport code and will be integrated into a single GUI-based system for all of the ORNL discrete ordinates transport codes

  3. Avaliação e tratamento da hiperglicemia em pacientes graves

    Marina Verçoza Viana

    2014-03-01

    Full Text Available A hiperglicemia é um problema frequentemente encontrado em pacientes graves em ambiente de terapia intensiva. Sua presença se associa ao aumento da morbidade e da mortalidade, independentemente da causa da admissão (infarto agudo do miocárdio, condição após cirurgia cardiovascular, acidente vascular cerebral e sepse. Entretanto, permanecem muitas dúvidas com relação à fisiopatologia e, particularmente, em relação ao tratamento da hiperglicemia no paciente graves. Na prática clínica, devem ser levados em consideração diversos aspectos para o controle desses pacientes, inclusive os alvos de glicemia, o histórico de diabetes mellitus, a via de nutrição (enteral ou parenteral e o equipamento de monitoramento disponível, o que aumenta substancialmente a carga de trabalho dos profissionais envolvidos nesse tratamento. Esta revisão descreveu a epidemiologia, a fisiopatologia, o tratamento e o monitoramento da hiperglicemia no paciente adulto grave.

  4. James George Frazer’s Anthropologic Heritage in the Work of Robert Graves

    Tomislav M. Pavlović

    2016-02-01

    Full Text Available The works of Sir James George Frazer had an outstanding influence on the literature of modernism. Among those who benefited from Frazer’s ritualism were W. B. Yeats, T. S. Eliot. James Joyce, Ernest Hemingway, D. H. Lawrence, Ezra Pound, Mary Renault, Joseph Campbell, Robert Graves and many others. Robert Graves was known for his famous adaptation of Frazer’s concept of the sacred king who is sacrificed for the benefit of his subjects thus forming the narrative frame for the one of his most controversial novels. The dying king is also identified with the poet striving to attain the favour of the Triple Muse Goddess - who represents the embodiment of true poetic inspiration. The aforementioned concept is not the only thing that Graves inherited from his famous ancestor. In our analysis we laid stress on the customs, rituals, magic symbols and deities both authors dealt with. We also observed a striking resemblance of the style Greves and Frazer developed and their euchemeristic approach to myths as well.

  5. Outcome of graves' disease after anti-thyroid drug treatment in South West of Iran

    Objective: This study was conducted to observe the optimal results of long term treatment with antithyroid drugs in patients with graves' disease. Methodology: Total of 268 patients with graves' disease who were referred to endocrinology clinic during 2005 - 2008 and treated with anti-thyroid drugs for a long term were studied. Data about the age, gender, estimated weight of thyroid before and after the treatment, level of thyroid hormones, disease relapse, hypothyroidism and the drug side-effects were collected and analyzed. Results: Eighty two (31%) patients were males, 186 (69%) females, mean age of 35 +- 27 years and follow-up course of 31+- 16 months], were studied. After the discontinuation of long term treatment, 53% were affected with relapse of hyperthyroidism. The mean duration of hyperthyroidism relapse after the treatment was 8.3 +- 7.3 months. The relapse rate was and patients with large thyroid and lower TSH level at the end of treatment, the rate of relapse treatment was about 6%. More decrease of thyroid size during the treatment course, higher level of serum TSH after discontinuation of the treatment, and lower thyroid hormone levels before the treatment were some of the effective factors in hypothyroidism incidence (P=0.005, patients (39%) remained euthyroid in the follow-up course. Conclusion: patients with graves' especially in middle-aged women with smaller goiters. (author)

  6. Reversible increase of serum activin A levels in women with Graves' disease.

    Centanni, M; Viceconti, N; Luisi, S; Reis, F M; Gargano, L; Maiani, F; Franchi, A; Canettieri, G; Petraglia, F

    2002-12-01

    The aim of this study was to analyze the serum levels of activin A in hyperthyroid patients with Graves' disease. Serum activin A and FSH levels were measured in a total of 93 females (64 regularly cycling and 29 post-menopausal). Of these, 20 were hyperthyroid patients with Graves disease, 33 were euthyroid goitrous patients (20 had autoimmune thyroiditis AT and 13 only had goiter) representing the internal control group and 40 were healthy subjects representing the external control group. Serum levels of activin A were higher in goitrous patients with AT than in control subjects (p=0.0388). Activin A levels were almost doubled in the cycling and in post-menopausal hyperthyroid women (0.91+/-0.21 vs 0.43+/-0.07 microg/l; phyperthyroid patients, studied even after methimazole treatment, that increase was substantially reversed, once euthyroidism was attained (p=0.002). These findings indicate that thyroid function and autoimmune processes significantly affect serum levels of activin A in patients with Graves' disease. PMID:12553556

  7. Randomized double-blind trial of prednisone versus radiotherapy in Graves' ophthalmopathy

    Corticosteriods are usually given for management of Graves' ophthalmopathy, but they have many and serious side-effects. By comparison, retrobulbar irradiation is well tolerated, although its efficacy has been evaluated only in uncontrolled studies. Therefore, the authors did a double-blind randomized trial, in which 28 patients with moderately severe Graves' ophthalmopathy were treated with a 3-month course of oral prednisone and sham irradiation, and 28 received retrobulbar irradiation (20 Gy) and placebo capsules. Therapeutic outcome, assessed twenty-four weeks after the start of treatment, was determined by the change in the highest NOSPECS class. A successful outcome was observed in 14 prednisone-treated and in 13 irradiated patients. Responders to treatment (but not nonresponders) in both groups showed improvements in total and subjective eye score and a decrease in eye-muscle volume. Response to either treatment was due largely to changes in soft-tissue involvement and eye-muscle motility. Radiotherapy and oral prednisone appear to be equally effective as initial treatment in patients with moderately severe Graves' ophthalmopathy. In view of its better tolerability, radiotherapy should be considered the treatment of first choice

  8. Protocolo de intervención para abordar la vía aérea difícil: alternativa en el modo de actuación del anestesiólogo

    Fernando Márquez Ercia

    2012-02-01

    Full Text Available Fundamento: la habilidad para asegurar la vía aérea en diversidad de pacientes y distintas circunstancias clínicas, representa un dominio obligado para el equipo de salud, constituye una actividad cotidiana del anestesiólogo, quien es considerado "el experto" en esta materia, razón por la cual con frecuencia se le solicita su cooperación en los Servicios de Urgencias, en las Unidades de Terapia Intensiva y en otras áreas del hospital, cuando el personal médico encuentra dificultades para ventilar y/o intubar la vía aérea de los pacientes. Objetivo: diseñar un protocolo de intervención para el abordaje de la vía aérea difícil. Métodos: se realizó un estudio exploratorio, donde se complementó la metodología cualitativa y cuantitativa. Dentro de los métodos científicos se utilizaron el análisis documental, la observación, criterio de expertos y encuesta a especialistas. Resultados: la sistematización teórica permitió evidenciar que la dificultad de abordar la vía aérea en el paciente quirúrgico constituye un reto en el modo de actuación del anestesiólogo. A pesar de que existen múltiples pruebas que permiten predecir de cierta manera el abordaje de la vía aérea, ninguno tiene un máximo absoluto de especificidad. Conclusiones: se diseñó un protocolo de intervención para el abordaje de la vía aérea difícil, que se erige de un diagnóstico de necesidades en el modo de actuación del Especialista en Anestesiología y Reanimación. El protocolo propuesto fue validado por expertos y es una alternativa que contribuye a aunar criterios y perfeccionar el modo de actuación del anestesiólogo.

  9. Diagnosis and treatment of Graves' disease with particular emphasis on appropriate techniques in nuclear medicine. General state of knowledge.

    Prasek, Karolina; Płazińska, Maria Teresa; Królicki, Leszek

    2015-01-01

    Graves' disease is an autoimmune disease. It accounts for 50-80% of cases of hyperthyroidism. Antibodies against the TSH receptor (TRAb) are responsible for hyperthyroidism (TRAB). The key role in monitoring and diagnosis of Graves' disease plays the level of hormones of free thyroxine and triiodothyronine. Helpful is an ultrasound of the thyroid scintigraphy which due to its functional character is both a valuable addition to morphological studies as well as plays an important role in the diagnosis and therapy in patients with Graves' disease. There is no perfect treatment for Graves' disease. The reason for this is the lack of therapy directed against primary pathogenic mechanisms. Currently available treatments need to be thoroughly discussed during the first visit as the patient's understanding of the choice of a treatment constitutes a vital role in the success of therapy. Graves' disease treatment is based on three types of therapies that have been carried out for decades including: pharmacological treatment anti-thyroid drugs, I131 therapy and radical treatment - thyroidectomy. The purpose of the treatment is to control symptoms and patient to return to euthyreosis. Treatment of Graves' disease is of great importance because if left untreated, it can lead to long-term harmful effects on the heart, bone and mental well-being of patients. PMID:26315874

  10. Correlation of orbital muscle changes evaluated by magnetic resonance imaging and thyroid-stimulating antibody in patients with Graves' ophthalmopathy

    To evaluate the relationship between eye changes and autoantibody to the thyrotropin receptor in patients with Graves' disease, the authors evaluated the eye changes using magnetic resonance imaging and the results were correlated with thyroid-stimulating antibody, thyrotropin binding inhibitor immunoglobulin and thyroid growth activity. Subjects were 15 patients with Graves' disease who had Graves' ophthalmopathy, including exophthalmos and other signs and symptoms, and 9 patients without ophthalmopathy; all were maintained in a euthyroid state by antithyroid drugs. The thyrotropin-binding inhibitor imunoglobulin was measured by a kit, and thyroid-stimulating antibody and thyroid growth activity were evaluated by cyclic adenosine 3', 5'-monophosphate production and [3H]thymidine incorporation, respectively, by cultured functional rat thyroid lined cells. The sum of the swelling ratios of the four extraocular muscles correlated well with the degree of exophthalmos. The thyrotropin-binding inhibitor immunoglobulin was positive in 9 out of 15 patients with ophthalmopathy; however, no correlation was observed between the activity and exophthalmos or muscle swelling. No significant correlation was observed between muscle changes and thyroid growth activity either. On the other hand, thyroid-stimulating antibody in Graves' patients with ophthalmopathy was significantly higher than that in patients without ophthalmopathy. Moreover, the level of the stimulating activity in Graves' patients with ophthalmopathy showed a significant positive correlation with the sum of the swelling ratios of the individual eight eye muscles. These results suggest that thyroid-stimulating antibody has a close relation to Graves' ophthalmopathy. 23 refs., 4 figs

  11. Morbidade materna extremamente grave: uso do Sistema de Informação Hospitalar

    Maria da Consolação Magalhães

    2012-06-01

    Full Text Available OBJETIVO: Estimar a prevalência da morbidade materna extremamente grave e identificar procedimentos hospitalares associados. MÉTODOS: Foram utilizados dados do Sistema de Informação Hospitalar fornecidos pela Secretaria de Saúde de Juiz de Fora, MG, de 2006 a 2007. Foram selecionadas as internações para procedimentos obstétricos (n = 8.620 mulheres cujo diagnóstico principal compreendia todo o capítulo XV, gravidez, parto e puerpério, da Classificação Estatística Internacional de Doenças e Problemas Relacionados à Saúde, Décima Revisão. Foram identificados os códigos dos procedimentos realizados, procedimentos especiais e atos profissionais que pudessem contemplar o critério de morbidade materna extremamente grave da Organização Mundial da Saúde e outros procedimentos não habitualmente utilizados no período gravídico-puerperal. A análise de regressão logística foi utilizada para identificar associações entre desfecho e variáveis selecionadas. RESULTADOS: A prevalência de morbidade materna foi 37,8/1000 mulheres e a proporção de mortalidade foi 12/100.000 mulheres. O tempo de internação > 4 dias foi 13 vezes mais alto entre as mulheres que apresentaram alguma morbidade. Após análise ajustada, os fatores preditores de morbidade materna extremamente grave foram: tempo de internação, número de internações e filhos natimortos, e os procedimentos/condições mais frequentes foram a transfusão de hemoderivados (15,7/1.000, "permanência a maior" (9,5/1.000 e pré-eclâmpsia grave/eclâmpsia (8,2/1.000. CONCLUSÕES: Foi alta a prevalência de morbidade materna extremamente grave, associada principalmente às internações e variáveis relacionadas ao recém-nascido. O critério para identificação dos casos e o uso do Sistema de Informações Hospitalares mostraram-se úteis para a vigilância da morbimortalidade materna e para ampliar o conhecimento sobre os aspectos que a envolvem, contribuindo para a

  12. Hipertiroidismo por doença de Graves durante a gestação Hyperthyroidism due to Graves' disease during pregnancy

    Carla Amaral de Almeida; Leonardo Vieira Neto; Sheila Mamede da Costa; Alexandru Buescu; Mário Vaisman

    2005-01-01

    OBJETIVO: avaliar a influência do hipertiroidismo na evolução da gravidez e a necessidade de ajustes na dose de antitiroidianos neste período e no pós-parto. MÉTODOS: avaliação prospectiva de dados clínicos e laboratoriais de treze gestações em onze mulheres com hipertiroidismo devido à doença de Graves, com dosagem de TSH e T4 livre a cada trimestre ou quatro semanas após ajuste do antitiroidiano. O objetivo foi manter o T4 livre no terço superior da normalidade usando a menor dose possível ...

  13. Technetium uptake predicts remission and relapse in Grave's disease patients on antithyroid drugs for at least 1 year in South Indian subjects

    Neha Singhal; Praveen, V. P.; Nisha Bhavani; Menon, Arun S.; Usha Menon; Nithya Abraham; Harish Kumar; R V JayKumar; Vasantha Nair; Shanmugha Sundaram; Padma Sundaram

    2016-01-01

    Context: Most of the information on remission related factors in Grave's disease are derived from Western literature. It is likely that there may be additional prognostic factors and differences in the postdrug treatment course of Grave's disease in India. Aim: To study factors which predict remission/relapse in Grave's disease patients from South India. Also to establish if technetium (Tc) uptake has a role in predicting remission. Subjects and Methods: Records of 174 patients with clinical,...

  14. Current perspectives on the role of orbital fibroblasts in the pathogenesis of Graves' ophthalmopathy.

    Dik, Willem A; Virakul, Sita; van Steensel, Leendert

    2016-01-01

    Graves' ophthalmopathy (GO) is an extra-thyroidal complication of Graves' disease (GD; Graves' hyperthyroidism) characterized by orbital tissue inflammation, expansion, remodeling and fibrosis. Although the initiating trigger of GO is still indistinct, excessive orbital fibroblast activity is at the heart of its pathogenesis. Orbital fibroblasts are activated by cellular interactions with immune cells and the soluble factors they secrete. Orbital fibroblasts, especially from GO patients, express the thyrotropin receptor (TSH-receptor; TSHR), and activation of the orbital fibroblast population by stimulatory autoantibodies directed against the TSHR may provide an important link between GD and GO. Furthermore, stimulatory autoantibodies directed against the insulin-like growth factor-1 receptor have been proposed to contribute to orbital fibroblast activation in GO. Activated orbital fibroblasts produce inflammatory mediators thereby contributing to the orbital inflammatory process in GO. Moreover, orbital fibroblasts exhibit robust proliferative activity and extracellular matrix (especially hyaluronan) synthesizing capacity and can differentiate into adipocytes and myofibroblasts with disease progression, thereby contributing to tissue expansion/remodeling and fibrosis in GO. Orbital fibroblasts, especially those from GO patients, exhibit a hyper-responsive phenotype when compared to fibroblasts from other anatomical regions, which may further contribute to GO pathogenesis. Fibrocytes have been identified as additional source of orbital fibroblasts in GO, where they may contribute to orbital tissue inflammation, adipogenesis and remodeling/fibrosis. This review addresses our current view on the role that orbital fibroblasts fulfill in GO pathogenesis and both established as well as less established not fully crystallized concepts that need future studies will be discussed. PMID:26675405

  15. Crystal structure of a TSH receptor monoclonal antibody: insight into Graves' disease pathogenesis.

    Chen, Chun-Rong; Hubbard, Paul A; Salazar, Larry M; McLachlan, Sandra M; Murali, Ramachandran; Rapoport, Basil

    2015-01-01

    The TSH receptor (TSHR) A-subunit is more effective than the holoreceptor in inducing thyroid-stimulating antibodies (TSAb) that cause Graves' disease. A puzzling phenomenon is that 2 recombinant, eukaryotic forms of A-subunits (residues 22-289), termed active and inactive, are recognized mutually exclusively by pathogenic TSAb and mouse monoclonal antibody 3BD10, respectively. Understanding the structural difference between these TSHR A-subunit forms could provide insight into Graves' disease pathogenesis. The 3-dimensional structure of the active A-subunit (in complex with a human TSAb Fab, M22) is known, but the structural difference with inactive A-subunits is unknown. We solved the 3BD10 Fab 3-dimensional crystal structure. Guided by prior knowledge of a portion of its epitope, 3BD10 docked in silico with the known active TSHR-289 monomeric structure. Because both TSAb and 3BD10 recognize the active TSHR A-subunit monomer, this form of the molecule can be excluded as the basis for the active-inactive dichotomy, suggesting, instead a role for A-subunit quaternary structure. Indeed, in silico analysis revealed that M22, but not 3BD10, bound to a TSHR-289 trimer. In contrast, 3BD10, but not M22, bound to a TSHR-289 dimer. The validity of these models is supported experimentally by the temperature-dependent balance between active and inactive TSHR-289. In summary, we provide evidence for a structural basis to explain the conformational heterogeneity of TSHR A-subunits (TSHR-289). The pathophysiologic importance of these findings is that affinity maturation of pathogenic TSAb in Graves' disease is likely to involve a trimer of the shed TSHR A-subunit. PMID:25419797

  16. Hyperthyroidism relapse after iodine radiotherapy in Graves' disease: influence of iodine uptake heterogeneity

    Full text of publication follows. We evaluated outcome of patients after 131I therapy for Graves' disease. 18 out 120 patients (15%) relapsed Graves' disease 9 ± 4 months [5;25] after treatment with fixed dose of 555 mCi. Thyroid scintigraphy was characterised as homogenous or heterogeneous. Planar image was segmented using a threshold at 50% of maximal activity measured in thyroid gland. Heterogeneous fixation was defined as more than half of thyroid gland do not achieved the maximal activity although total uptake was increased allowing radioiodine treatment. Heterogeneity of the fixation was observed in 88% of patients with relapse contrarily to 33% without relapse. Heterogeneity of radioiodine distribution on thyroid gland before treatment was the only predictive factor for relapse; Iodide uptake, hormone dosage (TSH, T3L, T4L), age, sex, TSH receptors or other antibodies positivity rate were not significantly different between the 2 groups of patients with or without relapse. In patients with relapse, iodine uptake was not different than before treatment but scintigraphy was homogenous for 8 of them and the 10 others shown an increase uptake in the area without high fixation on the first scintigraphy. TSH receptors were positive for 12 patients before the first treatment and there was more increase when relapse occurred (31 ± 14 vs 13 ± 12; p < 0.05). In conclusion: heterogeneity of iodine uptake is predictive of hyperthyroidism relapsed in Graves' disease. Recommendations for radioiodine treatment in this particular population should be reconsidered. (authors)

  17. Spectral color Doppler in the diagnosis and follow-up of Graves' disease

    Hyperthyroidism in Graves' disease is caused by the presence of circulating autoantibodies to the THS receptors on the thyroid cells. Thyroid-suppression therapy prevents hormone production directly, without affecting the pathogenetic process. They performed color Doppler US of the thyroid gland and pulsed Doppler analysis of thyroid artery flow in 21 patients with Graves' disease before and during medical treatment. US results were compared with those of a control group of 40 healthy subjects and correlated with the values of thyroid hormones, TSH and thyroid microsomal and thyroglobulin antibodies. The thyroid gland was hypo vascularized in the control group. Pulsed Doppler examination of the thyroid arteries exhibited peak systolic velocity of PSV 20 ± 4 cm/s, diastolic velocity of 8 ± 1 cm/s, and resistive index of 0.60 ± 0.04. The thyroid gland of Graves' disease patients was hyper vascularized. Pulsed Doppler examination of the thyroid arteries exhibited peak systolic velocity (PSV = 51 ± 12 cm/s), end diastolic velocity (VD = 15 ± 4 cm/s) and resistive index (RI = 0.71 ± 0.04) significantly higher than in normal subjects (p < 0.001). Circulating thyroid hormones and flow parameters normalized after 6-8 months of medical therapy (PSV = 20 ± 6 cm/s, VD = 9 ± 3 cm(s, RI = 0.58 ± 0.07). The color Doppler patterns normalized only in a patient with normal TSH and antibodies. Sampling of the thyroid arteries proved more repeatable than sampling of parenchymal vessels

  18. TEMPORAL RELATIONSHIP BETWEEN THE ONSET OF THYROID DERMOPATHY AND GRAVES' OPHTHALMOPATHY

    Mohammad Pajhouhi

    1993-06-01

    Full Text Available Pretibial myxedema is an uncommon manifestation of Graves' disease and because of its rarity, information regarding its natural course and its relationship with other manifestations of Graves' disease is not sufficient."nWe reviewed 150 consecutive cases diagnosed as having pretibial myxedema in a twenty-year period in a tertiary care center. Only one patient in this group did not have ophthalmopathy, and the majority of cases had significant proptosis and ophthalmopathy, 30% required orbital decompression surgery. Dermopathy is a late manifestation of the Graves' disease and its onset is usually after the diagnosis of hyperthyroidism and ophthalmopathy. In a few patients, dermopathy preceded diagnosis of hyperthyroidism or the onset of ophthalmopathy. Fourteen patients have never had hyperthyroid, eleven patients in this group had developed spontaneous hypothyroidism."nAll cases showed the involvement of the lower extremities, and only one patient showed to have combined upper and lower extremities involvement. The most common form of thyroid dermopathy was non-pitting edema. Nodular and plaque forms were also relatively common and occurred with equal frequency. Polypoid form occurred in one patient and elephantiatic form in another. There was no consistent correlation among different types of dermopathy and severity of eye disease."nDuring a three-month to nineteen-year follow up in 120 patients, complete remission was observed only in twelve patients. Partial remission was more common and occurred more frequently in patients who had local steroid therapy. it is possible that patients with remission might have been excluded of the follow up program.Thus, the remission data should be interpreted cautiously.

  19. Predictive factors of failure in radioiodine therapy of Graves' disease

    Full text of publication follows. Aim: to retrospectively evaluate any factors that may limit the success rate of radioiodine therapy (RIT) in Graves' disease patients. Methods: 80 Graves' disease patients submitted for RIT in our department in a two years' period (2010-2011) were enrolled in the study. A fixed dose of 12 mCi (444 MBq) of 131I was administered to all patients after antithyroid drug administration, in order to achieve normal FT3 serum values. Thyroid function outcome were assessed 10-12 months after RIT. Patient's sex, age, evidence of ophthalmopathy, ultrasound measurement of the thyroid volume and 99mTc thyroid uptake % prior to RIT were considered as potential interference factors for success. Multiple logistic regression analysis was performed. Results: after RIT, 9 patients (11%) became euthyroid, 48 patients (61%) became hypothyroid and 23 (28%) remained hyperthyroid. No statistically significant association between treatment outcome and sex (p = 0.56), age (p=0.61) and ophthalmopathy (p = 0.72) was found. On the contrary, 99mTc thyroid uptake % and thyroid volume were associated with success rate (thyroid uptake<14%, p<0.001, odds ratio 3.9 and thyroid volume <58 ml, p < 0.001, odds ratio 7.9). Conclusions: A radioiodine fixed dose of 12 mCi (444 MBq) for treatment of Graves' disease seems to be a practical and effective approach. However, this administration is not recommended for patients with large goiters and a high pre-RIT thyroid uptake, due to high failure rates observed in patients with thyroid volume more than 58 ml and thyroid uptake higher than 14%. (authors)

  20. POTENTIALLY GRAVE GASTRO-INTESTINAL TRACT PROBLEMS IN PREGNANCY - A CHALLENGE TO THE OBSTETRICIAN!

    Chaitra

    2016-02-01

    Full Text Available CONTEXT Acute surgical pathology may be overlooked in pregnancy. Despite advances in medical technology, preoperative diagnosis of potentially grave pathologies of the gastrointestinal tract (GIT is often delayed due to overlap with symptoms of pregnancy non-specific elevation of some laboratory parameters due to pregnancy and a dilemma for obstetricians and surgeons in ordering radiological imaging modalities given the risk associated with fetal exposure to ionizing radiation and contrast. AIMS The aim of this study is to analyse the cases of gastrointestinal tract problems encountered in pregnancy so that increasing awareness can be created among obstetricians. This is important because early diagnosis and timely intervention can significantly improve maternal and fetal outcome in these cases. SETTINGS AND DESIGN There is a retrospective case study of potentially grave GIT problems encountered at Vanivilas hospital, Bangalore, a tertiary referral institute wherein the clinical presentation was confounded by pregnancy. MATERIALS AND METHODS All the included cases were analysed for age of the patient, pre-existing gastrointestinal tract disorders, gestational age at diagnosis, maternal and fetal outcome. RESULTS A total of 8 cases of GIT problems in pregnancy were studied. Though acute appendicitis is the most common cause of GIT emergency in pregnancy as quoted in literature 5, we did not encounter any case of acute appendicitis in pregnancy in the study period. Other conditions which were encountered were small bowel obstruction, stomach and bowel perforation and bleeding oesophageal varices. Whilst few of the conditions could be managed conservatively without harm to the pregnancy, others required a laparotomy and reparative procedures. Delay in diagnosis and intervention proved to be fatal in some of these women. CONCLUSIONS Knowledge about potentially grave gastrointestinal tract problems during pregnancy, high index of clinical suspicion

  1. Study on the change of hepatic fibrosis indicators in serum before and after I-131 treatment in Graves' Patients

    Full text: Objective: To explore the change of hepatic fibrosis indicators, i.e., PC-III (type III procollagen), IV-C (type IV collagen), HA (hyaluronic acid), LN (laminin) levels in serum of Graves' patients before and after I-131 treatment. Methods: Control group were 40 healthy cases (female 25, male 15, aged 18-60 years) with normal serum levels of those indicators by medical examination in our hospital. Fifty-five Graves' patients (female 32, male 23, aged 17-58) were diagnosed by thyroid function indicators (TT3, TT4, FT3, FT4, TSH) tests, thyroid iodine intake and clinical symptoms and signs, with normal hepatic function indicators and without combined history of hepatic disease, cardiac disease, diabetes, and rheumatic disease. Three to six months after I-131 treatment these were completely recovered (back to normal thyroid function, shrunken thyroid gland volume from swelling, and disappeared clinical symptoms and signs). In both controls and Graves' patients, 2 ml venous blood was taken at early morning from each case with limosis respectively before and after I- 131 treatment. RIA method was adopted for detection of each serum indicator with reagents kit. Data were analyzed by t test in the SPSS statistical software pack. Results: 1. In Graves' patients, before treatment PC- III (type III procollagen) levels were statistically higher than that in controls (p0.05). 2. In Graves' patients, PC-III significantly decreased to a lower level after treatment than before (p05). 3. In Graves' patients, after treatment there is no significant difference of indicator levels when compared with controls (p>0.05). Conclusion: Graves' patients had certain degree of hyperplasia of hepatic connective tissue, and this pathogenesis recovered with healing of Graves' disease. PC-III positive rate and thyroid function indicator positive rate may be better in accordance with the disease process than IV-C, Ha and LN indicators. These data showed that of four serum hepatic

  2. Vasculite cerebral e doença de Basedow-Graves: relato de dois casos

    Rocha Maria Sheila Guimarães; Brucki Sônia Maria Dozzi; Ferraz Ana Cláudia

    2001-01-01

    OBJETIVO: Relatar dois casos de pacientes com vasculite cerebral associada à doença de Basedow-Graves. RELATO DOS CASOS: O primeiro é uma paciente de 22 anos de idade com quadro súbito de disartria e déficit motor em dimídio esquerdo. Ao exame clínico, apresentava taquicardia, exoftalmia bilateral e bócio difuso. Referia tratamento para hipertiroidismo há um mês. O segundo é uma paciente de 15 anos de idade, que apresentou quadro súbito de perda da consciência seguindo-se distúrbio de linguag...

  3. Association of the thyroid stimulating hormone receptor gene (TSHR) with Graves' disease

    Brand, Oliver J; Barrett, Jeffrey C; Simmonds, Matthew J;

    2009-01-01

    Graves' disease (GD) is a common autoimmune disease (AID) that shares many of its susceptibility loci with other AIDs. The thyroid stimulating hormone receptor (TSHR) represents the primary autoantigen in GD, in which autoantibodies bind to the receptor and mimic its ligand, thyroid stimulating...... hormone, causing the characteristic clinical phenotype. Although early studies investigating the TSHR and GD proved inconclusive, more recently we provided convincing evidence for association of the TSHR region with disease. In the current study, we investigated a combined panel of 98 SNPs, including 70...

  4. Evaluación psicopedagógica y la discapacidad intelectual grave

    Oms Senent, Nelia

    2013-01-01

    En el presente trabajo hablaremos sobre la tarea y razón de ser del diagnóstico, y de su importancia a la hora de realizar un buena intervención. También definiremos y explicaremos que es una evaluación psicopedagógica, y los problemas y dificultades a la hora de realizarla a personas con discapacidad intelectual grave, tanto en los instrumentos como en el proceso. Finalmente compararemos ambas partes, demostrando que para nuestro contexto particular, como es Afanías, un centro...

  5. Th1/Th2 cytokines in patients with Graves' disease with or without ophthalmopathy.

    Fatemeh Esfahanian; Effat Naimi; Farideh Doroodgar; Zohre Jadali

    2013-01-01

    About 25-50% of Graves' disease (GD) patients develop thyroid eye diseases, which is associated with inflammatory process and abnormalities in the levels of several cytokines in orbital tissues in GD.  The aim of this study was to determine the Th1 and Th2 serum cytokines in patients with GD with or without ophthalmopathy.Serum  levels of  cytokines  and  autoantibodies  including Interferon-gamma  (IFN-γ),Interleukin-2 (IL-2), Interleukin-4 (IL-4), Interleukin-10 (IL-10), TSH receptor autoan...

  6. Les cellulites cervico-faciales graves, facteurs et critères de gravité

    Lakouichmi, Mohammed; Tourabi, Khalid; Abir, Bader-eddine; Zouhair, Said; Lahmiti, Saad; Hattab, Nadia Mansouri

    2014-01-01

    La cellulite cervico-faciale grave est une infection polymicrobienne extensive et redoutable du tissu cellulo-adipeux de la face et du cou. L'objectif de cette étude est d'analyser certains facteurs favorisants et d’évaluer les critères de gravité en fonction des formes anatomo-cliniques. Il s'agit d'une étude rétrospective réalisée, entre janvier 2007 et décembre 2012, au service de chirurgie maxillo faciale de l'hôpital militaire Avicenne de Marrakech. Sur 147 cas de cellulites cervico-faci...

  7. Induction of animal model of Graves disease in BALB/c mice

    2009-01-01

    Objective To construct an animal model of Graves' disease(GD)by immunizing BALB/c mice with hM12 cells co-expressing major histocompatibility complex(MHC)class II molecules and human thyrotropin receptor(TSHR)molecules.Methods BALB/c mice in experimental group(H-2d)were immunized with hM12 cells intraperitoneally every 2 weeks for six times,while mice in control group were immunized with M12 cells.Five weeks later,the thyroids were histologically examined,and serum samples were tested for thyroid-stimulatin...

  8. Fisioterapia respiratoria na pressao intracraniana de pacientes graves internados em unidade de terapia intensiva: revisao sistematica

    Lucas Lima Ferreira; Vitor Engracia Valenti; Luiz Carlos Marques Vanderlei

    2013-01-01

    Objetivo: Analisar os desfechos aumento/diminuição da pressão intracraniana e/ou queda da pressão de perfusão cerebral, proporcionados pela fisioterapia respiratória em pacientes graves assistidos em unidade de terapia intensiva. Métodos: Por meio de uma revisão sistemática da literatura, foram selecionados ensaios clínicos publicados entre 2002 e 2012. A busca envolveu as bases de dados LILACS, SciELO, MedLine e PEDro, usando os descritores "physical therapy", "physiotherapy", "respiratory...

  9. Unidad hospitalaria de patología dual grave: un año de experiencia

    Esfors Hernández, Jorge; Villar García, Mariano; Rubio Perlado, Begoña; Juan i Porcar, María; Romero Marmaneu, Francisca

    2014-01-01

    Se trata de un estudio observacional, descriptivo, transversal en el que se incluyeron los pacientes ingresados en la Unidad de Hospitalización del Programa de Patología Dual Grave (UHPPDG) durante un año. Los datos sociodemográficos, clínicos y farmacológicos se obtuvieron mediante hojas de recogida de datos diseñadas al efecto. El total de pacientes ingresados fue de 82 en cuyo perfil prevalecen los varones con una edad media de 36,7 años, derivados del subprograma ambulatori...

  10. Factores pronósticos en el traumatismo craneoencefálico grave

    José Purón-Barrera; Elizabeth Reyes-Ramírez; Andrés Andrés-Matos; Alberto Piriz-Assa

    2011-01-01

    Se señalaron los factores relacionados con la mortalidad del trauma craneoencefálico grave y que pueden influir sobre su pronóstico. La presencia de puntuación en la Escala de Glasgow ¿ 8, hiperglicemia, shock, necesidad de ventilación mecánica, alteraciones pupilares y múltiples lesiones en la tomografía axial computarizada (TAC) entre las cuales siempre estuvo asociado el hematoma subdural concuerda con lo referido por otros estudios. El hallazgo de hipernatremia tuvo alta significación est...

  11. Perfil psicosocial y modelo de intervención en adolescentes con problemas graves de comportamiento

    Orrego Álvarez, José Manuel

    2014-01-01

    La presente Tesis persigue dos objetivos generales. En primer lugar, analizar el perfil psicosocial y los rasgos psicopatológicos, emocionales y escolares de un grupo de alumnos del Principado de Asturias, que participan en la experiencia socioeducativa Trampolín y que son considerados por las autoridades educativas regionales como los casos más graves en cuanto a problemas de comportamiento. En segundo lugar, examinar la intervención realizada con ellos en un centro especializado que, bien d...

  12. Image and Role of the Queen Mother of the West in Han Grave Art

    Nataša VAMPELJ SUHADOLNIK

    2015-01-01

    The present article is a detailed study of the image of an ancient Chinese goddess, The Queen Mother of the West, called Xiwangmu 西王母 in Chinese. In the mythological tradition, Xiwangmu is a goddess who possesses the elixir of immortality and dwells in the western paradise, on the magic mountain Kunlun 崑崙. While her image can be found in mural paintings, and on lacquered objects and bronze mirrors, it appears primarily in the form of relief images on the stones and bricks of grave chambers an...

  13. Samantha Matthews. Poetical Remains – Poets’ Graves, Bodies, and Books in the Nineteenth Century

    Marc PORÉE

    2005-10-01

    Full Text Available What is left of poets after they have passed away? Graves and books, answers Samantha Matthews in Poetical Remains, a study which capitalizes on body-oriented essays, while threatening to drive the trend into the ground, since it offers the ultimate take on poets—viewing them as terminal cases, but assessing their books as open-ended. The work purports to examine what it views as the particular affinity between poets' physical and literary “remains” in the Romantic to late Victorian period. B...

  14. Estudo dos linfócitos circulantes por anticorpos monoclonais na miastenia grave

    Paulo E. Marchiori; Duarte, Alberto J.; M. Izabel A. M. Birolli; Cristina A. Figueiredo; Milberto Scaff; J. Lamartine de Assis

    1988-01-01

    Os autores avaliam os linfócitos T (CD3, CD4, CD8, CD4/8) por anticorpos monoclonais e rosácea em 20 pacientes e linfócitos B por Fab' por imunofluorescência em 9 pacientes com miastenia grave. Observam elevação significante na população de linfócito B e redução nos linfócitos T totais CD3+ por rosáceas. Não foram observadas modificações nas subpopulações celulares com timectomia e corticosteróides.

  15. Estudo dos linfócitos circulantes por anticorpos monoclonais na miastenia grave

    Paulo E. Marchiori

    1988-09-01

    Full Text Available Os autores avaliam os linfócitos T (CD3, CD4, CD8, CD4/8 por anticorpos monoclonais e rosácea em 20 pacientes e linfócitos B por Fab' por imunofluorescência em 9 pacientes com miastenia grave. Observam elevação significante na população de linfócito B e redução nos linfócitos T totais CD3+ por rosáceas. Não foram observadas modificações nas subpopulações celulares com timectomia e corticosteróides.

  16. Clinical study of 1003 cases with Graves' disease treated with 131I

    Objective: To explore the treatment effects of individual 131I dose treatment of Graves' disease. Methods: Graves' disease patients were given individual 131I dose (131I MBq/per gram thyroid tissue), which ranged at 1.48-4.07 MBq/g. A total of 1003 cases (76.9%) were successfully followed up. The mean administered dose of 131I was (329.3 ± 307.1, 44.4-3700) MBq. The term of follow-up was (16.4 ± 10.0, 3.0-44.7) months. Results: After one dose 131I treatment, 593 patients (59.1%) were with euthyroid, 200 patients (19.9%) hypothyroidism, 190 patients (18.9%) were partially remitted, 20 patients (2.0%) showed no changes; 259 patients (25.8%) suffered from early hypothyroidism, 88 patients were with transient hypothyroidism. Logistic stepwise regression analysis revealed that hard thyroid texture was a risk factor for developing early hypothyroidism, whereas large goiter was a protective factor for developing permanent hypothyroidism. Partial-correlations analysis showed that curative effects correlated negatively with the weight of goiter mass, the course of disease and the use of antithyroid drugs (ATD). After 131I treatment, for 195 patients (41.7%) the ophthalmopathy was cured, 155 patients (33.1%) were partially remitted, 105 patients (22.4%) showed no effects, 13 patients (2.8%)were deteriorated. For 56 patients (77.8%) their hyperthyroid heart disease was cured, 10 patients(13.9%) were partially remitted, 6 patients (8.3%) were of no effects. For 60 patients (85.7%) periodic paralysis associated with thyrotoxicosis were cured, 2 patients (2.9%) were partially remitted, 8 patients (11.4%) were of no effects. Of 249 patients with large goiter (≥90 g), 219 cases (88.0%) were completely remitted. Conclusions: The individual 131I dose treatment for Graves' disease exerts good therapeutic efficiencies. 131I treatment for ophthalmopathy, hyperthyroid heart disease and Graves' disease with lager goiter is effective and safe. (authors)

  17. Impacto del estudio microbiológico en la neumonía comunitaria grave.

    Bodí Saera, María Amparo

    2002-01-01

    TESIS DOCTORALIMPACTO DEL ESTUDIO MICROBIOLOGICO EN LA NEUMONÍA COMUNITARIA GRAVEMaría Bodí SaeraOBJETIVO DE LA TESISEsta Tesis va dirigida a valorar el impacto que tiene el estudio microbiológico en las decisiones terepéuticas y en la evolución de la neumonía comunitaria grave.MATERIAL Y METODOSSe trata de un análisis retrospectivo de los datos recogidos de forma prospectiva.Se realiza en dos Servicios de Cuidados Intensivos españoles. Se analizan todos los casos de neumonía comunitaria grav...

  18. Morbidade Materna Grave e Near Misses em Hospital de Referência Regional

    Márcia Lait Morse

    2011-06-01

    Full Text Available OBJETIVO: Analisar perfil epidemiológico da morbidade materna grave/near miss em uma maternidade pública de referência regional, utilizando diferentes critérios identificadores. MÉTODOS: Trata-se de um estudo descritivo de corte transversal dos casos de morbidade materna grave/near miss realizado em Hospital de referência regional entre junho e outubro de 2009, identificados a partir dos livros de registro de internação da maternidade e análise dos prontuários clínicos. Foram estudadas mulheres que, durante a gestação, parto ou puerpério, apresentaram qualquer quadro clínico compatível com os critérios definidores de morbidade materna grave/near miss de Waterstone et al., Mantel et al. e Organização Mundial de Saúde. RESULTADOS: Entre as 1.544 internações foram identificadas 89 mulheres com morbidade materna grave, considerando os critérios adotados. As razões de morbidade materna grave/near miss variaram entre 81,4 a 9,4 por 1.000 NV, dependendo do critério utilizado. O índice de Mortalidade foi de 3,2%, chegando a 23% no critério da OMS. Das 89 mulheres, apenas 40% fizeram mais de seis consultas de pré-natal e 10% não realizaram qualquer consulta. Os marcadores mais encontrados foram a pré-eclâmpsia grave seguida de hemorragia grave, internação em UTI, Síndrome HELLP e eclâmpsia. Ocorreram três mortes maternas por causas obstétricas com RMM de 280/100.000 NV e uma morte tardia. O critério da OMS se mostrou mais específico, identificando os casos mais graves, enquanto o de Waterstone foi mais sensível. CONCLUSÃO: O estudo da morbidade materna grave/near miss em um hospital de referência regional pode contribuir para o conhecimento da magnitude deste evento, como também identificar suas características e condições clínicas mais frequentes, sendo extremamente importante para o enfrentamento da morbi-mortalidade materna.OBJECTIVE: To investigate severe maternal morbidity/near misses in a tertiary

  19. Coincidence of remission of postpartum Graves' disease and use of omega-3 fatty acid supplements

    Breese McCoy Sarah J

    2011-11-01

    Full Text Available Abstract I developed Graves' Disease four months postpartum. After one year on propylthiouracil, I learned that omega-3 fatty acids may reduce inflammation associated with certain autoimmune disorders, although no investigations for thyroiditis have been reported. Within eight weeks of beginning flaxseed oil supplements, TSH levels normalized, but fell somewhat when flaxseed was decreased and PTU discontinued. During another pregnancy, plasma TSH normalized, but was again suppressed by four weeks postpartum, then undetectable by four months. This time, flaxseed supplementation alone coincided with TSH normalization. Omega-3 fatty acids should be investigated as a potential treatment for autoimmune thyroid disease.

  20. A female burial with grave goods at the Roman villa of Almenara de Adaja (Valladolid

    C. GARCÍA MERINO

    2012-03-01

    Full Text Available Recent works in an area placed North from the pars urbana of the late imperial roman villa at Almenara de Adaja (Valladolid, Spain have uncovered a female burial with grave goods. These finds suggest the likely situation of a necropolis corresponding to the villa lifetime period. We study the artifacts found in the burial. Results of an analysis on the content of a ceramic vessel found there are also given. This finding complements the available data on the distribution and organization of contemporary habitat and adds up to the known information on cemeteries dating from this time period in the Spanish north inner plateau.

  1. Analysis of HLA-DQB and HLA-DPB alleles in Graves' disease by oligonucleotide probing of enzymatically amplified DNA.

    Weetman, A P; Zhang, L; Webb, S; Shine, B

    1990-07-01

    We have tested the possible association of HLA-DQB and HLA-DPB alleles with Graves' thyrotoxicosis, with or without severe ophthalmopathy, by polymerase chain amplification of genomic DNA and allele-specific oligonucleotide probing. There was no significantly abnormal distribution of DQB alleles compared to 50 control subjects except for a reduced prevalence of DQw 3.1 in the Graves' patients with severe ophthalmopathy (X2 = 6.23, P less than 0.02). HLA-DPB 2.1/8 was found in only 1 of 40 of these patients compared with 15 of the controls (X2 = 11.49, P less than 0.001). Ten of 48 patients with Graves' disease but without clinically significant eye involvement were HLA-DPB 2.1/8 positive, not significantly different from controls, but significantly different from the ophthalmopathy group (X2 = 6.70, P less than 0.01). The other DPB alleles in both groups of Graves' disease patients were the same as controls. These results suggest that HLA-DPB 2.1/8 may confer a protective effect in Graves' disease with respect to ophthalmopathy. PMID:2401099

  2. Graves' Disease

    ... you take a type of drug called a beta-blocker . Beta-blockers do not affect how much thyroid hormone is ... and reduces symptoms such as shaking and nervousness. Beta-blockers work quickly and can help you feel better ...

  3. Graves disease

    ... tests include: Blood tests to measure levels of TSH, T3, and free T4 Radioactive iodine uptake and ... stimulating immunoglobulin ( TSI ) Thyroid peroxidase (TPO) antibody Anti-TSH receptor antibody

  4. Watery Graves

    Dal Lago, Alessandro

    2010-01-01

    Written in the style of a seventeenth-century Jesuit sermon, “Watery Graves” (“Fluidi Feretri” in the original Italian) takes its title from a sonnet by Giacomo Lubrone, a distinguished Jesuit orator and poet of the period. The piece was inspired by the death of a group of young Senegalese who left Dakar or a nearby port for the Spanish Canary Islands on Christmas Eve in 2005. After drifting thousands of miles off course, the boat eventually ran aground off the Caribbean Island of Barbados. “...

  5. Graves' Disease

    ... thyroid disease may be sensitive to harmful side effects from iodine. Taking iodine drops or eating foods containing large amounts of iodine—such as seaweed, dulse, or kelp—may cause or worsen hyperthyroidism. ...

  6. A clinical analysis of 361 cases of Graves disease combined with neutropenia or agranulocytosis%Graves 病合并粒细胞减少或缺乏361例临床分析

    闫文博; 秦贵军

    2016-01-01

    Objective To explore the prevalence and the correlation factors of neutropenia or agranulocytosis in patients with Graves disease.Methods The clinical data of 361 patients diagnosed as Graves disease in General Hospital of Pingmei Shenma Medical Group from February of 201 0 to February of 201 5 were analyzed retrospectively.Results Among 361 patients,there were altogether 1 27 patients with neutropenia or agranulocytosis(35.1 8%),1 23 with neutropenia(34.07%),4 with agranulocy-tosis(1 .1 1 %).Among the 1 27 cases,72 (56.69%)were caused by Graves disease,and 55 were caused by antithyroid drugs (ATD)(43.31 %).Among neutropenia or agranulocytosis caused by Graves disease itself,the neutrophil count were negatively correlated with age,free triiodothyronine (FT3 ),free thyroxine(FT4 )and TSH receptor stimulation antibody(TSAb).Conclu-sion The incidence of neutropenia was relatively high in patients with Graves disease,and the neutropenia induced by Graves disease itself may be related with the degree of hyperthyroidism.%目的:探讨 Graves 病患者合并粒细胞减少或缺乏的发生率及相关因素。方法对平煤神马医疗集团总医院2010年2月至2015年2月收治的361例 Graves 患者的临床资料进行回顾性分析。结果361例 Graves 患者中,粒细胞减少或缺乏127例(35.18%):粒细胞减少123例(34.07%),粒细胞缺乏4例(1.11%)。其中 Graves 疾病本身导致者72例(56.69%),抗甲状腺药物(ATD)导致者55例(43.31%)。在 Graves 疾病本身所致的粒细胞减少或缺乏中,粒细胞计数与年龄、FT3、FT4、TSH 受体刺激性抗体(TSAb)呈负相关。结论Graves 病患者合并粒细胞减少的发生率较高,其疾病本身所导致的粒细胞减少可能与甲亢的病情程度相关。

  7. Thyroid Gland Hemiagenesis with Multinodular Graves' Disease: A Case Report [Multinodüler Graves' Hastaliğinin Eşlik Ettiği Tiroid Hemiagenezili Olgu

    Arduc, Ayse; Tuna, Mazhar Muslum; Aycicek Dogan, Bercem; Akbaba, Gulhan; Berker, Dilek; Guler, Serdar

    2015-01-01

    AbstractThyroid hemiagenesis (THA) is a rare congenital anomaly. It occurs more frequently in the left lobe and predominantly in women. Most of the cases are asymptomatic. The most frequent associated thyroid disorders with THA are nontoxic nodular goiter and Hashimoto's thyroiditis whereas association of Graves' disease with THA is very rare. We present a man patient with THA and multinodular Graves' disease.  A 47-year-old  male was admitted with  palpitation, hand tremor, and  weight loss,...

  8. Relationship between the serum TGA, TMA positiveness and development of hypothyroidism after 131I therapy in patients with Graves' disease

    Objective: To study the likelihood of development of hypothyroidism after 131I therapy in patients with Graves' disease as related to the serum positiveness of TGA and TMA before treatment. Methods: Altogether, 176 patients with Graves' disease were treated with 131I and followed for 3 years of these patients, serum TGA and TMA were positive in 70 and were negative in 106. Results: In the 70 patients with positive TGA and TMA, development of hypothyroidism after 131I treatment occurred in 22 subjects three years later (31.4%). However, only 4 of the 106 patients with negative TGA and TMA developed hypothyroidism 3 years after 131I therapy (3.8%). Difference in the incidence of hypothyroidism was significant (P131I be administered to patients with Graves' disease and positive serum TGA, TMA. (authors)

  9. Ubiquitous media in everyday practices of grief and commemoration on children’s graves and online memorial sites

    Sandvik, Kjetil; Christensen, Dorthe Refslund

    Ubiquitous media is not just a matter of (digital) media being everywhere and embedded in various objects (clothing, household hardware, buildings…). Using the practices of bereavement and commemoration as displayed by parents on children’s graves and online memorial sites as a case, this paper......’s graves in urban cemeteries. It is, however, also similarly apparent in the formation of network and peer-to-peer associations and, not the least, in the establishment of online networks and sites of grief and commemoration on social media. Facebook, Twitter and YouTube are media alive with discussions...... studies of specific fields, such as practices related to burial traditions, grave traditions and so on, however, in recent years the field has developed into becoming increasingly cross-disciplinary and forming networks across countries. The research tradition has evolved out of clinical practices (Rando...

  10. Study of the effect of 131I treatment of graves disease on the number of peripheral blood leucocyte

    Objective: To study the effect of 131I treatment of Graves disease on the number of peripheral blood leucocytes. Methods: The Graves disease patients were divided into groups according to the 131I dosage taken, peripheral blood leucocytes were measured before and after the taking of 131I. Results: On the 4th day after taking 131I, the absolute value of leucocyte, neutrophil, Lymphocyte were decreased, the number of neutrophil was significantly decreased (P 131I(P 131I. Conclusion: 131I treatment of Graves disease can reduce the number of leucocytes, especially neutrophil, in a short time (about one week), it is related with the dosage of 131I. After a week, they can nearly return to the primary level. Some medicine which can increase the number of leucocytes should be used when the patient taking 131I

  11. Parathyroid adenoma in patients with Graves' disease: a report of 21 cases.

    Wei, Shuanzeng; Baloch, Zubair W; LiVolsi, Virginia A

    2015-03-01

    Graves' disease (GD) is frequently associated with mild hypercalcemia. The hypercalcemia may be due to the activation of osteoclastic bone resorption caused by the excess thyroid hormone. In some cases of GD, the hypercalcemia can be attributable to concomitant parathyroid diseases. In this study, 21 patients with a history of GD developed parathyroid adenoma based on histology, intraoperative parathyroid hormone (IOPTH) monitoring, and other clinical features. There were 11 patients with a history of radioactive iodine therapy (RAI) for GD. The latency time of RAI was from 12 to 41 years. The case cohort was divided into two groups: patients with (group GR: 11 patients) and patients without a history of RAI (group G: 10 patients). Mean age of patients in group GR was 54.8 years compared to 62.2 years of group G (P = 0.08). There were no statistically significant differences regarding the parathyroid weight, serum calcium, and pre- and post-parathyroidectomy PTH levels. There was no histopathologic difference between the two groups. In conclusion, we report 21 cases of parathyroid adenoma in patients with Graves' disease. There may be a possible link between GD patients with a RAI history and an increased risk of parathyroid adenoma. The parathyroid adenomas showed no clinicopathological differences between GD patient with and without a history of RAI. PMID:25501495

  12. Peripheral blood T cell activation after radioiodine treatment for graves' disease

    Radioiodine therapy for Graves' thyrotoxicosis produces a rise in thyroid autoantibodies in the first three months after treatment, but little is known of its effects on T cells. We have therefore followed the changes in T cells subsets in sequential samples from 23 patients with Graves' disease treated with radioiodine, using dual-colour flow cytometry. In the first month after treatment there was a significant rise in activated T cells, identified by the markers HLA-DR (Ia) and CDW 26/Ta1 (P<0.025 in both case). CD45RO-positive T cells, which are the prime population containing memory cells, also increased (P<0.025), but there was no change in CD45R-positive, resting cells or in the CD4/CD8 (helper to cytotoxic/suppressor) ratio. Vicia villosa-binding T cells, containing the contra-suppressor population, showed a more variable response, but the trend was to an overall increase from pre-treatment values (P<0.025). The change did not appear to be related to antithyroid drugs treatment, since they were seen irrespective of whether patients convinced such therapy. These results suggest that T cell activation and enhanced contra-suppressor activity may in part be responsible for the rise in autoantibodies after radioiodine therapy

  13. Peripheral blood T cell activation after radioiodine treatment for Graves' disease

    Wei-Ping Teng; Stark, R.; Borysiewicz, L.K.; Weetman, A.P. (Department of Medicine, University of Cambridge Clinical School, Level 5, Addenbrooke' s Hospital, Cambridge (UK)); Munro, A.J. (Department of Clinical Oncology, Hammersmith Hospital, London (UK)); McHardy Young, S. (Department of Medicine, Central Middlesex Hospital, London (UK))

    1990-01-01

    Radioiodine therapy for Graves' thyrotoxicosis produces a rise in thyroid autoantibodies in the first three months after treatment, but little is known of its effects on T cells. We have therefore followed the changes in T cell subsets in sequential samples from 23 patients with Graves' disease treated with radioiodine, using dualcolour flow cytometry. In the first month after treatment there was a significant rise in activated T cells, identified by the markers HLA-DR(la) and CDw26/Tal (p<0.025 in both cases). CD45RO-positive T cells, which are the primed population containing memory cells, also increased (p<0.025), but there was no change in CD45R-positive, resting T cells or in the CD4 to CD8 (helper to cytotoxic/suppressor) ratio. Vicia villosa-binding T cells, containing the contrasuppressor population, showed a more variable response, but the trend was to an overall increase from pre-treatment values (p<0.025). The changes did not appear to be related to antithyroid drug treatment, since they were seen irrespective of whether patients continued such therapy. These results suggest that T cell activation and enhanced contrasuppressor activity may in part be responsible for the rise in autoantibodies after radioiodine. The T cell changes could also contribute to the worsening of ophthalmopathy seen in some radioiodine-treated patients. (author).

  14. Clinical significance of serum leptin levels in patients with graves' disease

    Objective: To investigate the levels of serum leptin in patients with graves' disease. Methods: Serum leptin levels were measured with IRMA in 51 patients with hyperthyroidism as well as 46 hypothyroid and 50 euthyroid subjects as controls. Serum TSH, free T3 and free T4 (FT3 and FT4) were also measured. Body fat percentage (% Fat) and body mass index (BMI) were calculated. Results: Serum leptin levels were significantly lower in patients with graves' disease (male 2.05 ± 1.54μg/L, female 7.47±5. 08 μg/L), than those in hypothyroid and euthyroid subjects. Levels in hypothyroid patients were significantly higher than those in controls, however, excluding the body fat factor, there were no obvious difference. Serum leptin levels in all the 3 groups were significantly positively correlated with BMI. The levels were negatively correlated with FT3, FT4 levels and positively correlated with TSH levels but both were not significant. Serum leptin levels were 2-3 times higher in women than in men among all 3 groups. Conclusion: Thyroid functional status affected serum leptin levels indirectly through the amount of body fat. (authors)

  15. Comparative study of low dose 131I treatment in patients with Graves' disease

    Objective: To investigate the low dose 131I therapy for Graves' disease we compared the results of 277 patients in our department with the report of Howarth D et al. Methods: 277 patients were classified as 45 Gy group and 77 Gy group according to the dose level. The results of these two groups were compared separately with results of 60 Gy group and 90 Gy group reported by Howarth D et al. Results: The euthyroidism rate and hypothyroidism rate among these four groups had no significant statistical difference after 6 months of 131I therapy, but there were high significant statistical difference between our study and Howarth D research about euthyroidism rate and hypothyroidism rate 24 months later. Conclusion: The low dose 131i management refered by Howarth D et al was an effective method for Graves' disease which could reduce or delay the incidence of hypothyroidism. Our study show that subsection on the foundation of this low dose procedure could further reduce the incidence of hypothyroidism and improve the euthyroidism rate. (authors)

  16. Analysis of factors affecting the early hypothyroidism following 131I treatment of Graves' disease

    Objective: It is a retrospective study designed to evaluate the early therapeutic outcome of radioiodine therapy in patients with Graves' disease and determine whether the outcome of radioiodine therapy in Graves' disease depends on thyroid volume, function, thyreo-stasis, therapeutic dosage, 131I uptake, age, sex, and absorbed doses by per gram of thyroid tissue. Methods: One year after treatment, 342 patients were divided into two groups according to whether there was hypothyroidism, t test and x2 test were used to compare the variable parameters between the two groups. Results: 92.1% were cured with a single dose of 131I, and 21.2% contracted hypothyroidism at 12 months after treatment. The outcome of treatment at 12 months depended on the volume of thyroid and the absorbed doses by per gram of thyroid tissue. And pretreatment with thyreo-stasis did not reduce the therapeutic efficacy of 131I in hyperthyroidism if antithyroid drugs were discontinued at least 3 days before 131I treatment. Conclusions: Since most hypothyroidism occurred in patients whose thyroid volume is small, appropriate reduction of target dose is recommended here for those patients

  17. Factors predlisposing to developing early hypothyroidism after 131I therapy in patients with Graves' disease

    Objective: To explore the clinical meanings of changes of serum TRAb, TGA, TMA contents during treatment of Graves' disease with 131I, especially in those patients developing early hypothyroidism. Methods: Serum levels of TRAb, TGA, TMA, TSH, T3, T4 were measured in 167 patients with Graves' disease both before and six months after mi therapy. Results: Six months after 131I treatment, the original 167 patients could be divided into three groups based apon their thyroid ruction statas: Group A, improved but remained hyperthyroid, n=91, Group B, enthyroid, n=48, Group C, developing early hypothyroidism, n=28. Average age in Group C (hypothyroid) was significantly lower than that in Group A (hyperthyroid) (P131I treatment in younger patients. (2) Patients with high TRAb levels before 131I therapy were less likely to be rendered enthyroid after a single course of treatment while those with low TRAb levels were easily rendered hypothyroid. (3) Development of hypothyroidism after 131I treatment was closely related to the increase of TGA, TMA levels. (authors)

  18. A case of Graves' disease with false hyperthyrotropinemia who developed silent thyroiditis.

    Iitaka, M; Ishii, J; Ishikawa, N; Yoshimura, H; Momotani, N; Saitou, H; Ito, K

    1991-12-01

    We encountered a patient who developed silent thyroiditis during the course of Graves' disease. The diagnosis of silent thyroiditis was made on the basis of a low thyroidal 131I uptake, no response to the thyrotropin releasing hormone (TRH) test, and subsequent hypothyroidism despite the presence of high titers of thyrotropin (TSH) receptor antibody (TRAb) and thyroid stimulating antibody (TSAb). The patient, in addition, had a discrepancy between serum TSH and thyroid hormone values. This was due to the presence of interfering substances that react to mouse IgG in the sera since serum TSH levels were decreased in a dose dependent manner by the addition of increasing amounts of mouse IgG to the sera. It should therefore be noted that silent thyroiditis can develop in patients with Graves' disease. Furthermore, clinicians should be aware that two-site immunoassay kits that use mouse monoclonal antibodies are subject to interference by some substances, possibly antibodies which react to mouse IgG. PMID:1688049

  19. A case of Graves-Basedow disease with orbitopathy and papillary thyroid cancer

    Coexistence of Graves-Basedow disease with orbitopathy and thyroid cancer is believed to be a rare event. A 39-year-old man with clinical features of hyperthyroidism associated with exophthalmos and goitre presented to out patient clinic. Thyroid function tests showed hyperthyroidism with elevated thyroid-stimulating antibodies. Graves-Basedow disease was diagnosed. Ultrasound revealed diffuse thyroid enlargement with hypoechoic pattern and hypoechoic lesions with regular edges of 1.0 cm diameter at the left and right lobe. Fine needle aspiration biopsy was negative. Due to the patients nodular goitre and mild orbitopathy, after some further 3 months of anti-thyroid medication, near total thyroidectomy was performed. Histologically, papillary micro carcinoma was found. Following surgery, the patient was referred to our Department of Endocrinology, L-thyroxine suppression treatment was commenced. Approximately 8 weeks post surgery, the patient reported with eye discomfort, soft tissue oedema and double vision. On CT thickening of the left superior rectus muscle was found. Methylprednisolone pulse therapy was applied (4 weeks, 2 grams per week). Glucocorticoid therapy resulted in significant improvement of soft tissue inflammation and of diplopia. The patient was qualified for 131I radioiodine complementary therapy (3657 MBq) and orbital irradiation. While some authors suggest that radioiodine therapy may be associated with worsening of pre-existing orbitopathy, so far we have not observed it in our patient, perhaps due to thyroid removal as a source of autoreactive T lymphocytes and the protective effect of applied glucocorticoids. (author)

  20. A mathematical model of optimized radioiodine-131 therapy of Graves' hyperthyroidism

    The current status of radioiodine-131 (RaI) dosimetry for Graves' hyperthyroidism is not clear. Recurrent hyperthyroidism and iatrogenic hypothyroidism are two problems which interact such that trying to solve one leads to exacerbation of the other. Optimized RaI therapy has therefore begun to be defined just in terms of early hypothyroidism (ablative therapy) as physicians have given up on reducing hypothyroidism. Optimized therapy is evaluated both in terms of the greatest separation of cure rate from hypothyroidism rate (non-ablative therapy) or in terms of early hypothyroidism (ablative therapy) by mathematical modeling of outcome after radioiodine and critically discussing the three common methods of RaI dosing for Graves' disease. Cure follows a logarithmic relationship to activity administered or absorbed dose, while hypothyroidism follows a linear relationship. The effect of including or omitting factors in the calculation of the administered I–131 activity such as the measured thyroid uptake and effective half-life of RaI or giving extra compensation for gland size is discussed. Very little benefit can be gained by employing complicated methods of RaI dose selection for non-ablative therapy since the standard activity model shows the best potential for cure and prolonged euthyroidism. For ablative therapy, a standard MBq/g dosing provides the best outcome in terms of cure and early hypothyroidism

  1. Clinical study of 131I and glucoside tripterygium total tablets on Graves' ophthalmopathy

    Objective: To evaluate the therapeutic effectiveness of 131I and glucoside tripterygium total tablets (GTTT) on Graves' ophthalmopathy (GO). Methods: Forty-eight Graves' disease (GD) patients with active GO were randomly assigned either for GTTT therapy or for prednisone therapy group. The group of prednisone used 131I and prednisone, the group of GTTT used GTTT and 131I. After four months, the responses to the treatment were evaluated by the standard of Mourits' commending, and the rates of recurrence of GO were compared. Data analysis was performed with χ2 test. Results: There were no significant differences in total effectiveness between the group of GTTT (75.0%) and the group of prednisone (58.3%). The effect of GTTT therapy (75.0%) on inflammation of parenchyma was obviously better than the effect of prednisone (50.0%). The rate of recurrence was markedly less in the group of GTTT (33.3%) than in the group of prednisone (71.4%). Conclusion: Side-effect of GTTT on GO is seldom seen, the rate of recurrence is low, and the effectiveness is better compared with that of prednisone

  2. Familial myasthenia gravis: report of four cases Miastenia grave familial: registro de quatro casos

    José Lamartine de Assis

    1976-09-01

    Full Text Available Two pairs of siblings with myasthenia gravis, belonging to two different families, are reported. This is the only record of familial myasthenia during the past twenty years, in a total of 145 patients seen at the Neurological Clinic of the São Paulo Medical School. In spite of the fact that myasthenia gravis does not show hereditary characteristics, the peculiar features of the four cases justify the present report. The two pairs of siblings were born from non myasthenic nor consanguineous parents. The disease started at birth showing bilateral partial eyelid ptosis in all patients. The course of the illness has been favorable. There was no thymoma.Os autores registram dois pares de gêmeos com miastenia grave, pertencentes a duas famílias diferentes. Este é o único registro de miastenia familial durante os últimos 20 anos, num total de 145 pacientes examinados na Clínica Neurológica da FMUSP. Apesar do fato de a miastenia grave não ter características hereditárias, os aspectos peculiares dos quatro pacientes justificam o presente registro. Os dois pares de gêmeos nasceram de pais não miastênicos e sem consanguinidade. A doença iniciou-se no nascimento, evoluindo com ptose bilateral parcial da pálpebra superior precocemente em todos os pacientes. O curso da moléstia tem sido favorável. Não havia timoma.

  3. Necessidades proteicas, morbidade e mortalidade no paciente grave: fundamentos e atualidades

    Haroldo Falcão Ramos da Cunha

    2013-03-01

    Full Text Available Evidências recentes sugerem que o balanço proteico negativo secundário à doença grave se associa ao aumento de morbidade. A perda da proteína corporal total é inevitável nesse cenário, mesmo com uma abordagem nutricional agressiva, e resulta, principalmente, do catabolismo da fibra muscular esquelética. O principal mecanismo bioquímico e metabólico envolvido nesse processo é o sistema ubiquitina-proteassoma, que, paradoxalmente, consome a adenosina trifosfatocomo fonte energética e motriz. É possível que a neutralidade do balanço proteico nessas instâncias clínicas, seja tão importante na melhora dos desfechos quanto atingir a meta calórica estimada ou medida pela calorimetria indireta. Estudos recentes apontam a utilização de concentrações mais elevadas de proteínas na terapia nutricional do paciente grave como importante para um impacto positivo na mortalidade. A proposta deste trabalho foi revisar alguns princípios da terapia nutricional relativos ao metabolismo proteico, sinalizar para as principais assertivas das diretrizes das sociedades especializadas e comentar estudos recentes, que abordam a questão em tela, sob a visão crítica da experiência clínica dos autores.

  4. A lesão muscular na miastenia grave: estudo de 17 casos com histoquimica muscular

    Lineu Cesar Werneck

    1982-03-01

    Full Text Available Estudo de 17 biópsias musculares de pacientes com miastenia grave, utilizando técnicas de coloração a fresco e histoquímica muscular. Foram encontradas 15 biópsias musculares anormais, sendo que as principais alterações foram fibras musculares angulares escuras atróficas, excesso de gotículas de gordura na membrana externa das fibras, variação no diâmetro das fibras e atrofia de fibras do tipo II. Os achados foram interpretados como denervação em 11 biópsias, atrofia de fibras do tipo II em 7, infiltrado linfocitário em 4, necrose de fibras musculares com fagocitose em 1 e em 2 biópsias não foi encontrada qualquer anormalidade. Quanto maior o tempo de doença, mais severa foi a anormalidade encontrada. Dois pacientes apresentavam timoma, um miastenia grave congênita, um artrite reumatoide, um neurite hipertrófica intersticial, um tireoidite de Hashimoto e um com síndrome miastênica concomitante. São discutidos os achados anatomopatológicos e sua possível explicação.

  5. Case misdiagnosed as bilateral abducens palsy. Importance of orbital CT scan in Graves' ophthalmopathy

    Takeda, Naoya; Kuwamura, Keiichi; Shirataki, Kunio; Tamaki, Norihiko; Matsumoto, Satoshi (Kobe Univ. (Japan). School of Medicine)

    1984-02-01

    A 66-year-old male was admitted to our neurosurgical floor because of double vision and gait disturbance. Neurological examinations revealed bilateral 6th nerve palsy with both eyes pointing toward the midline. Initially, using a tentative diagnosis of intracranial mass lesions, especially localized at the base of the skull, computerized tomography of the head, cerebral angiography, orbital venography, and metrizamide CT cisternography were performed; the findings were normal. An orbital CT scan showed an enlargement of the bilateral medial rectus muscles, and the thyroid functions of T/sub 3/ and T/sub 4/ and the T/sub 3/ uptake were all elevated, which was compatible with the diagnosis of Graves' disease. The limitations of both eyeballs were considered to be due not to the 6th nerve palsy, but to the hypertrophy of the bilateral medial rectus muscles. We neurosurgeons should recall Graves' disease as well as intracranial lesions, cerebrovascular disease, and post-traumatic sequelae when examining a patient who presents limitations of external ocular movement.

  6. Vasculite cerebral e doença de Basedow-Graves: relato de dois casos

    Rocha Maria Sheila Guimarães

    2001-01-01

    Full Text Available OBJETIVO: Relatar dois casos de pacientes com vasculite cerebral associada à doença de Basedow-Graves. RELATO DOS CASOS: O primeiro é uma paciente de 22 anos de idade com quadro súbito de disartria e déficit motor em dimídio esquerdo. Ao exame clínico, apresentava taquicardia, exoftalmia bilateral e bócio difuso. Referia tratamento para hipertiroidismo há um mês. O segundo é uma paciente de 15 anos de idade, que apresentou quadro súbito de perda da consciência seguindo-se distúrbio de linguagem e déficit motor em hemicorpo direito. RESULTADOS: Os exames de imagem revelaram áreas de lesão cerebral sugestivas de isquemia. Os estudos angiográficos cerebrais evidenciaram estenoses vasculares múltiplas compatíveis com arterite. Foram descartadas outras causas possíveis de vasculite cerebral. Os exames laboratoriais revelaram hipertiroidismo e presença dos anticorpos antimicrossomais e antitireoglobulina. As duas pacientes receberam tratamento para o hipertiroidismo. CONCLUSÃO: A associação entre arterite cerebral e doença de Basedow-Graves sugere que possa existir um elo na patogenia das duas doenças através de mecanismo auto-imune comum a ambas.

  7. Can bone loss be reversed by antithyroid drug therapy in premenopausal women with Graves' disease?

    Belsing Tina Z

    2010-09-01

    Full Text Available Abstract Context Hyperthyroidism can lead to reduced bone mineral density (BMD and increased fracture risk particularly in postmenopausal women, but the mechanism behind is still unclear. Objective Prospective examination of the influence of thyroid hormones and/or thyroid autoantibodies on BMD in premenopause. Design We have examined 32 premenopausal women with untreated active Graves' disease from time of diagnosis, during 18 months of antithyroid drug therapy (ATD and additionally 18 months after discontinuing ATD. Variables of thyroid metabolism, calcium homeostasis and body composition were measured every 3 months. BMD of lumbar spine and femoral neck were measured at baseline, 18 ± 3 and 36 ± 3 months. Data were compared to base line, a sex- and age matched control group and a group of patients with Hashimoto's thyroiditis treated with non-suppressive doses of levothyroxine. Results The study showed significantly (p Conclusion The results indicated a clinically relevant impact of thyroid function on bone modulation also in premenopausal women with Graves' disease, and further indicated the possibility for a direct action of TRAb on bones.

  8. Role of octreoscan and correlation with MR imaging in Graves' ophthalmopathy.

    Kahaly, G; Diaz, M; Just, M; Beyer, J; Lieb, W

    1995-04-01

    Since the identification of somatostatin receptors on lymphocytes, orbital infiltration with mononuclear cells in Graves' ophthalmopathy has provided a rationale for receptor imaging with the radiolabeled somatostatin analog Octreotide. In 40 patients with Graves' ophthalmopathy and 10 controls, 110 MBq indium-Octreotide were administered i.v., and scans were performed at 4 and 24 h after injection. An uptake ratio between the orbits and the brain was determined. In 20 ophthalmophathy patients, magnetic resonance imaging (MRI) of the orbits was performed and the T2 relaxation time was measured within the rectus muscles. Compared to controls (4 h Octreotide uptake: median 6.0 counts/pixel/MBq, orbit/brain ratio 5.6), ophthalmopathy patients showed a 2- to 3-fold increased uptake (15.8 counts/pixel/MBq vs controls p = 0.0032; ratio 12.6, vs controls p = 0.003). When considering patients with active disease only, a higher uptake was registered (16.8 counts/pixel/MBq vs controls p 0.0048, ratio 15.6 vs controls p = 0.0006). Untreated patients showed a markedly higher uptake (23 counts/pixel/MBq) compared to patients receiving steroid therapy (12.6, p = 0.001). MRI of the orbit revealed a correlation between T2 relaxation time of the eye muscles and orbital uptake of Octreotide (p < 0.001). PMID:7647569

  9. Evaluación del estatus taxonómico del cocodrilo del orinoco Crocodylus intermedius (Graves, 1819) en Colombia mediante marcadores mitocondriales como herramienta para establecer estrategias de conservación de la especie

    Posso-Peláez, Carolina

    2013-01-01

    La correcta identificación taxonómica de poblaciones de especies en peligro para programas de reproducción en cautiverio y de reintroducción es fundamental para su éxito. El cocodrilo del orinoco, Crocodylus intermedius es uno de los dos representantes del género Crocodylus presentes en el territorio colombiano. Esta especie, endémica de Sur América, se distribuye en el curso medio e inferior del río Orinoco y sus afluentes en Venezuela y Colombia. Actualmente está catalogado como en Peligro ...

  10. Caracterización, conservación y promoción de recursos genéticos de interés agroalimentario: caso práctico de la churra tensina, raza ovina española en peligro de extinción

    Sanz Pascua, María Albina; Alvarez Rodríguez, Javier; Joy Torrens, Margalida; Ripoll García, Guillermo; Marcos Carcavilla, Ane; Serrano, M.; Calvo Lacosta, Jorge Hugo

    2012-01-01

    Uno de los objetivos que se persigue desde hace anos en el CITA es el estudio de la base genetica de los sistemas de produccion de vacuno y ovino de carne de Aragon, a traves de la caracterizacion, preservación y mejora de diversas razas ganaderas. En este capitulo se presentan las actividades emprendidas con la Churra Tensina, raza ovina autoctona en peligro de extincion, originaria de la zona de montana del Pirineo Oscense. Se realizo una primera labor de prospeccion de individuos de la raz...

  11. Melampodium sinuatum (Asteraceae) endémica del extremo sur de la península de Baja California en peligro de extinción Melampodium sinuatum (Asteraceae), an endangered endemic species to the southernmost tip of the Baja California Peninsula

    Jose Luis Villaseñor; J. Ismael Calzada; Patricia Dávila

    2011-01-01

    Melampodium sinuatum Brandegee, especie endémica del extremo sur del estado de Baja California Sur, México, constituye una especie poco conocida debido a su rareza y distribución restringida. No se conoce de más de 5 sitios; todos ellos amenazados por las actividades humanas. El escaso número de individuos por población, así como la estrecha superficie que abarca su área de distribución la colocan como una especie en inminente peligro de extinción, por lo que es imperativo realizar acciones e...

  12. Caracterización y relaciones filogenéticas de cincos razas asnales españolas en peligro de extinción mediante la utilización de marcadores microsatélites: su importancia en los programas de conservación

    Aranguren Méndez, José Atilio

    2002-01-01

    Descripció del recurs: el 31 d'octubre de 2003 Con el objeto de caracterizar genéticamente a las poblaciones asnales españolas, que se encuentran en peligro de extinción, se llevo a cabo un estudio a partir del análisis de 15 loci microsatélites (AHT4, AHT5, ASB2, HMS1, HMS2, HMS3, HMS5, HMS6, HMS7, HTG4, HTG6, HTG7, HTG10, HTG15 y VHL20), en un total de 513 individuos, correspondiendo a: Andaluza (87), Catalana (140), Encartaciones (74), Mallorquina (104) y Zamorano-Leonesa (108). Adicion...

  13. El Copturomímus Perseae Hustache Nueva Especie Entomológica, Grave Plaga del Aguacate en Colombia.

    Mario Moreno Ernesto

    1947-06-01

    Full Text Available 1. Colombia, por la diversidad de climas y condiciones variadas de suelos, está capacitada para producir ventajosamente las especies frutales que en general son consideradas como de carácter comercial. Entre las cuales, el aguacate, dentro de la zona tropical y subtropical, ocupa lugar prominente, junto con el popular grupo de los Citrus. Aunque la explotación de estas especies frutales se encuentra en forma incipiente, y para mejor decirlo en estado semisilvestre, la correcta vegetación y fructificación abundante lograda dentro de vastas zonas, son un elocuente índice, que unido a la demanda creciente de fruta en los mercados, insatisfecha con la escasa producción nacional, aseguran el éxito de las empresas que consagren sus esfuerzos a la lucrativa industria de la producción de frutas. 2. Ante las perspectivas tan halagadoras que presenta el cultivo del aguacate en el país, y en el convencimiento de que el control de las plagas y enfermedades constituye uno de los factores de mayor importancia, es evidente la necesidad de propender por el establecimiento de las medidas sanitarias, que a la vez que sean económicas, tengan la suficiente efectividad para eliminar el peligro que puedan constituir. 3. El aguacate, dentro de la clasificación botánica pertenece a la familia Lauracea, género Persea y comprende 2 especies principales, Persea americana Mill. (P. gratissimaGaertn y PerseadrymifoliaCham. &Schelecnt. (P.americanavar. DrymifoliaMez. Comercialmente se ha dividido en 3 razas claramente diferenciadas, la Antillana, Guatemalteca y Mexicana, dentro de las cuales se hallan agrupadas variedades en crecido número; aunque existen ciertas variedades que participan de características comunes a dos de las razas mencionadas y se consideran como híbridos o cruces genéticos. Comúnmente tiene diferentes denominaciones que varían de país a país y aun en regiones del mismo país, entre las cuales las más conocidas son, aguacate

  14. Hidropesía fetal en una gestante con enfermedad hipertensiva grave. Presentación de un caso

    Maribel Rodríguez Matos; Laritza Isabel Mengana Fontes; Mayda Urrutia Carmenaty

    2013-01-01

    La hidropesía fetal es un grave proceso de elevada mortalidad perinatal, de etiología multifactorial, caracterizado por un síndrome edematoso generalizado, con o sin acumulación de líquido en las cavidades serosas del organismo fetal. Se presenta un caso de hidropesía fetal no inmunológica en una paciente de sexo femenino, de color de piel blanca y de 20 años de edad con enfermedad hipertensiva grave, diagnosticada mediante ultrasonido, como estudio de bienestar fetal a las 35,1 semanas de ge...

  15. Study on T lymphocyte subsets and NK cells in patients with Graves disease combined with type 2 diabetes

    魏枫; 杜婧; 苏秀兰; 乌兰; 王津京; 霍晓静

    2008-01-01

    Objective To investigate changes in T lymphocyte subsets and NK cells in patients with simple Graves' disease(GD)and Graves' disease combined with type 2 diabetes mellitus(GD/T2DM).Methods Fifteen cases of GD/T2DM were selected from our hospital from November 2001 to November 2004.Before and after therapy thyroid function,thyroglobulin antibody(TGA),thyroid microsomal antibody(TMA)and blood glucose level were measured,and T lymphocyte subsets(CD3,CD4,CD8,CD4/CD8)and NK cells(CD56)were measured by immunofluo...

  16. Tuberculose grave com necessidade de internação em UTI Severe tuberculosis requiring ICU admission

    Denise Rossato Silva; Marcelo Basso Gazzana; Paulo de Tarso Roth Dalcin

    2012-01-01

    A tuberculose é uma doença curável que pode evoluir para formas graves com necessidade de tratamento dos pacientes em UTI, especialmente se essa não for diagnosticada em tempo ou se afetar pacientes idosos, aqueles em diálise e aqueles com infecção pelo HIV ou outros estados de imunossupressão, assim como nos casos de doença multirresistente. O conhecimento da apresentação radiológica dos casos pode auxiliar no diagnóstico dessas formas graves, assim como a introdução de novos testes, como a ...

  17. Interferon-Alpha-Induced Destructive Thyroiditis Followed by Graves' Disease in a Patient with Chronic Hepatitis C: A Case Report

    Kim, Bu Kyung; Choi, Young Sik; Park, Yo Han; Lee, Sang Uk

    2011-01-01

    Interferon-induced thyroiditis (IIT) is a major clinical problem for patients receiving interferon-alpha (IFN-α) therapy. But, destructive thyroiditis followed by Graves' disease associated with IFN-α therapy is very rarely reported. Herein, we report a rare case of pegylated IFN-α (pegIFN-α) induced destructive thyroiditis followed by Graves' disease in a patient with HCV infection. A 31-yr-old woman suffered from chronic active hepatitis C and was treated with pegIFN-α and ribavirin for 12 ...

  18. B-cell depletion with rituximab in the treatment of autoimmune diseases. Graves' ophthalmopathy the latest addition to an expanding family

    Nielsen, Claus H; El Fassi, Daniel; Hasselbalch, Hans C;

    2007-01-01

    In this review, the authors summarise the clinical results obtained after therapy with rituximab in autoimmune diseases, including Graves' disease and Graves' ophthalmopathy. On the basis of qualitative and quantitative analyses of B- and T-cell subsets, and autoantibody levels obtained in other ...

  19. Hipertrigliceridemia familiar grave durante a gestação Severe familial hypertriglyceridemia during pregnancy

    Luiz Augusto Casulari

    2001-07-01

    Full Text Available A presença de hipertrigliceridemia grave durante a gravidez é rara, mas comporta grande possibilidade de desenvolver complicações, como a pancreatite aguda, que coloca em risco a mãe e o feto. Apresentamos o relato da evolução da gestação de uma paciente portadora de hipertrigliceridemia grave que havia apresentado pancreatite aguda dois meses antes da fecundação. Foi tratada durante o pré-natal com dieta e 3,0 g de ácidos graxos de cadeia ômega-3 (ácidos eicosapentaenóico 14% e docosahexaenóico 11,13%. Os níveis de triglicerídeos foram mantidos abaixo de 800 mg/dl, sendo este limite considerado seguro para evitar o desenvolvimento de pancreatite aguda. A gestação evoluiu, sem intercorrências, para parto vaginal, a termo. O recém-nato não apresentou alterações morfológicas ao nascimento. Concluímos que, nesta paciente grávida e portadora de hipertrigliceridemia grave, uma dieta adequada e o emprego de ácidos graxos de cadeia ômega-3 foram eficazes em prevenir a pancreatite aguda. Esta abordagem terapêutica pode ser uma alternativa para as gestantes portadoras de hipertrigliceridemia familiar.Severe hypertriglyceridemia during pregnancy rarely occurs but it frequently produces complications, such as acute pancreatitis, a serious health risk both for the mother and the fetus. The treatment of a patient who had had acute pancreatitis due to hypertriglyceridemia (triglyceridemia = 5100 mg/dl two months before fecundation is presented in this paper. During gestation, bezafibrate was substituted for 3.0 g omega-3 fatty acids (14% eicosapentaenoic and 11.13% docosahexaenoic acids. With this therapy, the triglyceride levels were maintained below 800 mg/dl, which is considered to be the safe limit to avoid acute pancreatitis. No complication occurred during pregnancy, the patient delivered vaginally (40 weeks, and the newborn (3075 g did not present any morphological alterations. We conclude that an adequate diet and the

  20. Ablative doses of radioiodine show a high efficacy and safety in the treatment of hyperthyroidism caused by Graves diseases

    The objective of this work is to compare the frequency of healing and persistence/relapse of hyperthyroidism using two protocols of different 131I doses in patients with Graves diseases, and to evaluate the presence of adverse effects observed in the patients after each of the protocols. (author)

  1. Leucopenia grave em paciente com artrite reumatoide tratada com combinação de metotrexato e leflunomida

    Paola Toth

    2014-04-01

    Full Text Available Apresentamos o caso de uma paciente com artrite reumatoide tratada por dois anos com associação de metotrexato e leflunomida. A paciente foi internada com leucopenia grave quatro semanas após acrescentar ao esquema medicamentoso as drogas clopidogrel, isosorbida, sinvastatina, AAS e omeprazol.

  2. Leucopenia grave em paciente com artrite reumatoide tratada com combinação de metotrexato e leflunomida

    Paola Toth; Roberto Bernd

    2014-01-01

    Apresentamos o caso de uma paciente com artrite reumatoide tratada por dois anos com associação de metotrexato e leflunomida. A paciente foi internada com leucopenia grave quatro semanas após acrescentar ao esquema medicamentoso as drogas clopidogrel, isosorbida, sinvastatina, AAS e omeprazol.

  3. The Presence of Thyroid-Stimulation Blocking Antibody Prevents High Bone Turnover in Untreated Premenopausal Patients with Graves' Disease.

    Cho, Sun Wook; Bae, Jae Hyun; Noh, Gyeong Woon; Kim, Ye An; Moon, Min Kyong; Park, Kyoung Un; Song, Junghan; Yi, Ka Hee; Park, Do Joon; Chung, June-Key; Cho, Bo Youn; Park, Young Joo

    2015-01-01

    Osteoporosis-related fractures are one of the complications of Graves' disease. This study hypothesized that the different actions of thyroid-stimulating hormone receptor (TSHR) antibodies, both stimulating and blocking activities in Graves' disease patients might oppositely impact bone turnover. Newly diagnosed premenopausal Graves' disease patients were enrolled (n = 93) and divided into two groups: patients with TSHR antibodies with thyroid-stimulating activity (stimulating activity group, n = 83) and patients with TSHR antibodies with thyroid-stimulating activity combined with blocking activity (blocking activity group, n = 10). From the stimulating activity group, patients who had matched values for free T4 and TSH binding inhibitor immunoglobulin (TBII) to the blocking activity group were further classified as stimulating activity-matched control (n = 11). Bone turnover markers BS-ALP, Osteocalcin, and C-telopeptide were significantly lower in the blocking activity group than in the stimulating activity or stimulating activity-matched control groups. The TBII level showed positive correlations with BS-ALP and osteocalcin levels in the stimulating activity group, while it had a negative correlation with the osteocalcin level in the blocking activity group. In conclusion, the activation of TSHR antibody-activated TSH signaling contributes to high bone turnover, independent of the actions of thyroid hormone, and thyroid-stimulation blocking antibody has protective effects against bone metabolism in Graves' disease. PMID:26650844

  4. Interferon-alpha-induced destructive thyroiditis followed by Graves' disease in a patient with chronic hepatitis C: a case report.

    Kim, Bu Kyung; Choi, Young Sik; Park, Yo Han; Lee, Sang Uk

    2011-12-01

    Interferon-induced thyroiditis (IIT) is a major clinical problem for patients receiving interferon-alpha (IFN-α) therapy. But, destructive thyroiditis followed by Graves' disease associated with IFN-α therapy is very rarely reported. Herein, we report a rare case of pegylated IFN-α (pegIFN-α) induced destructive thyroiditis followed by Graves' disease in a patient with HCV infection. A 31-yr-old woman suffered from chronic active hepatitis C and was treated with pegIFN-α and ribavirin for 12 months. Results of a thyroid function test and autoantibody levels were normal before IFN-α therapy was initiated. Destructive thyrotoxicosis appeared seven months after the initiation of IFN-α therapy, followed by Graves' thyrotoxicosis two months after the cessation of therapy. The diagnoses of destructive thyroiditis and Graves' disease were confirmed by the presence of TSH receptor antibodies in addition to Tc-99m scintigraphy findings. The patient's antithyroglobulin antibody titer increased gradually during IFN-α therapy and remained weakly positive after IFN-α therapy was discontinued. PMID:22148004

  5. Thyrotropinoma with Graves' disease detected by the fusion of indium-111 octreotide scintigraphy and pituitary magnetic resonance imaging.

    Okuyucu, Kursat; Alagoz, Engin; Arslan, Nuri; Taslipinar, Abdullah; Deveci, Mehmet Salih; Bolu, Erol

    2016-01-01

    Thyroid-stimulating hormone-secreting pituitary adenoma (TSHoma) is a rare benign endocrinological tumor which produces TSH in the pituitary gland. Herein, we presented a female patient having TSHoma with Graves' disease during and just after pregnancy that we found by indium-111 octreotide scintigraphy while investigating the patient for hyperthyroidism symptoms. PMID:27095865

  6. Treatment with radioiodine of Graves' disease. Calculated activity; fixed activity or ablation. Were are we going?

    The new tendencies of radioiodine (131I) treatment of Graves'disease are presented . One group have the objective of administrate an activity of radioiodine to bring back the patient to euthyroidism , using individual activities to each patient. Others propose a fixed dose, with high activity to cure the disease and anticipating the hypothyroidism of the patient. The third group propose directly the ablation of the thyroids with a calculated activity to deliver 300 Gy .This calculi demand the investigation of the maximum uptake of radioiodine, the biological half life, and the thyroid weight with adequate method (US, TC, MR) Finally, the dose to not thyroid tissues are discussed and the risk of these procedures are presented. (author)

  7. Normalization of thyroid blood flow in Graves' hyperthyroidism following radioactive iodine therapy

    Chang, D.C.S.; Woodcock, J.P.; Shedden, E.J.; Lazarus, J.H.; Wheeler, M.H.; McGregor, A.M. (University Hospital of Wales, Cardiff (UK). Medical Physics Dept.)

    1990-05-01

    In a group of 12 patients with Graves' hyperthyroidism, administration of 514 {plus minus} 43 (mean {plus minus} SD) MBq iodine-131 was associated with a fall of superior thyroid artery (STA) blood flow in two at 6 months and in eight at 11 months. The reduction in time-averaged velocity at 11 months correlated with the reduction in FT4 and in FT3 at this time. In four patients who had persistent elevated STA blood flow, two were still hyperthyroid. The diameter of the STA was unchanged at 6 months and only half the patients had reduction of their STA size at 11 months after radioiodine (RAI) therapy. These data indicate that normalization of STA blood flow precedes normalization of STA size in patients treated with RAI. Further work is required to determine whether STA blood flow measurements are of predictive value in treatment outcome. (author).

  8. Current opinions on the radioiodine treatment of Graves' hyperthyroidism

    Lee, Sang Woo; Lee, Jae Tae [School of Medicine, Kyungpook National Univ., Daegu (Korea, Republic of)

    2003-12-01

    Radioactive iodine therapy using I-131 for hyperthyroidism has been used for more than 50 years, and generally considered safe and devoid of major side effects. Appropriate patient selection criteria and clinical judgement concerning patient preparation should be employed for its optimal use. It has not been possible to resolve the trade-off between efficient definite cure of hyperthyroidism and the high incidence of post-therapy hypothyroidism. The dose of the I-131 needed to maintain euthyroid state remains an area of uncertainty and debate. Early side effects are uncommon and readily manageable. Other than the need for long-term monitoring and, in most cases, lifelong thyroid hormone treatment for late adverse consequences of this treatment remains only conjectural. We have reviewed general principles and recent advances in radioiodine treatment for Graves' hyperthyroidism, specially regarding to several controversies.

  9. Graves' Disease Mechanisms: The Role of Stimulating, Blocking, and Cleavage Region TSH Receptor Antibodies.

    Morshed, S A; Davies, T F

    2015-09-01

    The immunologic processes involved in Graves' disease (GD) have one unique characteristic--the autoantibodies to the TSH receptor (TSHR)--which have both linear and conformational epitopes. Three types of TSHR antibodies (stimulating, blocking, and cleavage) with different functional capabilities have been described in GD patients, which induce different signaling effects varying from thyroid cell proliferation to thyroid cell death. The establishment of animal models of GD by TSHR antibody transfer or by immunization with TSHR antigen has confirmed its pathogenic role and, therefore, GD is the result of a breakdown in TSHR tolerance. Here we review some of the characteristics of TSHR antibodies with a special emphasis on new developments in our understanding of what were previously called "neutral" antibodies and which we now characterize as autoantibodies to the "cleavage" region of the TSHR ectodomain. PMID:26361259

  10. TL, OSL and C-14 dating results of the sediments and bricks from mummified nuns' grave.

    Tudela, Diego R G; Tatumi, Sonia H; Yee, Márcio; Brito, Silvio L M; Morais, José L; Morais, Daisy de; Piedade, Silvia C; Munita, Casimiro S P; Hazenfratz, Roberto

    2012-06-01

    This paper presents the results of TL and OSL dating of soil and fragments of bricks from a grave, which was occupied by two mummified nuns, found at "Luz" Monastery, located in the state of São Paulo, Brazil. The TL and OSL ages were compared to C-14 dating ones obtained from bone collagens of the mummies. The majority of the ages is related to the eighteenth century. The gamma-ray spectroscopy was used to evaluate natural radioisotope concentrations in the samples, and by using these concentrations the annual dose rates, from 3.0 to 5.3 Gy/kyr, were obtained. Neutron activation analysis was performed and the radioisotope contents results are in agreement with those obtained by gamma-ray spectroscopy. The contents of U, Th and Ce elements were higher than those found in usual sediments. PMID:22569952

  11. TL, OSL and C-14 dating results of the sediments and bricks from mummified nuns' grave

    This paper presents the results of TL and OSL dating of soil and fragments of bricks from a grave, which was occupied by two mummified nuns, found at 'Luz' Monastery, located in the state of Sao Paulo, Brazil. The TL and OSL ages were compared to C-14 dating ones obtained from bone collagens of the mummies. The majority of the ages is related to the eighteenth century. The gamma-ray spectroscopy was used to evaluate natural radioisotope concentrations in the samples, and by using these concentrations the annual dose rates, from 3.0 to 5.3 Gy/kyr, were obtained. Neutron activation analysis was performed and the radioisotope contents results are in agreement with those obtained by gamma-ray spectroscopy. The contents of U, Th and Ce elements were higher than those found in usual sediments. (author)

  12. The early development of hypothyroidism after 131I treatment for hyperthyroid Graves' disease

    827 patients with Graves' hyperthyroidism following 131I treatment were followed up at 3 monthly intervals for 12∼36 months from 1985 to 1991. Physical examination and serum total T3, T4, TSH measurements were made at each visit. According to the authors data, 90% early hypothyroidism occurred within 2∼3 months after 131I treatment, thereby, careful follow-up study is very important during this period. T4 was much more sensitive than T3 in diagnosing early hypothyroidism, while the TSH level shows thyroid reservation function, and is less sensitive than T4 in diagnosing 131I induced hypothyroidism. The study confirmed the view that the early incidence of post 131I therapy hypothyroidism was strongly dose dependent

  13. Early prediction of hypothyroidism following 131I treatment for Graves' disease

    The aim of this study was twofold. Firstly to assess the post treatment predictive value of various biochemical and immunological tests for early hypothyroidism after 131I therapy of Graves' disease, and secondly to determine whether or not pretreatment with Carbimazole protects against post treatment hypothyroidism. The early changes observed in serum T3, T4, TSH, thyroid microsomal and thyroglobulin antibody levels were found to be of no predictive value. A sharp rise, around 2 months, in TRAb levels following 131I therapy indicated that hypothyroidism was likely to occur. This rise was thought to reflect a greater degree of thyroid damage. Lower levels of thyroglobulin in patients who had become hypothyroid by 12 months after treatment would support this view. Five weeks Carbimazole pretreatment in this relatively small group of patients did not appear to protect against hypothyroidism. (orig.)

  14. Reduced parietooccipital white matter glutamine measured by proton magnetic resonance spectroscopy in treated graves' disease patients

    Danielsen, Else Rubæk; Elberling, T.V.; Rasmussen, Åse Krogh;

    2008-01-01

    battery of biochemical, affective, and cognitive tests were used. RESULTS: Previously reported findings of reduced choline and myo-inositol in acute Graves' disease were confirmed and reversibility was demonstrated. Parieto-occipital white matter glutamine was and remained significantly reduced (P < 0.......01). Acute phase parieto-occipital white matter total choline correlated significantly (r = -0.57; P < 0.01) with impaired thyroid function. Pretreatment total T(3) predicted posttreatment occipital gray matter glutamine (r = -0.52; P < 0.01). Occipital gray matter total choline (r = -0.53; P < 0.01) and...... parietooccipital white matter glutamate (r = -0.54; P < 0.01) correlated with initial values of selected attention and concentration cognitive scores and predicted them at follow-up. CONCLUSIONS: The persistent reduction of glutamine in white matter, the decreasing glutamate in occipital gray matter, and the...

  15. Feasibility of tomotherapy for Graves' ophthalmopathy. Dosimetry comparison with conventional radiotherapy

    Nguyen, Nam P.; Krafft, Shane P. [Arizona Univ., Tucson, AZ (United States). Dept. of Radiation Oncology; Vos, Paul [East Carolina Univ., Greenville, NC (US). Dept. of Biostatistics] (and others)

    2011-09-15

    To compare the dosimetry of tomotherapy and the conventional half-beam technique (HBT) or non-split beam technique (NSBT) for target coverage and radiation dose to the lacrimal glands and lens. A retrospective review of 7 patients with Graves' ophthalmopathy who had radiotherapy because of disease progression on high steroid dose is reported: 3 patients were treated with tomotherapy and 4 patients with HBT. Compared to HBT, tomotherapy may provide better target coverage and significant reduction of radiation dose to the lacrimal glands and a higher dose to the lens. The NSBT improved target coverage but resulted in significantly higher doses to the lens and lacrimal glands. Tomotherapy may provide better coverage of the target volume and may be more effective in reducing severe exophthalmos compared to the conventional radiotherapy technique. (orig.)

  16. Downhole fiber optic sensing: the oilfield service provider's perspective: from the cradle to the grave

    Skinner, Neal G.; Maida, John L.

    2014-06-01

    For almost three decades, interest has continued to increase with respect to the application of fiber-optic sensing techniques for the upstream oil and gas industry. This paper reviews optical sensing technologies that have been and are being adopted downhole, as well as their drivers. A brief description of the life of a well, from the cradle to the grave, and the roles fiber-optic sensing can play in optimizing production, safety, and protection of the environment are also presented. The performance expectations (accuracy, resolution, stability, and operational lifetime) that oil companies and oil service companies have for fiber-optic sensing systems is described. Additionally, the environmental conditions (high hydrostatic pressures, high temperatures, shock, vibration, crush, and chemical exposure) that these systems must tolerate to provide reliable and economically attractive oilfield monitoring solutions are described.

  17. Myopathy Associated with Acute Hypothyroidism following Radioiodine Therapy for Graves Disease in an Adolescent

    Rivkees ScottA

    2010-08-01

    Full Text Available We describe acute myopathy following I-131 treatment for hyperthyroidism due to Graves Disease (GD in an adolescent. A 15 year-old diagnosed with GD required treatment with radioactive iodine (I-131 therapy. Six weeks post I-131, he developed generalized muscle cramps. The CK was 19.800 U/L, the total thyroxine was 2.3 mcg/dL (29.6 nmol/L SI and the estimated free thyroxine (EFT was 0.5 ng/dL (6.4 pmol/L SI. The ALT was 112 U/L and AST was 364 U/L (normal

  18. Clinical analysis of radioactive iodine treatment in Graves hyperthyroidism patients with leucopenia

    Objective: To evaluate the effects of 131I treatment for Graves hyperthyroidism patients with leucopenia and the alteration of WBC levels after treatment. Methods: A total of 257 Graves hyperthyroidism cases were retrospectively studied after 131I treatment. Based on baseline WBC count, 119 cases with WBC count<4.0 × 109/L before 131I treatment were diagnosed with leucopenia and 138 cases had normal WBC. There were no significant differences in age, weight of thyroid, 131I uptake rate in 24 h, dose of 131I and course of the disease between the two groups (all t<0.972, all P>0.05). WBC, lymphocyte, neutrophil and platelet counts were recorded before and 1, 3, 6 and 12 months after 131I therapy. The therapeutic effects were graded as clinical cure, improvement, invalidation and hypothyroidism. Statistical analyses, including independent samples t test, χ2 test and one-way analysis of variance, were performed using SPSS 13.0. Results: The WBC levels in the leucopenia group were (3.49 ± 0.43) × 109/L, (4.06 ±0.98) × 109/L, (4.20 ±1.04) × 109/L, (4.37 ±0.93) × 109/L and (4.88 ± 1.20) × 109/L before 131I treatment and 1, 3, 6, 12 months after 131I treatment, respectively; while, those in the normal WBC group were (5.70 ± 1.08) × 109/L, (5.50 ± 1.14) × 109/L, (5.74 ±0.99) × 109/L,(5.95 ± 1.14) × 109/L and (6.07 ± 1.17) × 109/L, respectively. There was no statistically significant difference of WBC levels before and 1 month after 131I treatment (t=1.662, P>0.05) in the normal WBC group, but WBC levels at those time points were significantly different in the leucopenia group (t=3.816, P<0.05). In the leucopenia group, there was no significant change of lymphocytes before and after 131I treatment, while the average neutrophil count showed an increasing trend during the 1, 3, 6 and 12 months after 131I treatment (F=40.583, t: 1.468-11.264, all P<0.05). The average platelet counts at 6 and 12 months after 131I treatment were (187.80 ± 36.03) × 109/L and

  19. Preliminary Study on Chinese Drug-Induced Apoptosis ofThyrocytes in Graves' Disease

    2000-01-01

    After 2-10 weeks treatment, effect of anti-thyroid drugs combined with Chinese drugs on the thyrocytes of Graves' disease: apoptosis ratio is 18.66±20.01% (n=13), P<0.01; Compared with that of single anti-thyroid drug group: 2.11±1.78%, n=13TUNEL  The increase of TUNEL-positive nuclei (blue color) was observed: 3-5 cells/vision field in combining Chinese drugs treatment group; 0-1 cell/vision field in treating with anti-thyroid drugs before combining with Chinese drugs group, and the control cell showed red color, see Figure 4.

  20. Graves' disease in two pregnancies complicated by fetal goitrous hypothyroidism: successful in utero treatment with levothyroxine

    Bliddal, Sofie; Rasmussen, Åse Krogh; Sundberg, Karin Milner;

    2011-01-01

    Treatment of Graves' disease during pregnancy with antithyroid drugs (ATDs) poses a risk of inducing hypothyroidism and, thus, development of a goiter to the fetus. PATIENT FINDINGS: We report two patients referred to our department after discovery of a fetal goiter by ultrasound examination in the...... second trimester of pregnancy. The women receiving 400¿mg/day propylthiouracil and 10¿mg/day thiamizole, respectively, had thyrotropin and total thyroxine values within the normal reference range but a lowered free thyroxine level. Fetal blood sampling by cordocentesis revealed severe fetal...... hypothyroidism as the cause of goiter development. Reduction of maternal ATD dose and injection of levothyroxine intra-amniotically quickly reduced the goiter size, and both babies were born euthyroid and without goiters....

  1. Cytokine Status, Thyroid Autoantibodies and Their Dynamic Changes During the Treatment of Graves' Disease

    V V Lazanovich

    2008-09-01

    Full Text Available It has been found during the research that the changes of Th1 and Th2 marker cytokine content in Graves Disease are dynamic and are directly correlated not only with the severity of autoimmune thyrotoxicosis, but also with the method of treatment used and duration of Thiamazole therapy. The beginning of autoimmune thyrotoxicosis shows the largest amounts of both pro-inflammatory (IL-1a, IL-8, IFN-γ and anti-inflammatory (IL-10 cytokines which are significantly reduced during Thiamazole therapy, with the exception of the cases of severe disease course. Thyroid resection does not result in immunologic remission either, which is confirmed by persisting high serum levels of IL-1a, IL-8, IFN-γ, IL-10 and TSH antibodies in the severe GBD group. Among the unfavorable prognostic factors for recurrent disease are high serum levels of TSH antibodies, IL-1a and IFN-γ during pre-surgery period.

  2. The impact of graves' disease and its treatment on handwriting characteristics

    Papi, Giampaolo; Botti, Cristina; Corsello, Salvatore Maria;

    2014-01-01

    BACKGROUND: Thyroid hormones are crucial for metabolism in all tissues in humans, including the nervous system and muscles, and could thus affect handwriting, which is the synthesis of complex and fine movements. Hyperthyroidism, characterized by symptoms such as tremor and weakness, could affect...... handwriting, although this has not been studied yet. The aim of this study was to evaluate handwriting characteristics before and after therapy for hyperthyroid Graves' disease (GD). METHODS: Twenty-two patients (15 women, 7 men) with untreated GD (median age: 44 years; range: 20-70 years) were asked to write...... a "standard text" before and 12 months after being rendered euthyroid. The letters underwent a standardized detailed analysis by a handwriting expert, through inspection and stereoscopic microscope and magnifying glass. RESULTS: All patients demonstrated handwriting variations, perceptible even to...

  3. Hipertiroidismo por doença de Graves durante a gestação Hyperthyroidism due to Graves' disease during pregnancy

    Carla Amaral de Almeida

    2005-05-01

    Full Text Available OBJETIVO: avaliar a influência do hipertiroidismo na evolução da gravidez e a necessidade de ajustes na dose de antitiroidianos neste período e no pós-parto. MÉTODOS: avaliação prospectiva de dados clínicos e laboratoriais de treze gestações em onze mulheres com hipertiroidismo devido à doença de Graves, com dosagem de TSH e T4 livre a cada trimestre ou quatro semanas após ajuste do antitiroidiano. O objetivo foi manter o T4 livre no terço superior da normalidade usando a menor dose possível de antitiroidiano. RESULTADOS: a média de idade no início da gravidez foi de 31,1 anos (23 a 41. Houve redução da dose de antitiroidiano em oito gestações (69,5% e, em duas, a droga foi suspensa. Antes da gravidez, a dose média de propiltiouracil era de 400 mg/dia (200 a 900 e a de metimazol, 45 mg/dia (20 a 60. Após o parto, a dose dos antitiroidianos foi reduzida para 200 e 30 mg/dia, respectivamente. Uma paciente apresentou parto prematuro (36ª semana de gestação e outra, recém-nato pequeno para a idade gestacional (2.000 g com 38 semanas de gestação. Houve um caso de natimortalidade. Não houve abortamentos ou anomalias congênitas. Após o parto, a dose de antitiroidiano foi aumentada em sete pacientes e mantida nas demais. CONCLUSÕES: recomendamos acompanhamento rigoroso de gestantes hipertiroidianas e titulação decrescente da dose dos antitiroidianos no decorrer da gestação, com o intuito de evitar o hipotiroidismo materno e suas conseqüências no desenvolvimento fetal. O acompanhamento após o parto dever ser cuidadoso, já que há a possibilidade de nova exacerbação do hipertiroidismo. O uso dos antitiroidianos foi seguro para as pacientes e sua prole.PURPOSE: to evaluate the influence of hyperthyroidism during pregnancy and the necessity of changing antithyroid drug dose in this period and after delivery. METHODS: prospective evaluation of clinical and laboratorial findings of thirteen pregnancies in eleven

  4. The assessment of adverse events of radioactive iodine therapy in patients with Graves disease

    Full text: Aim: The aim of the study is to assess the adverse events of RAI in patients with Graves disease. Study design: have analyzed the data of 42 patients (33 women, 9 men, median age 46,6 years) with Graves disease without thyroid ophthalmopathy, who were treated with RAI to control thyrotoxicosis. Radioiodine dose was determent individually and was taken into consideration of goiter volume and turnover of 1321I. Patients received one dose of 131I - median 10,2 (from 2,0 to 34,1 m #N-tilde# i). We asked the patients to fill questionnaire of sings and symptoms about their complaints after treatment. Results: The most frequent adverse events after radioiodine treatment were: fallout hair - in 31%, headache - in 28,5%, muscle pain - in 24,0%, edema of upper and lower eyelids - in 20,0%, pain in joints - in 19,0%, pain in thyroid gland - in 14,0%. Other adverse events were determent rarer: pain in eyeballs - 12,0%, sensation of the pressure in eyeballs - in 12,0%, tension in the field of thyroid gland - in 9,5%, muscle compactions - in 9,5%, diplopia - in 7,1%, deterioration of concomitant chronic diseases - in 7,1%, pain in hypochondrium- in 7,1%, heartburn - in 7,1%, weakness in legs- in 4,8%, dryness skin cover -in 2,4%, sleeplessness - in 2,4%. All adverse events were not serious, were nor demand of administration of special treatment and ended in 5 days after using of radioactive iodine. Conclusion: Radioactive iodine treatment does not entail of significant deterioration of condition of the patients. (author)

  5. THE EFFECT OF FCγ RECEPTOR ON THE PATHOGENESIS OF GRAVES' DISEASE

    Pu dan(蒲丹); Guo Hui(郭辉); Luo Wentian(雒文田); Liu Qiuyue(刘秋月); Aosai Fumie

    2004-01-01

    Objective To explore the roles of Fcγ receptor in the pathogenesis of Graves' disease. Methods Fcγ receptor gene knockout mice(Fcγ R KO mice) which were rooted in C57BL/6 mice and wild type C57BL/6 mice were immunized by hTSH receptor expressing cells (DAP3.WT).1-2×107 DAP3.WT cells were peritoneally injected into mice every two weeks for a total of six times.Two weeks after final immunization, mice were killed for measurement of total thyroxine,TRAb and pathological examination.Results The thyroxine level of the immunized Fcγ receptor gene knockout mice was significantly lower than that of the immunized wild type control mice (2.2±0.31 vs.3.32±0.59g·dL-1,P<0.05), but there was no significant difference between immunized Fcγ R KO mice and non-immunized wild type control group.The TRAb levels of the immunized Fγ R KO mice significantly increased compared to those of the immunized wild type mice (21.75±8.21 vs.14.11±6.21, P<0.05). The lymphocyte cells infiltration and destruction of thyroid follicles were found in the thyroid gland of the immunized Fcγ R KO mice. Conclusion These results suggest that Fcγ receptor may be involved in the pathogenesis of Graves'disease.

  6. Radiation therapy for Graves' ophthalmopathy: a systematic review and meta-analysis of randomized controlled trials

    Purpose: To evaluate the efficacy of radiotherapy (RT) with total dose of 20 Gy (RT 20 Gy) in the treatment of Graves' ophthalmopathy. Methods: A systematic review and meta-analysis of randomized controlled trials was performed comparing RT 20 Gy with or without glucocorticoid to clinical treatments for Graves' ophthalmopathy. The Medline, Embase, Cochrane Library databases and recent relevant journals were searched. Relevant reports were reviewed by two reviewers. Response to radiotherapy was defined as clinical success according to each trial. We also evaluated the quality of life and whether RT to produce fewer side effects than other treatments. Results: A total of 8 randomized controlled trials (439 patients) were identified. In the subgroup analysis, the overall response to treatment rates was better for: RT 20 Gy plus glucocorticoid vs glucocorticoids alone, OR=17.5 (CI95% 1.85-250, p=0.04), RT 20 Gy vs sham RT, OR= 3.15 (CI95% 1.59-6.23, p=0.003) and RT 20Gy plus intravenous glucocorticoid vs RT 20Gy plus oral glucocorticoid, OR=4.15(CI95% 1.34-12.87, p=0.01). There were no differences between RT 20 Gy versus other fractionations and RT 20 Gy versus glucocorticoid alone. RT 20 Gy with or without glucocorticoids showed an improvement in diplopia grade, visual acuity, optic neuropathy, lid width, proptosis and ocular motility. No difference was seen for costs, intraocular pressure and quality of life. Conclusion: Our data have shown that RT 20 Gy should be offered as a valid therapeutic option to patients with moderate to severe ophthalmopathy. The effectiveness of orbital radiotherapy can be increased by the synergistic interaction with glucocorticoids. Moreover, RT 20 Gy is useful to improve a lot of ocular symptoms, excluding intraocular pressure, without any difference in quality of life and costs. (author)

  7. Fixed dose of I-131 therapy for the treatment of Graves' hyperthyroidism

    Objectives: To evaluate short-term (6 month) efficacy of fixed-dose (555 MBq, 15 mCi) approach in the treatment of Graves' hyperthyroidism and analyze the relationship between clinical outcome (hyperthyroidism, hypothyroidism, and euthyroidism) and variances (patient age, thyroid weight, absorbed activity per gram of thyroid tissue, and radioactive iodine uptake value). Methods: 38 patients of Graves' hyperthyroidism were treated with 555MBq of radioactive iodine (in the form of capsule). Follow-up was done 3 and 6 months post therapy and the following clinical outcome was monitored: persistent hyperthyroidism, hypothyroidism, and euthyroidism. Statistical analysis was performed with SPSS software (version 11.5). P<0.05 was taken as indicating a statistically significant effect. Results: Of the 38 subjects, 14 (36.8%) were identified as euthyroidism, 18 (47.4%) hypothyroidism, and 6 (15.8%) hyperthyroidism. Cure rate (euthyroidism+hypothyroidism) was 84.2%. Statistical analysis revealed that there is a statistically significant difference of absorbed activity per gram of thyroid tissue and thyroid weight (F=17.639, P=0.000; F=28.453, P=0.000), but there is no statistically significant difference in terms of patient age and RAIU (F=1.375, P-0.266; F=2.453, P=0.101) among euthyroidism, hypothyroidism, and hyperthyroidism patients. Conclusion: We concluded that fixed-dose approach is very effective in the quickly restoration of thyroid function. There is a statistically significant difference of absorbed activity per gram of thyroid tissue and thyroid weight, but there is no statistically significant difference in terms of patient age and RAIU among euthyroidism, hypothyroidism, and hyperthyroidism patients. (authors)

  8. Malária grave importada: relato de caso Severe imported malaria: case report

    Alessandra Alves

    2007-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A malária ainda representa um problema de saúde global. A forma grave da doença é causada principalmente por P. falciparum e pode cursar com complicações cerebrais, renais, pulmonares, hematológicas, circulatórias e hepáticas. O objetivo deste estudo foi relatar um caso de paciente portador de malária grave importada. RELATO DO CASO: Paciente do sexo masculino, 30 anos, pardo, filipino, marinheiro, proveniente de embarcação vinda da Nigéria, com história de dor abdominal no hipocôndrio direito, icterícia, febre e rebaixamento do nível de consciência. Os exames laboratoriais de admissão mostraram hiperbilirrubinemia de 50 mg/dL, acidose metabólica grave, trombocitopenia, creatinina de 5,6 mg/dL, leucocitose com desvio até metamielócitos. O escore APACHE II foi de 37, com risco de óbito de 88%. Durante a internação foi diagnosticada malária por P. falciparum pelo teste de gota espessa. Mesmo com tratamento antimalárico adequado, o paciente evoluiu com insuficiência renal aguda necessitando de hemodiálise e síndrome de angústia respiratória aguda (SARA, necessitando de ventilação mecânica (VM, choque refratário tratado com aminas vasoativas, além de quadro hematológico, configurando um caso grave de disfunção de múltiplos de órgãos. Ainda apresentou pneumonia associada à VM e sepse relacionada ao uso de cateteres. Após a alta hospitalar, o paciente não apresentou seqüelas cerebral, pulmonar ou renal. CONCLUSÕES: Dos critérios definidores de malária grave descritos na literatura, o paciente preenchia: insuficiência renal aguda, síndrome da angústia respiratória aguda (SARA, acidose metabólica, alteração do nível de consciência, hemoglobinúria macroscópica, hiperparasitemia e hiperbilirrubinemia, que se relaciona a uma mortalidade maior que 10%, na dependência do tratamento precoce e dos recursos disponíveis. A malária grave exige diagnóstico e tratamento

  9. Association between TSH-Receptor Autoimmunity, Hyperthyroidism, Goitre, and Orbitopathy in 208 Patients Included in the Remission Induction and Sustenance in Graves' Disease Study

    Laurberg, Peter; Nygaard, Birte; Andersen, Stig;

    2014-01-01

    , goiter, and presence of orbitopathy) at the time of diagnosis of hyperthyroidism. Methods. We describe a cohort of 208 patients with newly diagnosed Graves' hyperthyroidism. Patients were enrolled in a multiphase study of antithyroid drug therapy of Graves' hyperthyroidism, entitled "Remission Induction......, whereas 25-30% had orbitopathy. Conclusions. A positive but rather weak correlation was found between TSH-receptor antibodies in serum and the major clinical manifestation of Graves' disease. Only half of the patients had an enlarged thyroid gland at the time of diagnosis....

  10. Avances en la propagación vía embriogénesis somática de Psychotria ipecacuanha (Brot. Stokes, planta medicinal en peligro crítico

    Esther J. Naranjo

    2014-06-01

    Full Text Available Título en ingles: Advances in vitro propagation via somatic embryogenesis of Psychotria ipecacuanha (Brot. Stokes, medicinal plant critically endangeredTítulo corto: Avances en la propagación vía embriogénesis somática de Psychotria ipecacuanhaResumen:  Psychotria ipecacuanha (Brot. Stokes (Rubiaceae Juss, es una especie vegetal con reconocidas propiedades medicinales. Esta especie se encuentra en peligro crítico de extinción, debido a la sobreexplotación de las poblaciones naturales. Conociendo además las dificultades para su propagación por medio de semillas (debido a la baja tasa de germinación y elevada muerte prematura de las plántulas y por vía vegetativa (lento crecimiento, el presente trabajo tuvo como objetivo evaluar el potencial de propagación vía embriogénesis somática directa. Segmentos de hojas jóvenes de plantas mantenidas en casa malla fueron desinfectados y  sembrados en el medio de cultivo MS (Murashige y Skoog suplementado con diferentes concentraciones y combinaciones de reguladores de crecimiento. Las combinaciones  IBA y BAP a 1 y 2 mg/L y 2 y 1 mg/L, respectivamente; mostraron ser efectivas en la formación de embriones somáticos en esta especie. La procedencia de la planta donadora parece tener influencia en la sensibilidad del tejido foliar a la respuesta.  Este es el primer reporte de embriogénesis somática directa para esta especie y el  primer reporte de cultivo in vitro de poblaciones colombianas.Palabras clave: micropropagación, conservación, nativa, extinción, regeneración in vitroAbstract: Psychotria ipecacuanha (Brot. Stokes (Rubiaceae Juss, is a species with known medicinal properties. This species is critically endangered due to overexploitation of natural populations.Besides knowing the difficulties in propagation by seed (due to the low rate of germination and high seedling premature death and by vegetative (slow growth, the present study evaluated the potential for propagation

  11. Administration of additional inactive iodide during radioiodine therapy for Graves' disease. Who might benefit?

    Aim: Graves' hyperthyroidism and antithyroid drugs empty the intrathyroid stores of hormones and iodine. The consequence is rapid 131I turnover and impending failure of radioiodine therapy. Can administration of additional inactive iodide improve 131I kinetics? Patients, methods: Fifteen consecutive patients, in whom the 48 h post-therapeutically calculated thyroid dose was between 150 and 249 Gy due to an unexpectedly short half-life, received 3 x 200 μg inactive potassium-iodide (127I) daily for 3 days (Group A), while 17 consecutive patients with a thyroid dose of = 250 Gy (Group B) served as the non-iodide group. 48 hours after 131I administration (M1) and 4 or 5 days later (M2) the following parameters were compared: effective 131I half-life, thyroid dose, total T3, total T4, 131I-activity in the T3- and T4-RIAs. Results: In Group A, the effective 131I half-life M1 before iodine (3.81 ± 0.93 days) was significantly (p 131I half-life M2 (4.65 ± 0.79 days). Effective 131I half-life M1 correlated with the benefit from inactive 127I (r = -0.79): Administration of 127I was beneficial in patients with an effective 131I half-life M1 of 131I activity of T3 and T4 showed lower specific 131I activity after addition of inactive iodine compared with patients from the same group with a lower initial specific 131I activity of T3 and T4 and compared with the patient group B who was given no additional inactive iodide. This correlation was mathematically described and reflected in the flatter gradient in Group A (y = 0.5195x + 0.8727 for 131I T3 and y = 1.0827x - 0.4444 for 131I T4) and steeper gradient for Group B (y = 0.6998x + 0.5417 for 131I T3 and y = 1.3191x - 0.2901 for 131I T4). Radioiodine therapy was successful in all 15 patients from Group A. Conclusion: The administration of 600 μg inactive iodide for three days during radioiodine therapy in patients with Graves' hyperthyroidism and an unexpectedly short half-life of <3 or 4 days was a safe and effective

  12. Radioiodine therapy of Graves' disease - a dosimetric comparison of different strategies concerning antithyroid drugs

    Aim: Premedication with antithyroid drugs (ATD) compared to patients not pretreated with ATD causes a higher failure rate of radioiodine therapy (RITh) or demands higher therapeutical dosage of radioiodine (RI). For clinical reasons and because of accelerated iodine metabolism in hyperthyreosis a compensated thyroid metabolism is desirable. Aim of this study was to investigate the influence of ATD on the biokinetics of RI in case of Graves' disease in order to improve RITh of patients pre-treated with ATD. Methods: 385 consecutive patients who underwent RITh because of Graves' disease for the first time were included: Group A (n = 74): RITh under continuous medication with ATD; Group B (n = 111): Application of RI under continuous medication with ATD, in case of insufficient RI-uptake or shortened effective RI-half-life ATD were stopped 1-5 days after RITh; Group C (n = 200): ATD were stopped 2 days prior to RITh in all patients. We examined the influence of ATD on RI-uptake and effective RI-half-life as well as the absorbed dose achieved on the thyroid in dependence of thyroid volume and applied RI-dosage [TEQ - therapy efficiency quotient, (2)]. Results: In the RI-pretest (all patients under ATD) the RI-uptake was comparable in all three groups. During RITh-RI-uptake, effective RI-half-life and therefore the TEQ were significantly higher in Group C as compared to Groups A and B (p<0,001, respectively). In Group B the medication with ATD was stopped in 61 of 111 cases 1-5 days after RITh. In this subgroup the effective RI-half-life increased from 4,4 ± 1,7 d to 5,1 ± 1,6 d after stopping of ATD (p = 0,001). Conclusion: Stopping of ATD 2 days prior to RITh leads to an increased efficiency of about 50% compared to RITh carried out under ATD and therefore to a clear reduction of radiation exposure to the rest of the body with equal absorbed doses of the thyroid. Stopping of ATD shortly after RITh increases efficiency in case of short effective RI-half-life, but it

  13. Geophysical Investigation of an Abandoned Cemetery: Teachers Discover Evidence of Unmarked Graves in Prairie View, TX

    Henning, A. T.; Sawyer, D. S.; Baldwin, R.; Kahera, A.; Thoms, A.

    2007-12-01

    In July 2007, a group of nineteen K-12 teachers investigated an abandoned cemetery in Prairie View, Texas, utilizing ground-penetrating radar (GPR) to image the subsurface. In a period of two weeks, the group acquired and interpreted 59 GPR profiles in Wyatt Chapel Cemetery and surrounding areas in order to determine the local stratigraphy and try to locate unmarked graves. The sandy soil in this area is ideally suited for GPR investigations and numerous geophysical anomalies were identified. Wyatt Chapel Cemetery is located adjacent to the campus of Prairie View A&M University in Prairie View, TX, and is thought to have originated as a slave burial ground in the 1850's. Participants in a summer course at Rice University conducted a geophysical investigation of the site. Participants were in-service K-12 teachers from urban Houston school districts where the majority of students are members of historically underrepresented minority groups. Recruitment efforts targeted educators who are currently teaching science without a science degree. Participants included elementary, middle and high school teachers. This summer experience is followed by a content-intensive academic year course in Physical Geology. GPR is an excellent tool for investigating the sandy soil encountered at Wyatt Chapel Cemetery. The stratigraphy in the area consists of 3-6 feet of reddish-brown, medium-grained sand overlying a light gray, highly compacted clay. The sand-clay boundary appears as a strong reflector on the GPR profiles. Participants identified numerous anomalies in the GPR data and two were excavated. One consisted of a pair of bright hyperbolae, suggesting two edges of a metal object. This excavation resulted in the discovery of a metal plank thought to be a burial cover. The second anomaly consisted of a break in the horizon representing the top of the clay layer, and subsequent excavation revealed a grave shaft. Participants experienced the process of science first-hand and used

  14. The role of imaging in Graves' disease: A cost-effectiveness analysis

    Cappelli, C. [Department of Medical and Surgical Sciences, Internal Medicine and Endocrinology Unit, University of Brescia (Italy)], E-mail: cappelli@med.unibs.it; Pirola, I.; De Martino, E.; Agosti, B.; Delbarba, A.; Castellano, M.; Rosei, E. Agabiti [Department of Medical and Surgical Sciences, Internal Medicine and Endocrinology Unit, University of Brescia (Italy)

    2008-01-15

    According to many guidelines, scintigraphy remains the first suggested diagnostic procedure in hyperthyroid patients in spite of the widespread availability of ultrasounds. The aim of this study was to evaluate the cost-effectiveness of sonography versus scintigraphy in the management of Graves's disease, and to assess ultrasound features suggesting cancer in detecting thyroid nodules. Among 1470 hyperthyroid patients evaluated in our department from 2002 to 2005, 426 (29%) had Graves' disease: echographic and scintigraphic features were not suggestive of GD in 20/426 (4.8%) and 11/426 (2.6%) patients, respectively (p = 0.763), even if one of the two procedures was almost always diagnostic. Ultrasound identified 68/426 (16%) patients with a concomitant solid lesion, while scintigraphy detected only 9/426 (2.1%) 'cold' nodules (p < 0.001). Thyroid cancer was diagnosed in 30/68 (47.7%) patients. Malignancy presented at ultrasound investigation blurred margins (26.7% versus 15.8%), microcalcifications (33.3% versus 28.9%) and an anteroposterior and transverse diameter ratio {>=}1 (73.3% versus 71.1%); more frequently than benign nodules, but this was not statistically significant. The total cost to obtain a diagnosis by ultrasound was Euro 14645.34 ( Euro 13312.5 for echography + Euro 1332.84 for scintigraphy in the 29 patients 'negative' at echographic evaluation for GD) versus Euro 19922.71 by scintigraphy ( Euro 19578.96 for scan + Euro 343.75 for ultrasounds in the 11 patients 'negative' at scintigraphy). Our data show no difference in terms of diagnosis between sonography and scintigraphy. Indeed, scintigraphy was less sensitive in detecting nodules (often of malignant nature) than ultrasound, and, moreover, with a consequent increase of the direct cost of nodule management when scintigraphy is the first line procedure. In conclusion, according to our results, we suggest that ultrasounds with color-Doppler evaluation should

  15. The role of imaging in Graves' disease: A cost-effectiveness analysis

    According to many guidelines, scintigraphy remains the first suggested diagnostic procedure in hyperthyroid patients in spite of the widespread availability of ultrasounds. The aim of this study was to evaluate the cost-effectiveness of sonography versus scintigraphy in the management of Graves's disease, and to assess ultrasound features suggesting cancer in detecting thyroid nodules. Among 1470 hyperthyroid patients evaluated in our department from 2002 to 2005, 426 (29%) had Graves' disease: echographic and scintigraphic features were not suggestive of GD in 20/426 (4.8%) and 11/426 (2.6%) patients, respectively (p = 0.763), even if one of the two procedures was almost always diagnostic. Ultrasound identified 68/426 (16%) patients with a concomitant solid lesion, while scintigraphy detected only 9/426 (2.1%) 'cold' nodules (p < 0.001). Thyroid cancer was diagnosed in 30/68 (47.7%) patients. Malignancy presented at ultrasound investigation blurred margins (26.7% versus 15.8%), microcalcifications (33.3% versus 28.9%) and an anteroposterior and transverse diameter ratio ≥1 (73.3% versus 71.1%); more frequently than benign nodules, but this was not statistically significant. The total cost to obtain a diagnosis by ultrasound was Euro 14645.34 ( Euro 13312.5 for echography + Euro 1332.84 for scintigraphy in the 29 patients 'negative' at echographic evaluation for GD) versus Euro 19922.71 by scintigraphy ( Euro 19578.96 for scan + Euro 343.75 for ultrasounds in the 11 patients 'negative' at scintigraphy). Our data show no difference in terms of diagnosis between sonography and scintigraphy. Indeed, scintigraphy was less sensitive in detecting nodules (often of malignant nature) than ultrasound, and, moreover, with a consequent increase of the direct cost of nodule management when scintigraphy is the first line procedure. In conclusion, according to our results, we suggest that ultrasounds with color-Doppler evaluation should be performed as first step in all

  16. Long-term results of irradiation for patients with progressive GRAVES' ophthalmopathy

    Purpose: To determine the long-term outcome of radiotherapy (RT) in patients with progressively symptomatic thyroid eye disease and to evaluate the potential long-term sequelae. Methods and Materials: Four hundred fifty-three patients provided written informed consent and received retrobulbar RT for Graves' ophthalmopathy at Stanford University Medical Center; 197 with ≥1 year of follow-up were retrospectively analyzed. Of the 197 patients, 189 received RT to the bilateral retrobulbar regions, and 4 received unilateral RT. The technical information was unavailable for 4 patients. Patients were assessed by chart review, telephone interview, questionnaire, and multidisciplinary physician examination. Eye impairment was scored using the SPECS system. The end point review included the before and after treatment SPECS score, surgical intervention, and patient satisfaction. Potential complications, including cataract development, retinopathy, and tumor formation, were investigated. Multivariate analyses were performed to assess the prognostic variables. Results: Improvement or resolution was 89% for soft-tissue findings; 70% for proptosis; 85% for extraocular muscle dysfunction; 96% for corneal abnormalities; and 67% for sight loss. The response to RT may take >6 months to stabilize. Factors predictive of response varied in the individual SPECS categories but included the initial SPECS score, pretreatment thyroid status, female gender, a 20-Gy RT dose, and a history of hypertension. Nonpredictive factors included a history of tobacco use, diabetes mellitus, steroids, and prior cataracts. Only 16% required surgical intervention to preserve their vision or restore binocular vision. Twenty-two patients (12%) developed cataracts after irradiation (median 11 years). No patient developed a tumor within the RT field during the follow-up period (range 1-29 years). Ninety-eight percent of patients were pleased with their results, and 2% believed their symptoms progressed

  17. Changing trends in the treatment of Graves' disease with radioiodine: a 12-year experience in a university hospital; Mudancas evolutivas no tratamento da doenca de Graves com iodo radioativo: 12 anos de experiencia em um hospital universitario

    Souza, Marcus Vinicius Leitao de [Instituto Estadual de Diabetes e Endocrinologia (IEDE), Rio de Janeiro, RJ (Brazil)], e-mail: marcusleitao@gmail.com; Souza, Honomar Ferreira de [Universidade Federal Fluminense (UFF), Niteroi, RJ (Brazil). Faculdade de Medicina. Dept. de Endocrinologia; Buescu, Alexandru; Vaisman, Mario [Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ (Brazil). Faculdade de Medicina. Dept. de Endocrinologia

    2009-03-15

    Objective: To evaluate the changes in clinical parameters and in the approach to patients submitted to radioiodine therapy for Graves' disease. Materials and methods: Dossiers of 226 patients submitted to radioiodine therapy for Graves' disease in the period between January 1990 and December 2001 were retrospectively evaluated. For the purposes of statistical analysis, the 12-year period was subdivided into three periods of 4 years, with a comparison of clinical and laboratory variables in these periods. Results: The authors have observed that the total number of patients referred for radioiodine therapy as well as the percentage of female patients presented a significant increase (from 62% to 86%; p = 0.005). The percentage of patients pretreated with methimazole before radioiodine therapy increased significantly (from 9.1% to 35.6%; p = 0.03). The mean radioiodine dose delivered has also presented a significant increase (from 7.6 mCi to 12.7 mCi; p = 0.000003) with a direct reflection on a higher percentage of patients cured one year after the radioiodine therapy (from 55.6% to 83.7%; p = 0.004). Conclusion: Radioiodine therapy has increasingly been accepted for treatment of patients with Graves' disease and the doses delivered have increased to achieve a permanent cure as well as a reduction of the chances of recurrence. (author)

  18. Thyrotropin receptor antibody activities significantly correlate with the outcome of radioiodine (131I) therapy for hyperthyroid Graves' disease

    The outcome of 131I therapy for 109 patients with Graves' disease was analysed according to pretreatment laboratory data including thyrotropin receptor antibody (TRAb) activities. Forty-five percent of patients became euthyroid, and 13% of patients became hypothyroid within one year after 131I therapy. Forty-two percent of patients remained hyperthyroid one year after 131I therapy. Pretreatment values for serum T4, T3, and the estimated weight of the thyroid were significantly higher in the hyperthyroid group. The mean for the TRAb index of the hyperthyroid group was significantly higher than that of the euthyroid group. Life table analysis revealed a significant effect of the TRAb index on the rate of hyperthyroidism after 3 months or later. These results appear to suggest that the TRAb index is one of the factors which influence the outcome of 131I therapy for Graves' disease. (author)

  19. Ophthalmopathy in the course of Graves-Basedow disease - diagnosis and treatment with regard to the role of the radiotherapy

    Thyroid ophthalmopathy is a most frequent extra thyroid symptom of the Graves-Basedow disease. The etiology is unknown, but supposes that she has an auto immunologic basis. For the pathogenesis of ophthalmic symptoms accepts three processes: the infiltration, the swelling and the fibrination of the extra ocular tissue. Clinically we favour two forms: gentle which appears more often and infiltration-edematous which worse prognoses. The disease can make for the permanent damage of the vision organ. For with the unknown etiology we can use only the symptomatic treatment such as: steroids, radiotherapy and surgical decompression. Purpose of this study is the performance of the present state of the knowledge on the subject of ophthalmopathy in the course of the Graves-Basedow disease with particular reference to the role of the radiotherapy - methods of the treatments seldom used in non neoplastic diseases. (authors)

  20. An inventory of archaeological sites and collections in the Mark Twain National Wildlife Refuge under the provisions of the Native American Graves Protection and Repatriation Act

    US Fish and Wildlife Service, Department of the Interior — The Native American Graves Protection and Repatriation Act (NAGPRA) requires Federal agencies and museums receiving federal funds to inventory human remains,...

  1. Aplicação de um teste preliminar a um folheto informativo sobre o estudo da efetividade da vacina antigripal contra formas graves de gripe

    Almeida, Maria Moitinho de; Santos, Ana João; Machado, Ausenda

    2015-01-01

    Objetivo: Este trabalho tem como objetivo apresentar os resultados da aplicação do teste preliminar ao folheto informativo sobre o estudo da efetividade da vacina antigripal contra formas graves de gripe.

  2. Effects of a Single Venous Dose of Zinc on Thyroid Status in Healthy Individuals and Patients With Graves' Disease

    Farooqi, Lubna; Gláucia M. F. S. Mazeto; Shuhama, Tadao; Brandão-Neto, José

    2000-01-01

    Zinc metabolism may regulate thyroid function acting at TRH (thyrotropin-releasing hormone) synthesis, peripheral deiodination of T4 (tetraiodothyronine), and binding of thyroid hormones to nuclear receptors. The aim of this study was to investigate the effect of acute zinc administration on TSH (thyroid-stimulating hormone), FT3 (free triiodothyronine), and FT4 (free tetraiodothyronine) in 10 healthy individuals and 12 hyperthyroid patients with Graves' disease. All these individuals were st...

  3. Clinical Association of Thyroid Stimulating Hormone Receptor Antibody Levels with Disease Severity in the Chronic Inactive Stage of Graves' Orbitopathy

    Woo, Young Jae; Jang, Sun Young; Lim, Tyler Hyung Taek; Yoon, Jin Sook

    2015-01-01

    Purpose To investigate associations between serum thyroid stimulating hormone (TSH) receptor antibody (TRAb) levels and Graves' orbitopathy (GO) activity/severity in chronic-stage GO and compare the performance of two newly-developed TRAb assays (third-generation TSH-binding inhibition immunoglobulin [TBII] assay versus Mc4 thyroid-stimulating immunoglobulin [TSI] bioassay). Methods This study is a retrospective review of medical charts and blood tests from Korean GO patients who first visite...

  4. The rs1990760 polymorphism within the IFIH1 locus is not associated with Graves' disease, Hashimoto's thyroiditis and Addison's disease

    Seidl Christian; Reisch Nicole; Willenberg Holger; Hahner Stefanie; Kahles Heinrich; Robbers Inka; Ramos-Lopez Elizabeth; Penna-Martinez Marissa; Segni Maria; Badenhoop Klaus

    2009-01-01

    Abstract Background Three genes have been confirmed as major joint susceptibility genes for endocrine autoimmune disease:human leukocyte antigen class II, cytotoxic T-lymphocyte antigen 4 and protein tyrosine phosphatase non-receptor type 22. Recent studies showed that a genetic variation within the interferon induced helicase domain 1 (IFIH1) locus (rs1990760 polymorphism) is an additional risk factor in type 1 diabetes and Graves' disease (GD). Methods The aim of the present study was to in...

  5. A stimulatory TSH receptor antibody enhances adipogenesis via phosphoinositide 3-kinase activation in orbital preadipocytes from patients with Graves' ophthalmopathy

    Kumar, Seema; Nadeem, Sarah; Stan, Marius N.; Coenen, Michael; Bahn, Rebecca S.

    2011-01-01

    Graves' ophthalmopathy (GO) is characterized by expanded volume of the orbital tissues associated with elevated serum levels of TSH receptor (TSHR) autoantibodies. Because previous studies have demonstrated evidence of adipogenesis within the GO orbit, we sought to determine whether M22, a human monoclonal antibody directed against TSHR, enhances adipogenesis in orbital fibroblasts from patients with GO and, if so, to identify signaling mechanisms involved. GO orbital fibroblast cultures (n=1...

  6. Iatrogenic myxoedema madness following radioactive iodine ablation for Graves' disease, with a concurrent diagnosis of primary hyperaldosteronism

    Larouche, V; Snell, L; Morris, D. V.

    2015-01-01

    Summary Myxoedema madness was first described as a consequence of severe hypothyroidism in 1949. Most cases were secondary to long-standing untreated primary hypothyroidism. We present the first reported case of iatrogenic myxoedema madness following radioactive iodine ablation for Graves' disease, with a second concurrent diagnosis of primary hyperaldosteronism. A 29-year-old woman presented with severe hypothyroidism, a 1-week history of psychotic behaviour and paranoid delusions 3 months a...

  7. Semblance analysis to assess GPR data from a five-year forensic study of simulated clandestine graves

    Booth, Adam D.; Pringle, Jamie K.

    2016-02-01

    Ground penetrating radar (GPR) surveys have proven useful for locating clandestine graves in a number of forensic searches. There has been extensive research into the geophysical monitoring of simulated clandestine graves in different burial scenarios and ground conditions. Whilst these studies have been used to suggest optimum dominant radar frequencies, the data themselves have not been quantitatively analysed to-date. This study uses a common-offset configuration of semblance analysis, both to characterise velocity trends from GPR diffraction hyperbolae and, since the magnitude of a semblance response is proportional to signal-to-noise ratio, to quantify the strength of a forensic GPR response. 2D GPR profiles were acquired over a simulated clandestine burial, with a wrapped-pig cadaver monitored at three-month intervals between 2008 and 2013 with GPR antennas of three different centre-frequencies (110, 225 and 450 MHz). The GPR response to the cadaver was a strong diffraction hyperbola. Results show, in contrast to resistivity surveys, that semblance analysis have little sensitivity to changes attributable to decomposition, and only a subtle influence from seasonality: velocity increases (0.01-0.02 m/ns) were observed in summer, associated with a decrease (5-10%) in peak semblance magnitude, SM, and potentially in the reflectivity of the cadaver. The lowest-frequency antennas consistently gave the highest signal-to-noise ratio although the grave was nonetheless detectable by all frequencies trialled. These observations suggest that forensic GPR surveys could be undertaken with little seasonal hindrance. Whilst GPR analysis cannot currently provide a quantitative diagnostic proxy for time-since-burial, the consistency of responses suggests that graves will remain detectable beyond the five years shown here.

  8. Thyrotoxic Periodic Paralysis and Polymorphisms of the ADRB2, AR, and GABRA3 Genes in Men with Graves Disease

    Park, Suyeon; Kim, Tae Yong; Sim, Soyoung; Lim, Seonhee; Kim, Mijin; Kwon, Hyemi; Jeon, Min Ji; Kim, Won Gu; Shong, Young Kee; Kim, Won Bae

    2016-01-01

    Background Thyrotoxic periodic paralysis (TPP) is a rare complication of thyrotoxicosis characterized by acute attacks of muscle weakness and hypokalemia. Recently, variation in several genes was suggested to be associated with TPP. This study evaluated the genetic predisposition to TPP in terms of the β2-adrenergic receptor (ADRB2), androgen receptor (AR), and γ-aminobutyric acid receptor α3 subunit (GABRA3) genes. Methods This study enrolled 48 men with Graves disease (GD) and TPP, and 48 G...

  9. Comprehensive analysis of the related factors of early hypothyroidism occurring in patients with Graves' disease after 131I treatment

    Objective: To make a comprehensive analysis of the related factors of early hypothyroidism occurring in patients with Graves' disease after 131I treatment. Methods: The information of 131I treated Graves' disease was collected including general data, clinical observation, laboratory data, thyroid function test, etc. Then a retrospective statistical analysis was carried out, using cluster analysis, factor analysis, discriminant analysis, multivariate regression analysis, etc. Results: 1) Cluster analysis and factor analysis showed that among clinical observation such as clinical course, treatment course, patients' state and disease occurrance, the first three factors correlated highly; among laboratory data such as thyrotrophin receptor antibody (TRAb), thyroid-stimulating immunoglobulins (TSI), thyroglobulin antibody (TgAb) and thyroid microsomal antibody (TMAb), both the first two and the last two correlated highly, each two factors had the similar effect. 2) Fsher discriminant analysis showed that among the thyroid weight, the effective half life, the maximum 131I uptake percentage, total dose of 131I and the average dose of 131I per gram of thyroid, the last one had the most predicting value for incidence of early hypothyroidism. 3) Logistic regression analysis showed that among all the related factors of early hypothyroidism occurred after 131I treated Graves' disease, thyroid weight, average dose of 131I per gram of thyroid, the maximum 131I uptake percentage and the level of TSI were effective factors. Conclusions: The occurrence of early hypothyroidism for 131I-treated Graves' disease is probably affected by many factors. If more factors are taken into consideration before therapy and the theraputic dose is well adjusted accordingly, it can reduce the incidence of early hypothroidism to a certain extent. (authors)

  10. Graves' Disease as a Manifestation of Immune Reconstitution in HIV-Infected Individuals after Initiation of Highly Active Antiretroviral Therapy

    Faria Farhat; Jhansi Gajjala; Robert Delapenha; Syeda Mehreen Zahra; Samad Rasul

    2011-01-01

    Graves' disease after the initiation of highly active antiretroviral therapy (HAART) in certain HIV-1-infected individuals has been described as an immune reconstitution inflammatory syndrome (IRIS). This phenomenon should be suspected in individuals who present with clinical deterioration and a presentation suggestive of hyperthyroidism despite good virological and immunological response to HAART. Signs and symptoms of hyperthyroidism may be discrete or overt and typically develop 8–33 month...

  11. Fibrose pulmonar grave: achado incomum em lúpus eritematoso sistêmico: relato de um caso

    Furtado Álvaro Porto Alegre; Genro Carlos Horácio; Silveira Márcio Fleck da; Abreu Marcelo de; Comiran Cristina; Moreira Roger Klein; Koppe Daniela; Marconato Marlon Cesar; Zignani Juliana

    2001-01-01

    Os autores relatam o caso de uma paciente do sexo feminino, 51 anos de idade, branca, com diagnóstico estabelecido de lúpus eritematoso sistêmico associado a evidência radiológica de fibrose pulmonar grave. A epidemiologia das manifestações pleuropulmonares do lúpus eritematoso sistêmico, dando ênfase à fibrose pulmonar, é discutida.

  12. Comparison of short-term effects between interventional embolization treatment and iodine-131 therapy for graves'hyperthyroidism

    Objective: To compare the short-term effects between interventional arterial embolization and iodine-131 therapy in treating Graves' disease. Methods: A total of 84 patients with Graves' disease (GD), confirmed by clinical data and laboratory tests, were divided into two groups: interventional group (n = 42) receiving arterial embolization and iodine-131 group (n = 42)receiving iodine-131 therapy. Before and after the treatment thyroid angiography and SPECT / CT imaging were performed to determine the shape and size of the thyroid, and radioimmunoassay method was used to measure serum levels of FT3, FT4, TSH and TRAb at 3, 6 and 12 months after the therapy. The results were compared and statistically analyzed. The occurrence of complications was observed. Results: No statistically significant difference in short-term therapeutic effects was found between interventional group and iodine-131 group. The occurrence of early severe complication was much higher in interventional group than that in iodine-131 group, while the occurrence of hypothyroidism was obviously higher in iodine-131 group than that in interventional group. Conclusion: Both interventional embolization and iodine-131 therapy have reliable effect for the treatment of Graves' disease. Iodine-131 therapy may be used in patients who plan to receive initial treatment or in patients who failed to effectively respond to other kinds of therapies, while interventional embolization may be employed in patients who are not able to receive surgery or in patients who have failed to respond to anti-thyroid drug treatment, or in patients whose iodine-131 intake rate is too low to undergo iodine-131 therapy, especially in patients with refractory and intractable hyperthyroidism. Interventional embolization can be regarded as an alternative treatment for Graves' disease. (authors)

  13. Impact Analysis of Changes in Human Resource Capital on Economic Development - from Gravely Underdeveloped to Highly Developed Societies

    Zeljko Pozega; Boris Crnkovic

    2009-01-01

    This research encompasses 177 countries around the world with the data on human resource variables for the year 2005. The countries have been put into four groups: gravely underdeveloped, developing, developed, and highly developed. The research has looked into the variables Human Development Index, population, population over 65 years of age, primary education enrolment, investment into secondary education, investment into tertiary education, investment into research and development, Gender–...

  14. The effects of radioiodine therapy on peripheral blood lymphocyte subpopulations in patients with Graves' disease. Preliminary report

    Treatment of Graves' disease patients with radioactive iodide (131I) is becoming the standard therapy in an increasing group of cases but can induce alterations in immune response, like increasing levels of thyroid autoantibodies, and, in part, exacerbation of ophthalmopathy. The aim of this study was to assess the changes in peripheral blood (PB) lymphocyte subpopulations after 131I treatment of patients with Graves' disease. The study was carried out in a group of 30 patients with Graves' disease (23 f; 7 m) 49.5±10.0 years of age, 26 with different subjective ocular signs like gritty sensation, increased lacrimation, orbital pain, and exophthalmos. PB lymphocyte subsets were analysed by cytofluorometry, serum concentration of TSH and fT4 were evaluated before and 6 weeks after radioiodine treatment. After 131I treatment a significant increase in CD3+, CD4+, CD3+HLA-DR+ and a decrease in CD19+ percentages of lymphocyte subsets were found in comparison with the initial evaluation. No significant changes in percentage of CD8+ and NK (CD3-CD16+ CD56+) cells were observed during this study. A significant increase in TSH and a slight decrease in fT4 concentration concentration took place in the 6th week after 131I application. The patients without subjective improvement of ocular signs during the therapy initially had a percentage of CD3+, CD8+ lymphocytes which was significantly lower compared with those with regression of ocular signs observed after 131I treatment. The changes in PB lymphocyte subsets caused by 131I treatment of Graves' disease confirm the involvement of acquired cellular immunity after radiation damage of the thyroid gland. The decreased initial percentage of CD8+ and CD3+ lymphocytes could help make a prediction of ocular symptoms persisting after radioiodine treatment in some patients with ophthalmopathy. (author)

  15. Advanced Age and Mild Thyrotoxicosis are Associated with Nodular Goiter in Graves Disease

    Serkan Yener

    2009-06-01

    Full Text Available Objective: The primary goal of this study is to evaluate predictors of nodular goiter in Graves Disease (GD.Materials and Methods: A total of 202 consecutive patients (mean age: 45; 145 female, 57 male were enrolled. All patients were treated with antithyroid drugs as initial therapy. TSH, FT3, FT4, TRAb, ATPO, and ATG were measured. Radioactive iodine uptake and thyroid ultrasonography were performed, and thyroid volume and nodule diameter were assessed. Ultrasound-guided fine needle aspiration was performed on thyroid nodules ≥8mm. Results: Diffuse goiter was detected in 51% of patients. Solitary nodules were detected in 16%, and multi-nodular disease in 33%. Mean nodule diameter was 8.82 mm. Nodular disease was slightly more common in women (p=0.063. Patients with nodular GD were older (p=0.004, had lower levels of FT3 (p=0.016 and TRAB (p=0.002 when compared with subjects with diffuse GD. Age (OR:6.867 was the independent variable predicting nodular GD. Conclusion: Increased prevalence of nodules was associated with advanced age and milder thyrotoxicosis. Apoptosis of thyroid follicular cells due to excess iodine might interfere with nodule formation, and lead to diffuse goiter in severe thyrotoxicosis. Because of increased rate if malignancy in GD, comprehensive evaluation of thyroid nodules of any size is mandatory. Turk Jem 2009; 13: 1-4

  16. Changes of serum TRAb after 131I radiotherapy in patients of Graves hyperthyroidism

    Objective: To study the changes of serum thyrotrophin receptor antibody (TRAb) in patients of Graves' hyperthyroidism after 131I radiotherapy and explore its clinical significances. Methods: A total of 128 patients and 45 nomal controls were included in the study. Serum concentration of TRAb was measured by radioreceptor assay before and at 3, 6, 12 and 18 months after 131I radiotherapy. Results: The TRAb level of 45 nomal controls was (2.95±1.48) U/L. Abnormally higher TRAb level [( 81.52±36. 1 5 ) U/L)] was noted in patients before 131I treatment (t=8.17, P131I radiotherapy, the level of TRAb [(4.29±2.56)U/L)] was back to normal with no difference to that of controls (t=1.53, P>0.05). Conclusion: It is of great significance to measure serum concentrations of TRAb after 131I radiotherapy, which is of important clinical value for therapy guidance, efficacy assessment, recurrence prediction and hypothyroidism identification. (authors)

  17. Cradle-to-grave tracking of hazardous and radioactive materials for pollution prevention

    As part of Sandia National Laboratories' (SNL) pollution prevention program a system is under development to track the movement of hazardous and radioactive materials from procurement, through use, to final disposition. The information provided by this system will improve the flow and enhance the quality of data, avoid duplication of effort, facilitate timely and accurate reporting, better support the information needs of various Environmental, Safety, and Health (ES ampersand H) programs, and allow waste to be minimized more effectively. Such a comprehensive system will incorporate information from other sources and build upon existing databases. The component include the Chemical Information System/Material Safety Data Sheet (CIS/MSDS) system installed by AT ampersand T Bell Laboratories (AT ampersand T-BL) at SNL in Livermore, along with a barcode chemical waste tracking system already in operation at SNL in Albuquerque. Also being developed in Albuquerque are Process Waste Assessments, a radioactive material tracking system, and a radioactive/mixed waste tracking system. A SNL and AT ampersand T-BL joint project is addressing how PWAs will link raw materials to waste streams. With a ''cradle-to-grave'' tracking system, it is possible to assess both financial and environmental life cycle costs. Once in place, this information will improve long-run efficiency and environmental protection, and provide benefits exceeding the initial demands placed upon personnel

  18. Cradle-to-grave tracking of hazardous and radioactive materials for pollution prevention

    As part of Sandia National Laboratories' (SNL) pollution prevention program, a system is under development to track the movement of hazardous and radioactive materials from procurement, through use, to final disposition. The information provided by this system will improve the flow and enhance the quality of data, avoid duplication of effort, facilitate timely and accurate reporting, better support the information needs of various Environmental, Safety, and Health (ES and H) programs, and allow waste to be minimized more effectively. Such a comprehensive system will incorporate information from various sources and build upon existing databases. The components include the Chemical Information System/Material Safety Data Sheet (CIS/MSDS) system installed by AT and T Bell Laboratories (AT and T-BL) at SNL in Livermore, and a Waste Information System (WIS) developed in Livermore. At SNL, Albuquerque a bar code chemical waste tracking system is already in operation and being developed are Process Waste Assessments (PWA), a radioactive material tracking system, and a radioactive/mixed waste tracking system. A SNL and AT and T-BL joint project is addressing how PWAs will link raw materials to waste streams. With a 'cradle-to-grave' tracking system, it is possible to assess both financial and environmental life cycle costs. Once in place, this information will improve long-run efficiency and environmental protection, and provide benefits exceeding the initial demands placed upon personnel. (author)

  19. Early Medieval Muslim Graves in France: First Archaeological, Anthropological and Palaeogenomic Evidence

    Pemonge, Marie-Hélène; Hubert, Christophe; Groppi, Alexis; Houix, Bertrand; Deguilloux, Marie-France; Breuil, Jean-Yves

    2016-01-01

    The rapid Arab-Islamic conquest during the early Middle Ages led to major political and cultural changes in the Mediterranean world. Although the early medieval Muslim presence in the Iberian Peninsula is now well documented, based in the evaluation of archeological and historical sources, the Muslim expansion in the area north of the Pyrenees has only been documented so far through textual sources or rare archaeological data. Our study provides the first archaeo-anthropological testimony of the Muslim establishment in South of France through the multidisciplinary analysis of three graves excavated at Nimes. First, we argue in favor of burials that followed Islamic rites and then note the presence of a community practicing Muslim traditions in Nimes. Second, the radiometric dates obtained from all three human skeletons (between the 7th and the 9th centuries AD) echo historical sources documenting an early Muslim presence in southern Gaul (i.e., the first half of 8th century AD). Finally, palaeogenomic analyses conducted on the human remains provide arguments in favor of a North African ancestry of the three individuals, at least considering the paternal lineages. Given all of these data, we propose that the skeletons from the Nimes burials belonged to Berbers integrated into the Umayyad army during the Arab expansion in North Africa. Our discovery not only discusses the first anthropological and genetic data concerning the Muslim occupation of the Visigothic territory of Septimania but also highlights the complexity of the relationship between the two communities during this period. PMID:26910855

  20. Ultrasonography compared to magnetic resonance imaging in thyroid-associated Graves' ophthalmopathy

    Vlainich, Ana R.; Romaldini, Joao H.; Pedro, Ana B.; Farah, Chady S.; Sinisgalli Junior, Cicero A., E-mail: anavlainich@uol.com.b [Hospital do Servidor Publico Estadual de Sao Paulo (IAMSPE), SP (Brazil)

    2011-04-15

    Objective: to compare ultrasonography (US) to magnetic resonance imaging (MRI) and the clinical activity score (CAS) in Graves' ophthalmopathy. Subjects and methods: Nineteen patients underwent extraocular muscle thickness measurements by US and MRI, reflectivity by US and signal-intensity ratio by MRI. There were also twelve US control subjects. Results: US median thicknesses were greater than in controls. Correlation was found between US and MRI in the median thickness of the left eye rectus medial muscle as well as between signal-intensity ratio (SIR) and thickness by US. An inverse correlation was found between reflectivity and SIR in the inferior and lateral rectus. On associating the tests for detecting activity the best results were obtained with CAS plus MRI (sensitivity 75%), and US and MRI (positive predictive value 77% and specificity 80%). Conclusion: CAS and US results showed poor correlation with MRI results suggesting that they cannot replace each other but when combined these methods can improve the evaluation of thyroid-associated ophthalmopathy. (author)

  1. Choroidal changes observed with enhanced depth imaging optical coherence tomography in patients with mild Graves orbitopathy.

    Özkan, B; Koçer, Ç A; Altintaş, Ö; Karabaş, L; Acar, A Z; Yüksel, N

    2016-07-01

    PurposeTo evaluate the choroidal thickness in patients with Graves orbitopathy (GO) using enhanced depth imaging-optical coherence tomography (EDI-OCT).MethodsThirty-one patients with GO were evaluated prospectively. All subjects underwent ophthalmologic examination including best-corrected visual acuity, intraocular pressure measurement, biomicroscopic, and fundus examination. Choroidal thickness was measured at the central fovea. In addition, visual evoked potential measurement and visual field evaluation were performed.ResultsThe mean choroidal thickness was 377.8±7.4 μ in the GO group, and 334±13.7 μ in the control group. (P=0.004). There was a strong correlation between the choridal thickness and the clinical activity scores (CAS) of the patients (r=0.281, P=0.027). Additionally, there was a correlation between the choroidal thickness and the visual-evoked potential (VEP) P100 latency measurements of the patients (r=0.439, P=0.001).ConclusionsThe results of this study demonstrate that choroid is thicker in patients with GO. The choroidal thickness is also correlated with the CAS and VEP P100 latency measurements in these patients. PMID:27315349

  2. Early Medieval Muslim Graves in France: First Archaeological, Anthropological and Palaeogenomic Evidence.

    Gleize, Yves; Mendisco, Fanny; Pemonge, Marie-Hélène; Hubert, Christophe; Groppi, Alexis; Houix, Bertrand; Deguilloux, Marie-France; Breuil, Jean-Yves

    2016-01-01

    The rapid Arab-Islamic conquest during the early Middle Ages led to major political and cultural changes in the Mediterranean world. Although the early medieval Muslim presence in the Iberian Peninsula is now well documented, based in the evaluation of archeological and historical sources, the Muslim expansion in the area north of the Pyrenees has only been documented so far through textual sources or rare archaeological data. Our study provides the first archaeo-anthropological testimony of the Muslim establishment in South of France through the multidisciplinary analysis of three graves excavated at Nimes. First, we argue in favor of burials that followed Islamic rites and then note the presence of a community practicing Muslim traditions in Nimes. Second, the radiometric dates obtained from all three human skeletons (between the 7th and the 9th centuries AD) echo historical sources documenting an early Muslim presence in southern Gaul (i.e., the first half of 8th century AD). Finally, palaeogenomic analyses conducted on the human remains provide arguments in favor of a North African ancestry of the three individuals, at least considering the paternal lineages. Given all of these data, we propose that the skeletons from the Nimes burials belonged to Berbers integrated into the Umayyad army during the Arab expansion in North Africa. Our discovery not only discusses the first anthropological and genetic data concerning the Muslim occupation of the Visigothic territory of Septimania but also highlights the complexity of the relationship between the two communities during this period. PMID:26910855

  3. [A study on observation of bone metabolism in middle-aged and senile female Graves' disease].

    Zhu, L Q; Liu, Y H; Zhou, Y B

    1996-08-01

    Sixty-nine cases of middle aged and senile female Graves' desease (GD) patients suffered from abnormal bone metabolism have been studied. They were divided randomly into group A and B, treated separately with antithyroid drugs (Tapazol and inderal, etc.) in group A, and added with Chinese herbal medicine for tonifying Kidney and promoting blood circulation in group B. Before treatment, patients of both groups showed obvious higher blood calcium (Ca) 24-hour urinary Ca, phosphorus (P) and serum clcitonin (CT) levels than that in normal subjects. These patients' serum Ca, moreover, had a parallel relationship with serum T3 levels (r = 0.6142, P < 0.01) and the serum Ca also a paralleled with serum CT levels (r = 0.5714, P < 0.05). After six months of treatment, the serum Ca, 24-hour urinary Ca, P and blood CT values were all reduced in various degree. The decrease of these bone metabolic parameters were more significant in group B than that in group A. PMID:9387746

  4. Compensated low-dose /sup 131/I therapy of Graves' disease

    Roudebush, C.P.; Hoye, K.E.; DeGroot, L.J.

    1977-10-01

    To minimize the high rate of residual thyrotoxicosis encountered in low-dose /sup 131/I therapy of Graves' disease, we have treated 62 patients with a low-dose /sup 131/I protocol that includes a compensation for thyroid size. Dose varied between 40 ..mu..Ci retained/g for glands of normal size to 100 ..mu..Ci/g for glands of 100 g or greater. Mean dose was 51.9 ..mu..Ci/g. At 1 year after therapy, 66.1 percent of subjects were euthyroid, 9.7 percent hypothyroid, and 24.2 percent hyperthyroid, a significant improvement (P less than 0.01) over our previous experience using 50 ..mu..Ci/g independent of gland size. Several factors, other than /sup 131/I dose, which might influence the outcome of therapy, were investigated. Initial free thyroxine index observed before therapy was found to have prognostic significance. Hypothyroidism developed only in patients having an initial free thyroxine index of 22.5 or less (about 2.5 times the upper limit of normal in our laboratory).

  5. The outcome of adjusted accumulation dose of treatment of Graves` disease

    Gomi, Yukari; Inoue, Takeshi; Suzuki, Seiji [Showa Univ., Yokohama (Japan). Fujigaoka Hospital; Hamada, Noboru; Yoshimura, Hiroshi; Ishikawa, Naofumi; Momotani, Naoko; Ito, Kunihiko

    1997-12-01

    We evaluated the outcome of {sup 131}I treatment of Graves` disease in two different protocols (old and new protocol) of adjusted accumulation dose from 1988 to 1995. Adjusted accumulation doses of patients with above 50 g thyroid weights were increased by 5-20 Gy/g tissue in new protocol compared to those in old one. In 166 patients treated with single and plural doses of {sup 131}I treatment in 1990 (Group In), the therapeutic doses were calculated according to new protocol and in 130 patients in 1988 (Group Io), according to old one, modification of Quimby`s formula. The patients treated with plural doses were classified as hyperthyroidism because the efficacies of the first treatments with {sup 131}I were insufficient. At the 5-yr follow up, the incidence of hypothyroid in Group In was 9%, subclinical hypothyroid 17%, euthyroid 30%, subclinical hyperthyroid 7%, hyperthyroid 37%. In Group Io, 11% of the patients were hypothyroid, 6% subclinical hypothyroid, 29% euthyroid, 3% subclinical hyperthyroid, 51% hyperthyroid. The incidence of hyperthyroid in Group In was lower than that in Group Io (p<0.05). There were no significant differences in hypothyroid and euthyroid. In conclusion, we suggest that an adjusted dose of {sup 131}I in relation to the patients` thyroid weight shows some room for improvement. (author)

  6. The influence of tapazole on iodine metabolism in patients with Graves' disease after 131I radiotherapy

    Objective: To study the influence of tapazole on 131I metabolism in patients with Graves' disease (GD) after 131I radiotherapy. Methods: One hundred and fifty-eight GD patients of first 131I radiotherapy were assigned to three groups. Group 0 did not receive tapazole, and group I, II received tapazole of different doses at 24 h after 131I radiotherapy. The radioactive counts of patients' thyroid and urine were measured dynamically after 131I radiotherapy and the 131I metabolism state was estimated. Results: All three groups after 131I radio-therapy showed a continuous decreasing tendency in radioactive counts of the thyroid, but no significant difference (P>0.05) was observed between them. Three groups' radioactive counts of urine were highest at 24 h, and decreased at 24-48 h after 131I radiotherapy; after 48 h (received tapazole for 24 h ) group I, II showed an obvious increasing tendency again, and they were significantly different from group 0 (P131I radiotherapy, but be given accordingly to the state of illness at a suitable time

  7. Thyroid sialyltransferase mRNA level and activity are increased in Graves' disease.

    Kiljański, Jacek; Ambroziak, Michał; Pachucki, Janusz; Jazdzewski, Krystian; Wiechno, Wieslaw; Stachlewska, Elzbieta; Górnicka, Barbara; Bogdańska, Magdalena; Nauman, Janusz; Bartoszewicz, Zbigniew

    2005-07-01

    Sialylation of cell components is an important immunomodulating mechanism affecting cell response to hormones and adhesion molecules. To study alterations in sialic acid metabolism in Graves' disease (GD) we measured the following parameters in various human thyroid tissues: lipid-bound sialic acid (LBSA) content, ganglioside profile, total sialyltransferase activity, and the two major sialyltransferase mRNAs for sialyltransferase-1 (ST6Gal I) and for sialyltransferase-4A (ST3Gal I). Fragments of toxic thyroid nodules (TN), nontoxic thyroid nodules (NN) and nontumorous tissue from patients with nodular goiter or thyroid cancer were used as a control (C). The LBSA content and sialyltransferase activity were the highest in the GD group (164 +/- 4.44 versus 120 +/- 2.00 nmoL/g, p = 0.005 and 1625 +/- 283.5 versus 324 +/- 54.2 cpm/mg of protein, p TSH-receptor antibody titer determined by the TRAK test. These results indicate that sialyltransferases expression and activity are increased in GD. Exact mechanism of this upregulation remains unknown, though one of possible explanations is the activation of the thyrotropin (TSH) receptor. PMID:16053379

  8. Comparative study of Graves' ophthalmopathy by ultrasonography, computed tomography, and fish bioassay

    In 35 patients with Graves' ophthalmopathy (GO) thyroid function was tested by T3-RIA, T4-RIA, TBI, TRH-test, thyroid scanning, and determination of thyroid autoantibodies. Additional ultrasonography (A-scan), computed tomography (CT) of the orbit, and the determination of an exophthalmogenic serum activity in fish bioassay was performed. Typical alterations for GO were observed in 26 cases with ultrasonography. CT showed an enlargement of medial and/or lateral rectus muscles in 24 of 33 patients, and in 17 cases a region of high density in the apex of the muscle cone. The density of retrobulbar fat after i.v. injection of contrast medium did not differ significantly from that observed in normal men. Characteristic signs of GO were not detected in only 2 cases using both methods together. Exophthalmogenic serum activity was found in the IgG fraction of serum protein. The incidence rate was high (69%), but for diagnostic purpose the fish bioassay cannot be recommended. (orig.) 891 AJ/orig. 892 BRE

  9. Ultrasonography compared to magnetic resonance imaging in thyroid-associated Graves' ophthalmopathy

    Objective: to compare ultrasonography (US) to magnetic resonance imaging (MRI) and the clinical activity score (CAS) in Graves' ophthalmopathy. Subjects and methods: Nineteen patients underwent extraocular muscle thickness measurements by US and MRI, reflectivity by US and signal-intensity ratio by MRI. There were also twelve US control subjects. Results: US median thicknesses were greater than in controls. Correlation was found between US and MRI in the median thickness of the left eye rectus medial muscle as well as between signal-intensity ratio (SIR) and thickness by US. An inverse correlation was found between reflectivity and SIR in the inferior and lateral rectus. On associating the tests for detecting activity the best results were obtained with CAS plus MRI (sensitivity 75%), and US and MRI (positive predictive value 77% and specificity 80%). Conclusion: CAS and US results showed poor correlation with MRI results suggesting that they cannot replace each other but when combined these methods can improve the evaluation of thyroid-associated ophthalmopathy. (author)

  10. Expression of IL-10, TNF-α mRNA in TEC in Graves' disease

    To study the transcription profiles of interleukin-10 (IL-10) and tumor necrosis factor-α (TNF-α) gene in human thyroid epithelial cells (TEC) from patients with Graves disease (GD), thyrocyte was isolated from thyroid tissues and cultured with RPMI-1640, then the expression of IL-10, TNF-α mRNA in the TEC was detected by means of RT-PCR. IL-10 mRNA expression in TEC was detected only in one case of GD group, and TNF-α mRNA was transcribed in all GD TEC. Neither IL-10 nor TNF-α mRNA was found in normal TEC. Thyroid as well as TEC can produce some kinds of cytokines. The transcription profiles of certain cytokines in the thyroid of patients with autoimmune thyroid disease (AITD) are different from those of normal thyroid tissues taken from MNG, which means that they are important features for the pathogenesis of AITD and abnormal thyroid function

  11. Prediction of post-treatment hypothyroidism using changes in thyroid volume after radioactive iodine therapy in adolescent patients with Graves' disease

    Fukata Shuji; Nakatake Nobuhiro; Tajiri Junichi

    2011-01-01

    Abstract Background The goal of iodine-131 therapy for pediatric Graves' disease is to induce hypothyroidism. However, changes in post-treatment thyroid volume have not been investigated in pediatric and/or adolescent patients. Objective The aim of this retrospective study was to examine whether changes in thyroid volume predict post-treatment hypothyroidism in adolescent Graves' disease patients. Patients and Methods We used ultrasonography to examine changes in thyroid volume, and also asse...

  12. Immunoglobulin Heavy Chain Variable Region and Major Histocompatibility Region Genes Are Linked to Induced Graves' Disease in Females From Two Very Large Families of Recombinant Inbred Mice

    McLachlan, Sandra M.; Aliesky, Holly; Banuelos, Bianca; Magana, Jessica; Williams, Robert W.; Rapoport, Basil

    2014-01-01

    Graves' hyperthyroidism is caused by antibodies to the TSH receptor (TSHR) that mimic thyroid stimulation by TSH. Stimulating TSHR antibodies and hyperthyroidism can be induced by immunizing mice with adenovirus expressing the human TSHR A-subunit. Prior analysis of induced Graves' disease in small families of recombinant inbred (RI) female mice demonstrated strong genetic control but did not resolve trait loci for TSHR antibodies or elevated serum T4. We investigated the genetic basis for in...

  13. The change of serum TRAb and its prognosis assess to graves disease with one-off successful 131I therapy

    To investigate dynamic change of serum receptor and antibody of thyrotrophic anti- body (TRAb) and its prognosis value after a one-off successful therapy on Graves disease with 131I, 257 Graves disease patients were treated with one dose of 131I therapy. 175 of them with average age of 40 (43 male and 132 female patients) were cured. The 131I activity given to patients was 207.2±66. 6 MBq. The serum levels of TRAb were determined once every three months before and after 131I therapy. The results showed that the serum TRAb levels in all patients were positive before 131I therapy. The serum TRAb levels in 60. 6% of patients were raised once, and then reduced to normal, The serum levels of TRAb in 16.0% of patients were remained high or reduce slowly, and the clinical symptom was improved slowly, but these patients didn't recrudesce. The TRAb levels in 9.7% of patients decreased continually, their prognosis was well. The TRAb levels in 13.7% of patients were raised twice after the therapy, and appear hypothyroidism. The detection of dynamic changes of serum TRAb levels in Graves disease patients may be useful in assessing prognosis after 131I therapy. (authors)

  14. Predictive value of thyrotropin receptor antibodies using the second generation TRAb human assay after radioiodine treatment in Graves' disease

    The detection of TSH-receptor antibodies (TRAb) in patients with Graves' disease is routinely used in nuclear medicine laboratories. This determination has been possible for approximately 3 years with a second generation human TRAb assay. Studies showed that this TRAb determination is diagnostically more sensitive compared to established, porcine TRAb assays. Objective: The aim of our study was to investigate, based on a ROC analysis, whether TRAb determination with the new, second generation assay allows a dependable statement about probability of occurence of relapse after radioiodine therapy in patient suffering from Graves' disease. Methods: 57 patients were examined with the DYNOtest trademark TRAKhuman (BRAHMS Diagnostica AG, Hennigsdorf) directly before and six months after therapy with radioiodine (dose: 150 Gy). A ROC-analysis was performed to determine positive/negative predictive values depending on different cut-off values. Results: Whereas 21/57 patients became eu- or hypothyroid after six months, 36/57 patients relapsed. Non-relapsed patients showed a significant lower median TRAb titer (4.2 IU/I vs. 19.2 IU/I; ptrademark TRAKhuman in the diagnostic of Graves' disease. It is not held over the established radioreceptorassay concerning the positive predictive value for relapsing patients. (orig.)

  15. Preliminary results of sequential monitoring of simulated clandestine graves in Colombia, South America, using ground penetrating radar and botany.

    Molina, Carlos Martin; Pringle, Jamie K; Saumett, Miguel; Hernández, Orlando

    2015-03-01

    In most Latin American countries there are significant numbers of missing people and forced disappearances, 68,000 alone currently in Colombia. Successful detection of shallow buried human remains by forensic search teams is difficult in varying terrain and climates. This research has created three simulated clandestine burial styles at two different depths commonly encountered in Latin America to gain knowledge of optimum forensic geophysics detection techniques. Repeated monitoring of the graves post-burial was undertaken by ground penetrating radar. Radar survey 2D profile results show reasonable detection of ½ clothed pig cadavers up to 19 weeks of burial, with decreasing confidence after this time. Simulated burials using skeletonized human remains were not able to be imaged after 19 weeks of burial, with beheaded and burnt human remains not being able to be detected throughout the survey period. Horizontal radar time slices showed good early results up to 19 weeks of burial as more area was covered and bi-directional surveys were collected, but these decreased in amplitude over time. Deeper burials were all harder to image than shallower ones. Analysis of excavated soil found soil moisture content almost double compared to those reported from temperate climate studies. Vegetation variations over the simulated graves were also noted which would provide promising indicators for grave detection. PMID:25596556

  16. Proposal of a methodology for individualized iodine-131 therapy for Graves' disease in patients with hyperthyroidism

    Araujo, Francisco de [Instituto de Radioprotecao e Dosimetria (IRD), Rio de Janeiro, RJ (Brazil)]. E-mail: faraujo@ird.gov.br; Melo, Rossana Corbo de [Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil); Rebelo, Ana Maria de Oliveira [Universidade Federal, Rio de Janeiro, RJ (Brazil). Coordenacao dos Programas de Pos-graduacao de Engenharia (COPPE); Dantas, Bernardo Maranhao; Dantas, Ana Leticia A.; Lucena, Eder Augusto de [Universidade do Estado do Rio de Janeiro (UERJ), RJ (Brazil)

    2007-11-15

    Objective: Several methods are utilized for determining the radioiodine activity in the treatment of Graves' disease (hyperthyroidism). Some of this methods do not take into consideration the thyroid absorbed dose or the necessary parameters for this estimation. The association between absorbed dose and administered activity depends on effective half-life, iodine uptake and thyroid mass of each patient. The present study was aimed at developing a methodology for individualized {sup 131}I therapy for Graves' disease in patients with hyperthyroidism of the Graves' disease. Materials and methods: A neck-thyroid phantom developed at Instituto de Radioprotecao e Dosimetria, containing a standard solution of {sup 131}I, was utilized for calibrating the scintillation gamma camera and uptake probe installed in the Department of Nuclear Medicine of the Hospital Universitario Clementino Fraga Filho da Universidade Federal do Rio de Janeiro. Results: The view angle of the collimator/detector assembly presented values compatible with the thyroid gland size for distances of 25 cm (uptake probe) and 45.8 cm (scintillation gamma camera). Calibration factors were 39.3 {+-} 0.78 and 4.3 {+-} 0.17 cpm/kBq, respectively. The 14-30-hour interval in the retention curve allows the estimation of activity between two points for determining the effective iodine half-life in the thyroid. Conclusion: The utilization of equipment usually available in nuclear medicine clinics is feasible, so this is a simple, effective and low cost methodology. (author)

  17. Formas graves de retinopatia predizem aterosclerose subclínica em indivíduos com diabetes tipo 1

    Fernando K. Almeida

    2011-10-01

    Full Text Available FUNDAMENTO: Em pacientes com diabetes tipo 2, a presença de retinopatia está associada a doença cardiovascular aumentada, independentemente dos fatores de risco conhecidos para a doença vascular. OBJETIVO: Investigar a associação da retinopatia diabética (RD e seus graus com a presença de aterosclerose coronariana subclínica em pacientes com diabetes tipo 1. MÉTODOS: Um estudo transversal foi conduzido com 150 pacientes com diabetes tipo 1, assintomáticos para doença arterial coronariana. Foram submetidos à avaliação clínica para verificar complicações microvasculares e avaliação para a presença de calcificação arterial coronariana (CAC. RESULTADOS: Formas graves de RD (RD grave não proliferativa - RDNP - e RD proliferativa - RDP foram associadas à CAC (RC: 3,98; IC de 95%; 1,13-13,9, p = 0,03, de maneira independente dos fatores de risco conhecidos para a doença cardiovascular (idade, A1C, hipertensão, dislipidemia e sexo masculino. CONCLUSÃO: Os pacientes com formas graves de RD estão em risco de presença de doença arterial coronariana, de maneira independente dos tradicionais fatores de risco cardiovascular.

  18. Prediction of late (24-hour) radioactive iodine uptake using early (3-hour) uptake values in Japanese patients with Graves' disease

    Measurement of 24-hour radioactive iodine uptake (RAIU), which is commonly used to calculate the dose of radioiodine (RI) therapy, cannot be accomplished in a single day. The purpose of this study was to predict 24-hour RAIU from 3-hour RAIU in Japanese patients with Graves' disease, and to investigate other factors that could be used to predict 24-hour RAIU. A total of 66 Japanese patients (14 men and 52 women; age, 17-83 years) with Graves' disease who had undergone both 3-hour and 24-hour 123I RAIU measurements between January 2006 and September 2011 were included in this study. Stepwise multiple regression analyses were performed in order to identify factors that could be used to predict 24-hour RAIU. The investigated factors were gender, age, thyroid volume, thyroid stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), serum creatinine, second generation assay TSH receptor antibody (TRAb2), antithyroid drugs discontinuation period (ADP), iodine restriction period and 3-hour RAIU. The ADP was converted to an ordinal scale ADP score (ADPS) for multiple regression analyses. Multiple regression analyses showed that 3-hour RAIU (P10 EU +23.0 x log10 FT3 -2.7 x ADPS (r=0.82, P<0.001). The present results indicate that prediction of LU from EU, FT3 and ADPS is feasible in Japanese patients with Graves' disease. (author)

  19. Clinical evaluation of the 2nd generation radio-receptor assay for anti-thyrotropin receptor antibodies (TRAb) in Graves' disease

    Full text: Detection of autoantibodies to the TSH receptor by radioreceptorial assays (RRA) is largely requested in clinical practice for the diagnosis of Graves' disease and its differentiation from diffuse thyroid autonomy. Additionally, TRAb measurement during antithyroid drug treatment can be useful to evaluate the risk of disease's relapse alter therapy discontinuation. Nevertheless, some patients affected by Graves' disease are TRAb negative when 1st generation assay is used. Recently a new RRA method for TRAb assay was developed by using human recombinant TSH-receptor and solid-phase technique. Aim of our work was the comparison between 1st and 2nd generation TRAb assays in Graves' disease patients and, particularly, the evaluation of 2nd generation test in a sub-group of patients affected by Graves' disease but with negative 1st generation TRAb assay. We evaluated the diagnostic performance of a newly developed 2nd generation TRAb assay (DYNOtest(r) TRAK human, BRAHMS Diagnostica GmbH, Germany) in 46 patients affected by Graves' disease with negative 1st generation TRAb assay (TRAK Assay(r), BRAHMS Diagnostica GmbH, Germany) . A control groups of 50 Graves' disease patients with positive 1st generation TRAb assay, 50 patients affected by Hashimoto's thyroiditis and 50 patients affected by nodular goiter were also examined. 41 out of 46 patients affected by Graves' disease with negative 1st generation TRAb assay showed a positive 2nd generation test. The overall sensitivity of the 2nd generation test was significantly improved respect the 1st generation assay in Graves' disease patients (χ2 = 22.5, p<0.0001). 1 and 3 out of 50 patients affected by Hashimoto's thyroiditis were positive by 1st and 2nd generation TRAB assay, respectively. All these patients showed primary hypothyroidism. No differences resulted in euthyroid Hashimoto's thyroiditis sub-group and in nodular goiter control group. The 2nd generation TRAB assay is clearly more sensitive than the 1

  20. Administration of additional inactive iodide during radioiodine therapy for Graves' disease. Who might benefit?

    Dietlein, M.; Moka, D.; Reinholz, U.; Schmidt, M.; Schomaecker, K.; Schicha, H.; Wellner, U. [Koeln Univ. (Germany). Dept. of Nuclear Medicine

    2007-07-01

    Aim: Graves' hyperthyroidism and antithyroid drugs empty the intrathyroid stores of hormones and iodine. The consequence is rapid {sup 131}I turnover and impending failure of radioiodine therapy. Can administration of additional inactive iodide improve 131I kinetics? Patients, methods: Fifteen consecutive patients, in whom the 48 h post-therapeutically calculated thyroid dose was between 150 and 249 Gy due to an unexpectedly short half-life, received 3 x 200 {mu}g inactive potassium-iodide ({sup 127}I) daily for 3 days (Group A), while 17 consecutive patients with a thyroid dose of = 250 Gy (Group B) served as the non-iodide group. 48 hours after {sup 131}I administration (M1) and 4 or 5 days later (M2) the following parameters were compared: effective {sup 131}I half-life, thyroid dose, total T3, total T4, {sup 131}I-activity in the T3- and T4-RIAs. Results: In Group A, the effective {sup 131}I half-life M1 before iodine (3.81 {+-} 0.93 days) was significantly (p <0.01) shorter than the effective {sup 131}I half-life M2 (4.65 {+-} 0.79 days). Effective {sup 131}I half-life M1 correlated with the benefit from inactive {sup 127}I (r = -0.79): Administration of {sup 127}I was beneficial in patients with an effective {sup 131}I half-life M1 of <3 or 4 days. Patients from Group A with high initial specific {sup 131}I activity of T3 and T4 showed lower specific {sup 131}I activity after addition of inactive iodine compared with patients from the same group with a lower initial specific {sup 131}I activity of T3 and T4 and compared with the patient group B who was given no additional inactive iodide. This correlation was mathematically described and reflected in the flatter gradient in Group A (y = 0.5195x + 0.8727 for {sup 131}I T3 and y = 1.0827x - 0.4444 for {sup 131}I T4) and steeper gradient for Group B (y = 0.6998x + 0.5417 for {sup 131}I T3 and y = 1.3191x - 0.2901 for {sup 131}I T4). Radioiodine therapy was successful in all 15 patients from Group A

  1. Mass graves gone missing: Producing knowledge in a world of absence

    Douglas, Lee

    2014-12-01

    Full Text Available On May 1st, 2014 members of the historical memory team from the Aranzadi Sciences Society arrived in Oropesa de Toledo. The objective: to locate two mass graves containing the remains of Republicans killed in the weeks after Franco’s troops entered the town in 1936. Despite evidence regarding the mass graves’ existence, they were never found. Drawing on empirical, ethnographic data collected in the town of Oropesa in the months following this “unsuccessful” exhumation, this paper narrates the curious story of two graves that have “gone missing.” It considers the intellectual labor exerted to produce historical knowledge in a context where municipal archives remain inaccessible and family histories are marked by silence and dis-information. The author suggests that the absence of information –the dearth of historical, narrative evidence– regarding the lives of the defeated makes the production of historical and forensic knowledge a complicated affair. It tracks how kin-based knowledge and scarce archival documents are gathered and animated in order to make exhumations possible. Considering the forms of knowledge that are needed in order to engage techno-scientific expertise in meaningful ways, the paper attends to the important role that kin-based knowledge and seemingly “unimportant” documents play in processes of historical enunciation.El 1 de mayo de 2014, los miembros del equipo forense de la Sociedad de Ciencias Aranzadi llegaron a Oropesa de Toledo. El objetivo: localizar dos fosas comunes que contenían los restos de republicanos asesinados en las semanas posteriores a la llegada de las tropas de Franco en 1936. A pesar de la evidencia que apuntaba a la existencia de las dos fosas comunes, nunca se encontraron. Utilizando los datos empíricos y etnográficos recogidos en Oropesa en los meses posteriores a esta exhumación “fallida”, este trabajo narra la curiosa historia de dos tumbas que han “desaparecido”. El

  2. Clinical observation of associated treatment for Graves' disease with traditional chinese medicine and 131I

    To investigate the method and curative effect of associated treatment for Graves Disease (GD) with traditional Chinese medicine and 131I. 100 patients with GD were randomly divided into two groups, the patients in group A was only given 131I treatment and the patients in group B was given traditional Chinese medicine (Shimaiqing Fluid, 3 times of 20 mL per day for 40 days) after 7 days of 131I treatment. The serum FT3, FT4 and TSH were measured before and 30 and 90 days after treatment. 8 cardinal symptoms were selected and Kupperman 4-grade grading method was used to assess the remission of the disease. The Results showed that the symptoms of patients in group B were improved ahead of time, and pass through the FT3 and FT4 rebound elevation period safely after one month of 131I treatment. The symptoms of patients in group A after 30 days treatment were more serious than that of before treatment, the levels of serum FT3 and FT4 were both higher than those of before treatment. The symptoms of patients in group B after 90 days treatment were improved significantly, and the levels of serum FT3, FT4 and TSH were in normal value. The clinical symptoms of patients in group A were improved, but the levels of serum FT3 and FT4 were lower and TSH was higher than normal value. The curative effect in group B was better than that in group A, the patients passed through the high risk period safely after 30 days treatment, and the hypothyroidism rate was decreased after 90 days treatment. The Shimaiqing Fluid is a nontoxic and safe medicine, and it may be widely used in clinical treatment for patients with GD. (authors)

  3. Measurement of thyrotropin receptor antibodies (TRAK) with a second generation assay in patients with Graves' disease

    Aim: The detection of TSH-receptor-antibodies (TRAb) in patients (pts) with Graves' disease (GD) is routinely used in nuclear medicine laboratories. It is performed by commercial, porcine radioreceptorassays (RRA) measuring TSH binding inhibitory activity. A second generation assay using the human, recombinant TSH-receptor was developed during the last years. The manufacturer composed this new assay as a coated tube RRA (CT RRA) and claimed a higher sensitivity for GD. Methods: TRAb was measured in 207 pts with various thyroid disorders and 205 healthy controls using the new coated tube RRA (Fa. B.R.A.H.M.S. Diagnostica GmbH, Berlin, Germany) as well as a conventional RRA (Fa. Medipan Diagnostica GmbH, Selchow, Germany): 60 pts suffering from GD showing a relapse after anti-thyroid drug treatment and before radioiodine therapy, 109 pts with disseminated autonomia (DA) and 38 pts suffering from Hashimoto's thyroiditis. A ROC-analysis was performed to find the optimal decision threshold level for positivity. Results: We found 42/60 TRAb-positive pts with GD in the established RRA (threshold 6 U/L) and 52/60 in the CT RRA, respectively. The sensitivity increased from 70% (RRA) to 86,7% (CT RRA). The CT RRA found 2 false positives (one Hashimoto's and one healthy control) and the RRA detected 3 Hashimoto's and 2 healthy controls as false positive. Conclusion: The increased sensitivity of CT RRA for GD provides an advantage compared to conventional RRA, especially in GD-patients relapsing afte antithyroid drug treatment. Functional sensitivity and Interassayvariation of CT RRA are very precisely compared to conventional RRA. Handling of the new assay is also improved. (orig.)

  4. Th1/Th2 cytokines in patients with Graves' disease with or without ophthalmopathy.

    Fatemeh Esfahanian

    2013-06-01

    Full Text Available About 25-50% of Graves' disease (GD patients develop thyroid eye diseases, which is associated with inflammatory process and abnormalities in the levels of several cytokines in orbital tissues in GD.  The aim of this study was to determine the Th1 and Th2 serum cytokines in patients with GD with or without ophthalmopathy.Serum  levels of  cytokines  and  autoantibodies  including Interferon-gamma  (IFN-γ,Interleukin-2 (IL-2, Interleukin-4 (IL-4, Interleukin-10 (IL-10, TSH receptor autoantibody (TRAb, thyroid  peroxidase antibody (TPOAb  and  thyroglobulin antibody(TgAb were measured by enzyme linked immunosorbent assay(ELISA in 34 patients with GD and in 33 normal controls. Patients were also divided in two subgroups: 18 cases with ophthalmopathy and 16 cases without ophthalmopathy. Cytokine and antibody responses were analyzed in both groups.Compared with control subjects, patients with GD  showed elevated levels of IL-2 and IL-10. IFN-γ  levels were lower in patients in comparison to the controls. No significant differences were found  between patients and controls regarding the IL-4. There was no statistically significant  difference  in  cytokine  levels  between  those   with  or   without ophthalmopathy.Quantitative-cytokine  analysis  demonstrated  that  a  combination  of  Th1  and  Th2 cytokines may contribute to the pathogenesis of GD. These results also indicate that IL-10, but not IL-4, is related to the moderate and severe forms of thyroid associated ophthalmophathy.

  5. The thyroid function of Graves' disease patients is aggravated by depressive personality during antithyroid drug treatment

    Miyauchi Akira

    2011-08-01

    Full Text Available Abstract Background We previously reported that depressive personality (the scores of hypochondriasis, depression and psychasthenia determined by the Minnesota Multiphasic Personality Inventory (MMPI and daily hassles of Graves' disease (GD patients treated long trem with antithyroid drug (ATD were significantly higher in a relapsed group than in a remitted group, even in the euthyroid state. The present study aims to examine the relationship among depressive personality, emotional stresses, thyroid function and the prognosis of hyperthyroidism in newly diagnosed GD patients. Methods Sixty-four untreated GD patients responded to the MMPI for personality traits, the Natsume's Stress Inventory for major life events, and the Hayashi's Daily Life Stress Inventory for daily life stresses before and during ATD treatment. Results In the untreated thyrotoxic state, depressive personality (T-scores of hypochondriasis, depression or psychasthenia greater than 60 points in MMPI were found for 44 patients (69%. For 15 (23% of these patients, the scores decreased to the normal range after treatment. However, depressive personality persisted after treatment in the remaining 29 patients (46%. Normal scores before treatment were found for 20 patients (31%, and the scores were persistently normal for 15 patients (23%. The remaining 5 patients (8% had higher depressive personality after treatment. Such depressive personality was not associated with the severity of hyperthyroidism. Serum TSH receptor antibody activity at three years after treatment was significantly (p = 0.0351 greater in the depression group than in the non- depression group. The remission rate at four years after treatment was significantly (p = 0.0305 lower in the depression group than in the non- depression group (22% vs 52%. Conclusion The data indicate that in GD patients treated with ATD, depressive personality during treatment reflects the effect of emotional stress more than that of

  6. Turf wars: authority and responsibility for the investigation of mass graves.

    Skinner, Mark; Sterenberg, Jon

    2005-07-16

    Mass graves are complex products of large-scale crimes. Such scenes pose four conceptual challenges to investigators and forensic experts: the individual victim, the crime, the setting, and the statistical. Exhumation and post-mortem examination of mortal remains with associated personal and forensic evidence require integrated management of core forensic personnel including investigators, archaeologists, anthropologists, odontologists and pathologists, among whom there is overlapping expertise. The key to avoiding competition and ill-will among experts is to recognize that all such experts should be enabled to make known how their expertise matches with the temporal and spatial boundaries of victim, crime and setting. In turn, they should be apprised of where they fit into the overall judicial process and their limits within the investigation. Consequently, each expert requires access to the factual background of the case, to the site and its contents throughout the investigation. Each forensic team member has a responsibility to influence the investigation--throughout its course when possible--to make findings within their areas of expertise, and to make these available to the rest of the team so as to contribute most meaningfully to the aims of the investigation, both forensic and humanitarian. The on-site crime scene manager has an overarching role to enable integrated access to the complete scene and its contents by each forensic expert team member. In other words, the forensic scientist is given access and the ability to influence the investigation while control of evidence from the site as to identity and criminal activity are maintained by the crime scene manager. This contribution is directed at both the crime scene manager and each forensic expert; it describes the essential spatial and temporal parameters of an expert's opinion so as to encourage cooperation, and discourage conflict, within the forensic team. PMID:15939156

  7. Indium-111 octreotide in graves` disease and in evaluation of active exophthalmos

    Mansi, L.; Rambaldi, P.F.; Del Vecchio, E.; Bizzarro, A.; Di Martino, S.; De Bellis, A.; Panza, A.

    1995-06-01

    Thyroid Associated Ophthalmopathy (TAO) is an autoimmune disorder associated with Graves` disease (GD). This study evaluated the uptake of indium-111 Octreotide ({sup 111}In-OCT), a somatostatin (SS) analogue able to bind specific SS receptors, at the level of the thyroid and orbits in patients with TAO. Seven patients with exophthalmos were investigated: six had GD while one was affected with a non small cell lung cancer (NSCLC). One patient with GD had undergone total thyroidectomy (TT) for a thyroid cancer. At the time of the study two patients were hyperthyroid, four were euthyroid and one was hypothyroid. 111 MBq of {sup 111}In-OCT were i.v. injected and two 30 minute scans were performed at 4 and 24 hours; 5 minute planar images were also obtained at 25, 60 and 120 minutes. A 180 SPECT was carried out 5 hours after the injection in one patient. A qualitative analysis was performed, comparing these images with those obtained in 7 control patients without thyroid illness or exophthalmos. Moreover, in the TAO patients thyroid, orbit and brain counts were evaluated in comparison with background (BK) and blood activity (BA), measured at the level of the venous longitudinal sinus. In GD intense thyroid uptake was demonstrated independently of the functional state, with highest ratio compared to BK seen at 24 hours. Low uptake in the patient with NSCLC, no activity in the patient with GD that underwent TT, and slight or absent thyroid uptake in the controls were observed. Intense uptake was seen in the orbits of the patient who clinically had the most severe ophthalmopathy. SPECT identified the intra orbital location of this accumulation. Moderate uptake was seen in two GD patients and slight uptake in two others. No accumulation was found in one patient with GD, or in the patient with NSCLC, despite his exophthalmos. Lastly, when cerebral uptake was compared to BA, no significant blood brain barrier permeability to {sup 111}In-OCT was demonstrated.

  8. Impact of smoking on the course of Graves' disease after withdrawal of antithyroid drugs.

    Quadbeck, B; Roggenbuck, U; Janssen, O E; Hahn, S; Mann, K; Hoermann, R

    2006-09-01

    Cigarette smoking has been reported to alter relapse rate in patients with Graves' disease (GD). However, the predictive effect of smoking in GD patients after withdrawal of antithyroid drug treatment (ATDT) is still controversial. A prospective multicenter trial has previously identified smoking as an independent risk factor for relapse. Based on this study, the present paper gives a more detailed analysis of the impact of smoking on the long-term course of GD after ATDT withdrawal. To this end, 86 smokers and 177 non-smokers were followed during two years after ATDT cessation. At the end of ATDT (visit 1) and four weeks later (visit 2) smokers had significant higher TSH receptor antibody (TRAb) levels than non-smokers (10.0 IU/L+/-1.6; mean+/-SEM vs. 6.4 IU/L+/-0.9; 11.0 IU/L+/-1.8 vs. 6.8 IU/L+/-0.8, p 10 IU/L had the highest risk to develop relapse during follow-up. Among them, smokers more often relapsed than non-smokers irrespective of TRAb levels, p or =10 IU/L the predictive values of a positive and negative test for relapse was 68% and 73%, respectively (specificity 95%). In conclusion, we identified two effects by which smoking alters the course of GD. First, smoking is implicated to elevate TRAb levels and therefore increase the risk for relapse during follow-up. Second, smoking is an independent risk factor to worsen the clinical course of both, GD patients with low and high immunological risk to experience relapse after a successful outcome of ATDT. Thus, our data suggest that smoking has modifying immunological consequences and an adverse impact on the course of GD after withdrawal of ATDT. Therefore, patients should be encouraged to stop smoking. PMID:17039420

  9. Cytotoxic T lymphocyte-associated molecule-4 polymorphism and relapse of Graves' hyperthyroidism after antithyroid withdrawal.

    Wang, Pei-Wen; Liu, Rue-Tsuan; Juo, Suh-Hang Hank; Wang, Shan-Tair; Hu, Ya-Hui; Hsieh, Ching-Jung; Chen, Ming-Hong; Chen, I-Ya; Wu, Chia-Ling

    2004-01-01

    We studied the A/G single nucleotide polymorphism (SNP) at position 49 in exon 1 of the cytotoxic T lymphocyte-associated molecule-4 gene in 148 Chinese Graves' disease (GD) patients and 171 controls. Our primary aim was to test for the association of this SNP with the relapse of the hyperthyroidism after antithyroid withdrawal. Our secondary aim was to investigate the relationship between GD patients and controls according to the SNP genotypes. All GD patients were divided into the following three groups according to the time of relapse after drug discontinuation: group 1, early relapse within 9 months; group 2, relapse between 10 and 36 months; and group 3, relapse 3 or more years after discontinuation of treatment. There was a significant difference of genotype frequencies (P TSH-receptor antibody was statistically different (A/A, 9.0%; A/G, 20.8%; G/G, 45.5%; P = 0.004). Using 3 yr as the cutoff point for multivariate logistic regression analysis, we found that the G/G genotype (adjusted odds ratio, 3.1 compared with A/G plus A/A; 95% confidence interval, 1.3-7.1), larger goiter size at the end of treatment, and positive TSH-receptor antibody at the end of treatment were independent risk factors of recurrence. We conclude that the A/G polymorphism of the cytotoxic T lymphocyte-associated molecule-4 gene affects the progress of GD. The G/G genotype is associated with poor outcome. PMID:14715845

  10. Does an individual estimation of halflife improve the results of radioiodine therapy of Graves' disease?

    Aim: The impact of our dosimetry concept on radioiodine therapy success in Graves' disease (GD) was analysed. Three questions arised: Did individual estimation of pretherapeutic halflife improve therapeutic success? Did individual dosimetry result in accurate dose calculation? Did antithyroid medication have a measurable influence on therapeutic success under the prevailing conditions? Methods: 126 consecutive patients were treated with 200 Gy I-131 in our therapy ward for GD and followed-up six to nine months after therapy. Success quote was assessed using a standardized protocol and treatment was classified as successful when the patients was eu- or hypothyroid, or unsuccessful when he or she presented with a suppressed TSH-level or in hyperthyroid condition after antithyroid medication withdrawal. Antithyroid medication, activity I-131, dose, concentration of fT3 and fT4, specific delivered dose and halflife were put into a multiple regression model to assess their influence on therapeutic success. In order to assess possible factors disturbing the therapeutic outcome, relevant parameters were analyzed using Logit transformation. Results: Out of 126 patients 84 were classified as successfully treated and 42 (33,3%) as failures. A significant influence on the outcome only was found for thyroid mass. However, therapeutic success appeared to be more distinctly determined by the specific delivered dose using an estimated halflife of 5.5 days (Odds: 10.0, p <0.001). Accurate intratherapeutic dosimetry did not play a significant role to enhance therapeutic success. Neither did antihyroid medication during radioiodine therapy exert any significant impact. Conclusions: Measurement of individual intratherapeutic halflife as opposed to an estimate using a standard halflife did not provide improved results concerning the target dose. Retrospectively, the therapeutic outcome on the basis of a measured halflife as compared to a standard halflife did not significantly improve

  11. Gene Map of the HLA Region, Graves' Disease and Hashimoto Thyroiditis, and Hematopoietic Stem Cell Transplantation.

    Sasazuki, Takehiko; Inoko, Hidetoshi; Morishima, Satoko; Morishima, Yasuo

    2016-01-01

    The human leukocyte antigen (HLA) genomic region spanning about 4 Mb is the most gene dense and the polymorphic stretches in the human genome. A total of the 269 loci were identified, including 145 protein coding genes mostly important for immunity and 50 noncoding RNAs (ncRNAs). Biological function of these ncRNAs remains unknown, becoming hot spot in the studies of HLA-associated diseases. The genomic diversity analysis in the HLA region facilitated by next-generation sequencing will pave the way to molecular understanding of linkage disequilibrium structure, population diversity, histocompatibility in transplantation, and associations with autoimmune diseases. The 4-digit DNA genotyping of HLA for six HLA loci, HLA-A through DP, in the patients with Graves' disease (GD) and Hashimoto thyroiditis (HT) identified six susceptible and three resistant HLA alleles. Their epistatic interactions in controlling the development of these diseases are shown. Four susceptible and one resistant HLA alleles are shared by GD and HT. Two HLA alleles associated with GD or HT control the titers of autoantibodies to thyroid antigens. All these observations led us to propose a new model for the development of GD and HT. Hematopoietic stem cell transplantation from unrelated donor (UR-HSCT) provides a natural experiment to elucidate the role of allogenic HLA molecules in immune response. Large cohort studies using HLA allele and clinical outcome data have elucidated that (1) HLA locus, allele, and haplotype mismatches between donor and patient, (2) specific amino acid substitution at specific positions of HLA molecules, and (3) ethnic background are all responsible for the immunological events related to UR-HSCT including acute graft-versus-host disease (GVHD), chronic GVHD, graft-versus-leukemia (GvL) effect, and graft failure. PMID:26791860

  12. Cardiovascular complications secondary to Graves' disease: a prospective study from Ukraine.

    Iryna Tsymbaliuk

    Full Text Available Graves' disease (GD is a common cause of hyperthyroidism resulting in development of thyrotoxic heart disease (THD.to assess cardiovascular disorders and health related quality of life (HRQoL in patients with THD secondary to GD.All patients diagnosed with THD secondary to GD between January 2011 and December 2013 were eligible for this study. Clinical assessment was performed at baseline and at the follow-up visit after the restoring of euthyroid state. HRQoL was studied with a questionnaire EQ-5D-5L.Follow-up data were available for 61 patients, but only 30 patients with THD secondary to GD were consented to participate in investigation of their HRQoL. The frequency of cardiovascular complications was significantly reduced as compared before and after the antithyroid therapy as follows: resting heart rate (122 vs. 74 bpm, blood pressure: systolic (155 vs. 123 mm Hg, diastolic (83 vs. 66 mm Hg, supraventricular premature contractions (71% vs. 7%, atrial fibrillation (72% vs. 25%, congestive heart failure (69% vs. 20%, thyrotoxic cardiomyopathy (77% vs. 26%, all p<0.01. Anti-TSH receptor antibodies were determined as independent predictor of left ventricular geometry changes, (b-coefficient = 0.04, 95%CI 0.01-0.07, p = 0.02. HRQoL was improved in all domains and self-rated health increased from 43 to 75 units by visual analogue score (p<0.001.Restoring of euthyroid state in patients with GD is associated with significant elimination of cardiovascular disorders and improvement of HRQoL. To our knowledge this is the first study evaluating Ukrainian patients with THD secondary to GD with focus on HRQoL.

  13. Fenótipos clínicos de asma grave Clinical phenotypes of severe asthma

    Roseliane de Souza Araújo Alves

    2008-09-01

    Full Text Available OBJETIVO: Estabelecer os fenótipos clínicos em portadores de asma grave. MÉTODOS: Foram estudados, retrospectivamente, 111 pacientes em um ambulatório especializado. Os pacientes foram avaliados e acompanhados de maneira sistemática, estabelecendo-se ao final do acompanhamento a adesão e o controle ou não da doença por dados clínicos e funcionais. A resistência ao tratamento foi definida como o não preenchimento, ao final do acompanhamento, por pelo menos seis meses, dos critérios de controle de asma, apesar do uso correto e adesão à medicação. Os fenótipos foram determinados por análise fatorial e comparados por testes diversos. RESULTADOS: Ao final, 88 pacientes foram considerados aderentes e 23 não aderentes. Por análise fatorial do grupo aderente, quatro fenótipos foram determinados: o fenótipo 1 (28 pacientes, formado pelos pacientes resistentes ao tratamento, com maior freqüência de sintomas noturnos, maior número de exacerbações e uso mais freqüente de broncodilatador de resgate; o fenótipo 2 (48 pacientes, formado pelos pacientes com obstrução persistente, com menores valores de relação volume expiratório forçado no primeiro segundo/capacidade vital forçada na avaliação inicial, idade mais avançada e maior tempo de doença; o fenótipo 3 (42 pacientes, representa os pacientes com rinossinusite alérgica, sendo constituído de não fumantes com obstrução predominantemente reversível; e o fenótipo 4 (15 pacientes, formado por casos com história de intolerância à aspirina associado à asma quase fatal. CONCLUSÕES: Um número significativo de portadores de ama grave não adere ao tratamento. Muitos pacientes com asma grave têm obstrução irreversível, mas o fenótipo clínico mais relevante é constituído pelos pacientes resistentes ao tratamento habitual.OBJECTIVE: To characterize clinical phenotypes of severe asthma. METHODS: A total of 111 patients were retrospectively evaluated at a

  14. PROPUESTA PARA ABORDAR EL QUÉ Y CÓMO ENSEÑAR LAS HABILIDADES MOTRICES EN SECUNDARIA: UN EJEMPLO A TRAVÉS DEL PATINAJE | PROPOSAL TO DEAL WITH THE 'WHAT' AND 'HOW' TEACH MOTOR SKILLS IN SECONDARY PHYSICAL EDUCACION: AN EXAMPLE OF INLINE SKATING

    Juan Mañeru-Cámara

    2011-08-01

    Full Text Available RESUMEN.- Uno de los contenidos que han acabado conformando las señas de identidad de la Educación Física Escolar es el de las Habilidades Motrices. En el presente artículo pretendemos mostrar nuestra forma particular de entenderlas y abordar su desarrollo en la etapa de secundaria. Para ello, tras exponer nuestras ideas respecto a este contenido y las características del contexto en el que hemos venido desarrollando nuestro trabajo, mostramos, a modo de ejemplo, el diseño y posterior desarrollo de una Unidad Didáctica concreta, sobre el patinaje en línea.En todo momento relacionamos y justificamos nuestro trabajo desde la legislación vigente, pero también desde el aval que, para nosotros, constituyen los numerosos documentos que nuestro alumnado ha generado a lo largo del proceso. Creemos que estos documentos reflejan fragmentos de nuestra particular contribución al desarrollo de sus capacidades (competencias, desde la concepción integral del alumno que preside nuestra idea de educación.Como exponemos en las conclusiones, consideramos que las claves metodológicas expuestas en el artículo podrían configurarse, como sucede en nuestro caso, en puntos de una guía válida no sólo para abordar el desarrollo de las habilidades motrices, sino también del resto de contenidos de la actual Educación Física Escolar.ABSTRACT.- Motor skills is one of the most influential contents in the shaping of the identity of PE. In this paper, we'll show our understanding of this PE content and the way we approach its development in the Secondary Education.To do so, we expose first our conception of this content and the features of the context in which we have developed our work. Then, we show, as an example, the design and subsequent development of a specific Teaching Unit about inline skating.Our work is always framed and justified by the existing curricular legislation and by the numerous documents that our students produce throughout the process

  15. Kinetic analyses of changes in serum TSH receptor antibody values after total thyroidectomy in patients with Graves' disease.

    Yoshioka, Waka; Miyauchi, Akira; Ito, Mitsuru; Kudo, Takumi; Tamai, Hidekazu; Nishihara, Eijun; Kihara, Minoru; Miya, Akihiro; Amino, Nobuyuki

    2016-02-29

    We often recommend total thyroidectomy for patients with Graves' disease who wish to have a child in the near future in order to prevent fetal or neonatal hyperthyroidism, especially if the patients' serum thyrotropin receptor antibody (TRAb) values are high. The aim of this study was to analyze changes in serum TRAb values using a quantitative third-generation assay after total thyroidectomy and the half-lives of serum TRAb values to estimate the postoperative time needed to achieve the safe TRAb value for mothers. We retrospectively examined the records of 45 Graves' disease patients who underwent a total thyroidectomy and had high serum TRAb values. We also evaluated factors that prolonged the postoperative reduction of serum TRAb values. The serum TRAb values decreased rapidly in most of the patients, especially within the early postoperative (3-month) period. The presence of Graves' ophthalmopathy (GO) (p=0.001), smoking (p=0.004), and serum thyroglobulin values > 0.5 ng/mL at postoperative 12 months (p=0.039) were significantly associated with prolonged half-lives of the serum TRAb values. The median TRAb value half-life was 93.5 days in the patients without GO or smoking, 162.5 days in the patients with GO or smoking, and 357.4 days in the patients with both GO and smoking. Our findings indicate that using the half-life of patients' serum TRAb values determined by this third-generation assay would be effective to evaluate the reduction of serum TRAb values after total thyroidectomy and to estimate the postoperative time needed to achieve the maternal safe value. PMID:26632172

  16. Hidropesía fetal en una gestante con enfermedad hipertensiva grave. Presentación de un caso

    Maribel Rodríguez Matos

    2013-09-01

    Full Text Available La hidropesía fetal es un grave proceso de elevada mortalidad perinatal, de etiología multifactorial, caracterizado por un síndrome edematoso generalizado, con o sin acumulación de líquido en las cavidades serosas del organismo fetal. Se presenta un caso de hidropesía fetal no inmunológica en una paciente de sexo femenino, de color de piel blanca y de 20 años de edad con enfermedad hipertensiva grave, diagnosticada mediante ultrasonido, como estudio de bienestar fetal a las 35,1 semanas de gestación, cuando fue remitida desde su área de salud por presentar cifras de tensión arterial de 160/100 mmHg. A su llegada al cuerpo de guardia de ginecobstetricia del hospital Héroes del Baire de la Isla de la Juventud se constataron cifras de 140/90 mmHg, se presentaba asintomática, por lo que se ingresó para estudio y tratamiento. Teniendo en cuenta el examen físico y el resultado del ultrasonido obstétrico, se decidió la interrupción de embarazo por cesárea de urgencia. Se recibió un recién nacido pretérmino de aspecto malformado. Se decide la presentación del caso por lo poco común de esta patología asociada a una enfermedad hipertensiva grave lo que incrementa el riesgo perinatal.

  17. Cuadriceplastia de Judet : una alternativa quirúrgica para las rigideces graves en extensión de la rodilla

    Pérez Ortiz, S.; Gómez Barbero, Patricia; Borrás Cebrián, Juan Carlos; Ripoll Vidal, F.

    2016-01-01

    Introducción. La contractura en extensión de la rodilla es una complicación de las fracturas femorales con importante afectación de partes blandas. La cuadriceplastia de Judet es una alternativa quirúrgica para aumentar la movilidad. Material y métodos. Presentamos el caso de un paciente con rigidez grave de rodilla en extensión tras una fractura abierta bifocal de fémur estabilizada mediante osteosíntesis que se complicó con una infección y retardo de consolidación que requirió v...

  18. Fênomeno de Raynaud grave associado a terapia com interferon-beta para esclerose múltipla: relato de caso

    CRUZ BORIS AFONSO; QUEIROZ EUSTÁQUIO DE; SIMONE VILELA NUNESi; CRUZ FILHO ACHILES; CAMPOS GILBERTO BELISARIO; MONTEIRO ERNESTO LENTZ DE CARVALHO; CRIVELLARI HUMBERTO

    2000-01-01

    Interferon-B (IFN-beta) é usado no tratamento de esclerose múltipla (EM). Descrevemos o caso de uma mulher com EM que apresentou fenômeno de Raynaud grave, livedo reticular e necrose digital duas semanas após tratamento com IFN-beta. Os sintomas melhoraram após suspensão do IFN-beta e início de anticoagulação associada a ciclofosfamida e corticóide. Fenômeno de Raynaud é um efeito colateral provável da terapia com IFN-beta para EM.

  19. Fênomeno de Raynaud grave associado a terapia com interferon-beta para esclerose múltipla: relato de caso

    CRUZ BORIS AFONSO

    2000-01-01

    Full Text Available Interferon-B (IFN-beta é usado no tratamento de esclerose múltipla (EM. Descrevemos o caso de uma mulher com EM que apresentou fenômeno de Raynaud grave, livedo reticular e necrose digital duas semanas após tratamento com IFN-beta. Os sintomas melhoraram após suspensão do IFN-beta e início de anticoagulação associada a ciclofosfamida e corticóide. Fenômeno de Raynaud é um efeito colateral provável da terapia com IFN-beta para EM.

  20. Tratamento da miastenia grave mediante imunossupressão medicamentosa não esteróide

    José Lamartine de Assis; Paulo Eurípedes Marchiori; Milberto Scaff; Antonio Alberto Zambon

    1986-01-01

    São estudados 14 pacientes (doze dos quais eram mulheres) com miastenia grave severa e resistente aos procedimentos terapêuticos habituais. Em um paciente a prednisona foi substituída pela imunossupressão com citotóxicos e em outro o emprego destes permitiu redução da dose do esferóide, que passou a ser bem tolerado. Nos dois casos o emprego dos citostáticos foi decorrência de complicações da prednisona. São empregadas azatioprina e ciclosfosfamida em programas em que estão associadas, na mai...

  1. Protocolo de actuación ante conductas problematicas graves y uso controlado de intervenciones físicas

    Mendizábal, Pako

    2007-01-01

    En este artículo, se hace una aproximación al modelo de apoyo a las personas con discapacidad intelectual y necesidades generalizadas de apoyo que presentan conductas problemáticas graves. Basándose en los conceptos de calidad de vida y de planificación centrada en la persona, los profesionales del centro Uliazpi identifican y trabajan las necesidades y deseos de las personas atendidas mediante los denominados planes personales de apoyo. En el caso de personas que presentan conductas problemá...

  2. A Modified ELISA Accurately Measures Secretion of High Molecular Weight Hyaluronan (HA) by Graves' Disease Orbital Cells

    Krieger, Christine C.; Gershengorn, Marvin C.

    2013-01-01

    Excess production of hyaluronan (hyaluronic acid [HA]) in the retro-orbital space is a major component of Graves' ophthalmopathy, and regulation of HA production by orbital cells is a major research area. In most previous studies, HA was measured by ELISAs that used HA-binding proteins for detection and rooster comb HA as standards. We show that the binding efficiency of HA-binding protein in the ELISA is a function of HA polymer size. Using gel electrophoresis, we show that HA secreted from ...

  3. There is no Gradient of TSH Receptor Antibody Activity Between Thyroidal and Peripheral Venous Blood in Patients with Graves' Disease

    Thyrotropin binding inhibitory immunoglobulin (TBII) and thyroid stimulating antibody (TSAb) activities were measured in the thyroidal and peripheral venous blood samples at the time of subtotal thyroidectomy from twenty one patients with Graves' disease prepared for surgery with antithyroid drugs. There was no difference in TBII and TSAb activities between thyroidal and peripheral blood samples. These findings were regarded that while intrathyroidal lymphocytes are major site of thyrotropin receptor antibody (TRAb) production, similar levels are found in thyroidal and peripheral veins and that this in vive study cannot exactly ascertain the TRAb producing site.

  4. Orbital fibrosis in a mouse model of Graves' disease induced by genetic immunization of thyrotropin receptor cDNA

    Zhao, Shuang-Xia; Tsui, Shanli; Cheung, Anthony; Douglas, Raymond S.; Smith, Terry J.; Banga, J Paul

    2011-01-01

    The TSH receptor (TSHR) is the critical target for antibody production in Graves' disease (GD). Insulin-like growth factor 1 receptor (IGF1R) has been proposed as a second autoantigen in complications of GD such as orbitopathy. We attempted to induce orbital tissue remodeling in mice undergoing immunizations with plasmids encoding TSHR and IGF1R delivered by in vivo skeletal muscle electroporation, a procedure known to give a sustained, long-term antibody response. Female BALB/c mice were cha...

  5. La falsificación: un delito grave que pasa desapercibido/Counterfeiting: a serious crime that goes unnoticed

    Sandro Calvani (Italia); Mtro. Marco Musumeci (Italia)

    2015-01-01

    La asociación a la delincuencia organizada es en sí misma un “factor de riesgo” para la seguridad de los ciudadanos y para el orden público. La falsificación es una actividad delictiva peligrosa porque, al copiar productos, los falsificadores causan enormes daños al mercado y ponen en grave riesgo a los consumidores. Una de las consecuencias negativas de las economías son el resultado de la pérdida de ventas que sufren los legítimos productores cmoo0 resultado de la pérdida de ventas. Otras...

  6. Targeted biological therapies for Graves' disease and thyroid-associated ophthalmopathy. Focus on B-cell depletion with Rituximab

    Hegedüs, Laszlo; Douglas, Raymond S; Nielsen, Claus H; Smith, Terry J

    2011-01-01

    Based on experience from the treatment of other autoimmune diseases and because of the limitations imposed by existing therapeutic options for Graves' disease (GD) and thyroid-associated ophthalmopathy (TAO), rituximab (RTX) was recently proposed as a novel therapy option. Here, we summarize the...... respond favourably to conventional therapy. It is the first in what is likely to be a series of new and emerging treatments specifically targeting relevant components of the immune system. Further studies will hopefully lead to improved and better tailored, individualized therapy for GD and especially TAO....

  7. La inclusión educativa de alumnos con discapacidades graves y permanentes en la Unión Europea

    López Torrijo, Manuel

    2009-01-01

    Este artículo presenta un estudio comparado de la atención realizada a los alumnos con discapacidades graves y permanentes en los seis países de la UE que presentan mayores índices de inclusión educativa (Italia, Grecia, Portugal, Noruega, Chipre e Islandia). Dicho estudio está realizado teniendo en cuenta los siguientes indicadores: concepción de las necesidades educativas especiales, identificación de los déficit, alumnado escolarizado en Centros Específicos de Educación Especial, marco leg...

  8. Estudio clínico del proceso conductual de la emergencia del coma grave por accidente cerebrovascular

    Romero López, Modesto Jesús

    2007-01-01

    Objetivos: Estudiar el proceso de la emergencia del coma en pacientes en coma grave por accidente cerebrovascular (ACV). Método: Se han evaluado a 32 pacientes ingresados en una unidad de cuidados intensivos por un coma de origen cerebrovascular. Se ha realizado un seguimiento diario por neuropsicólogos e intensivistas y monitorizado el despertar del coma mediante 8 escalas de evalua ... ción clínica de los niveles de coma. Se han analizado las variables: edad, género, residencia, índice prem...

  9. Neumonía grave del adulto adquirida en la comunidad SEVERE COMMUNITY-ACQUIRED PNEUMONIA IN ADULTS

    2005-01-01

    El paciente con neumonía grave adquirida en la comunidad es aquel que necesita de la vigilancia y monitorización de una Unidad de Cuidados Intensivos (UCI) donde, si es necesario, puede recibir apoyo especializado con conexión a un ventilador mecánico y/o soporte hemodinámico. Los pacientes que requieren tratamiento en la UCI representan entre 10 y 30% de los pacientes hospitalizados por neumonía. En esta categoría, la tasa de complicaciones, estadía en el hospital y mortalidad son elevadas. ...

  10. Reclassificando o espectro de pacientes septicos com o uso do lactato: sepse grave, choque criptico, choque vasoplegico e choque disoxico

    Otavio Tavares Ranzani

    2013-12-01

    Full Text Available Objetivo: A definição atual de sepse grave e choque séptico inclui um perfil heterogêneo de pacientes. Embora o valor prognóstico de hiperlactatemia seja bem estabelecido, ela está presente em pacientes com ou sem choque. Nosso objetivo foi comparar o prognóstico de pacientes sépticos estratificando-os segundo dois fatores: hiperlactatemia e hipotensão persistente. Métodos: Este estudo é uma análise secundária de um estudo observacional conduzido em dez hospitais no Brasil (Rede Amil - SP. Pacientes sépticos com valor inicial de lactato das primeiras 6 horas do diagnóstico foram incluídos e divididos em 4 grupos segundo hiperlactatemia (lactato >4mmol/L e hipotensão persistente: (1 sepse grave (sem ambos os critérios; (2 choque críptico (hiperlactatemia sem hipotensão persistente; (3 choque vasoplégico (hipotensão persistente sem hiperlactatemia; e (4 choque disóxico (ambos os critérios. Resultados: Foram analisados 1.948 pacientes, e o grupo sepse grave constituiu 52% dos pacientes, seguido por 28% com choque vasoplégico, 12% choque disóxico e 8% com choque críptico. A sobrevida em 28 dias foi diferente entre os grupos (p<0,001, sendo maior para o grupo sepse grave (69%; p<0,001 versus outros, semelhante entre choque críptico e vasoplégico (53%; p=0,39 e menor para choque disóxico (38%; p<0,001 versus outros. Em análise ajustada, a sobrevida em 28 dias permaneceu diferente entre os grupos (p<0,001, sendo a maior razão de risco para o grupo choque disóxico (HR=2,99; IC95% 2,21-4,05. Conclusão: A definição de pacientes com sepse inclui quatro diferentes perfis, se considerarmos a presença de hiperlactatemia. Novos estudos são necessários para melhor caracterizar pacientes sépticos e gerar conhecimento epidemiológico, além de possível adequação de tratamentos dirigidos.

  11. Induction of Graves' disease in patients with non-autoimmune hyperthyroidism or nontoxic goiter after radioiodine treatment

    Thyrotropin receptors antibodies may occur and induce Graves' disease (GD) several months after radioiodine therapy in a small number of patients with non-autoimmune hyperthyroidism or nontoxic goiter. The prevalence of radiation-induced GD is between 0.05% and 5%. The hypothesis of this disease includes induction by autoimmune reaction and others. Detection of the thyroid autoantibodise or of 99mTc pertechnetate scan can forecast the appearance of GD. Antithyroid drugs, again radioiodine therapy and surgery are the treatments. (authors)

  12. The dose analysis of 131I treatment in pediatric patients with Graves hyperthyroidism

    Objective: To analyze the radioactive 131I dose of treatment in pediatric patients with Graves hyperthyroidism. Method: Fifty one pediatric patients with hyperthyroidism and 150 adult patients with hyperthyroidism were retrospectively analyzed, who were contraindicated or refractory for medical therapy and treated with 131I in this study. All pediatric and adult patients treated with 131I were divided into five groups according to the thyroid weight. Group 1: ≤30 g,Group 2: 31∼50 g, Group 3: 51∼70 g, Group 4: 71 ∼90 g and Group 5: >90 g. The pediatric patients were comparable to the adult patients in data distribution of the thyroid weight. All pediatric patients who were either contraindicated or refractory to antithyroid drugs treatment and adult patients received radioactive 131I treatment with a dose of (2.41±0.71), (3.27±0.97) MBq/g thyroid tissue respectively. The total administrated doses of 131I in all pediatric and adult patients were (224.36±130.10) MBq and (354.88 ±308.04) MBq respectively. All the pediatric and adult patients treated with 131I were followed-up (median 32 months, range 24 to 83 months; median 23 months,range 15 to 62 months, respectively). The treatment results were divided into euthyroid, hyperthyroidism, late-onset hypothyroidism and relapsed. Results: The results by followed-up found that 16 and 65 patients became euthyroid, 22 and 56 patients developed late-onset hypothyroidism, 12 and 25 patients still had hyperthyroidism, 1 and 4 patients relapsed after radioiodine therapy in pediatric group and adult group who were treated with 131I, respectively. The total efficiency was 98% and 97.3%, respectively. There were no statistical significance of treatment effect between pediatric and adult patients (χ2=0.058, P>0.05). Conclusion: When the radioactive 131I dose was administrated in pediatric patients with hyperthyroidism, who were contraindicated or refractory for medical therapy, it is recommended that the ratios of total

  13. Thyroid storm associated with Graves' disease covered by diabetic ketoacidosis: A case report

    Osada Erika

    2011-04-01

    Full Text Available Abstract Background Thyroid storm is a condition in which multiple organ dysfunction results from failure of the compensatory mechanisms of the body owing to excessive thyroid hormone activity induced by some factors in patients with thyrotoxicosis. While diabetic ketoacidosis (DKA is an important trigger for thyroid storm, simultaneous development of DKA and thyroid storm is rare. Case presentation A 59-year-old woman with no history of either diabetes mellitus or thyroid disease presented to our hospital because of developing nausea, vomiting and diarrhea for 2 days. Physical examination showed mild disturbance of consciousness, fever, and tachycardia. There were no other signs of thyrotoxicosis. Laboratory studies revealed elevation of random blood glucose and glycosylated hemoglobin, strongly positive of urine acetone, and metabolic acidosis. Since DKA was diagnosed, we initiated the patient on treatment with administration of insulin and adequate fluid replacement. Although the hyperglycemia and acidosis were immediately relieved, the disturbance of consciousness and tachycardia remained persistent. Levels of FT3 and FT4 were extremely high and TSH was below the detectable limit. TRAb was positive. The thyroid storm score of Burch & Wartofsky was 75/140, and the thyroid storm diagnostic criteria of the Japan Thyroid Association were satisfied. Oral administration of thiamazole, potassium iodide and propranolol resulted in immediate relief of the tachycardia. Discussion We encountered a case of thyroid storm associated with Graves' disease covered by DKA. Thyroid storm and DKA are both potentially fatal, and the prognosis varies depending on whether or not these conditions are detected and treated sufficiently early. The thyroid storm diagnostic criteria prepared in 2008 by the Japan Thyroid Association are very simple as compared to the Burch & Wartofsky scoring system for thyroid storm. The Japanese criteria may be useful in the diagnosis

  14. Comprehensive genotyping in two homogeneous Graves' disease samples reveals major and novel HLA association alleles.

    Pei-Lung Chen

    Full Text Available BACKGROUND: Graves' disease (GD is the leading cause of hyperthyroidism and thyroid eye disease inherited as a complex trait. Although geoepidemiology studies showed relatively higher prevalence of GD in Asians than in Caucasians, previous genetic studies were contradictory concerning whether and/or which human leukocyte antigen (HLA alleles are associated with GD in Asians. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a case-control association study (499 unrelated GD cases and 504 controls and a replication in an independent family sample (419 GD individuals and their 282 relatives in 165 families. To minimize genetic and phenotypic heterogeneity, we included only ethnic Chinese Han population in Taiwan and excluded subjects with hypothyroidism. We performed direct and comprehensive genotyping of six classical HLA loci (HLA-A, -B, -C, -DPB1, -DQB1 and -DRB1 to 4-digit resolution. Combining the data of two sample populations, we found that B*46:01 (odds ratio under dominant model [OR]  = 1.33, Bonferroni corrected combined P [P(Bc]  = 1.17 x 10⁻², DPB1*05:01 (OR  = 2.34, P(Bc = 2.58 x 10⁻¹⁰, DQB1*03:02 (OR  = 0.62, P(Bc  = 1.97 x 10⁻², DRB1*15:01 (OR  = 1.68, P(Bc = 1.22 x 10⁻² and DRB1*16:02 (OR  = 2.63, P(Bc  = 1.46 x 10⁻⁵ were associated with GD. HLA-DPB1*05:01 is the major gene of GD in our population and singly accounts for 48.4% of population-attributable risk. CONCLUSIONS/SIGNIFICANCE: These GD-associated alleles we identified in ethnic Chinese Hans, and those identified in other Asian studies, are totally distinct from the known associated alleles in Caucasians. Identification of population-specific association alleles is the critical first step for individualized medicine. Furthermore, comparison between different susceptibility/protective alleles across populations could facilitate generation of novel hypothesis about GD pathophysiology and indicate a new direction for future

  15. Indium-111 octreotide in graves' disease and in evaluation of active exophthalmos

    Thyroid Associated Ophthalmopathy (TAO) is an autoimmune disorder generally associated with Graves' disease (GD). The aim of this study was to evaluate the uptake of indium-111 Octreotide (111In-OCT), a somatostatin (SS) analogue able to bind specific SS receptors, at the level of the thyroid and orbits in patients with TAO. Seven patients with exophthalmos were investigated: six had GD while one was affected with a non small cell lung cancer (NSCLC). One patient with GD had undergone total thyroidectomy (TT) for a thyroid cancer. At the time of the study two patients were hyperthyroid, four were euthyroid and one was hypothyroid. 111 MBq of 111In-OCT were i.v. injected and two 30 minute scans were performed at 4 and 24 hours; 5 minute planar images were also obtained at 25, 60 and 120 minutes. A 180 SPECT was carried out 5 hours after the injection in one patient. A qualitative analysis was performed, comparing these images with those obtained in 7 control patients without thyroid illness or exophthalmos. Moreover, in the TAO patients thyroid, orbit and brain counts were evaluated in comparison with background (BK) and blood activity (BA), measured at the level of the venous longitudinal sinus. In GD intense thyroid uptake was demonstrated independently of the functional state, with highest ratio compared to BK seen at 24 hours. Low uptake in the patient with NSCLC, no activity in the patient with GD that underwent TT, and slight or absent thyroid uptake in the controls were observed. Intense uptake was seen in the orbits of the patient who clinically had the most severe ophthalmopathy. SPECT clearly identified the intra orbital location of this accumulation. Moderate uptake was seen in two GD patients and slight uptake in two others. No accumulation was found in one patient with GD, or in the patient with NSCLC, despite his exophthalmos. No orbital activity was seen in the controls. Lastly, when cerebral uptake was compared to BA, no significant blood brain

  16. Severe forms of neurocysticercosis: treatment with albendazole Formas graves da neurocisticercose: tratamento com albendazol

    Svetlana Agapejev

    1996-03-01

    Full Text Available Study of 22 patients with the severe form of neurocysticercosis treated with albendazole (ABZ administered in 6 different schedules ranging from 15 to 30 mg/kg/day for 21 to 60 days. Dextrochloropheniramine and ketoprofen were the adjuvant drugs. Multiple symptoms were observed in 90.9% of patients. Intracranial hypertension was manifested in 90.9%. Hydrocephaly occurred in 86.4%. Evolution was satisfactory in 10 patients, 8 died and 4 had sequelae. Tomographic studies showed the appearance of an isolated IVth ventricle in 9 patients, after ventriculoperitoneal shunt, before ABZ treatment in 3 of them, during in 5 and after treatment in one. Median clinical follow-up duration was 10 months for the patients who died and 3-4 years for survivors. In 3 patients there was an increase in cyst size during the administration of the 15 mg/kg/day ABZ dose, which was not observed in any patient when the 30 mg/kg/day dose was used.Estudo de 22 doentes, com a forma grave de neurocisticercose, tratados com albendazol (ABZ, administrado em 6 diferentes esquemas, que variaram de 15 a 30 mg/kg/dia, durante 21 a 60 dias. A dextroclorofeniramina e o cetoprofeno foram as drogas coadjuvantes. Múltiplos sintomas ocorreram em 20 doentes. Hipertensão intracraniana foi manifestação mais comum em 20. Hidrocefalia foi detectada em 19. A evolução foi satisfatória em 45,4%, faleceram 36,4% e 18,2% ficaram com sequelas. Na evolução tomográfica apareceu IVº ventrículo isolado em 40,9%, após derivação ventriculoperitoneal, em 3 deles antes do tratamento com ABZ, em 5 durante e, em um, após o tratamento. A mediana estatística do período de seguimento clínico foi 10 meses para aqueles que faleceram e 3-4 anos para os sobreviventes. Em 3 doentes houve aumento no tamanho dos cistos durante a dose de 15 mg/kg/dia de ABZ, não observado na vigência de 30 mg/kg/dia.

  17. TL, OSL and C-14 dating results of the sediments and bricks from mummified nuns' grave

    Diego R.G. Tudela

    2012-06-01

    Full Text Available This paper presents the results of TL and OSL dating of soil and fragments of bricks from a grave, which was occupied by two mummified nuns, found at "Luz" Monastery, located in the state of São Paulo, Brazil. The TL and OSL ages were compared to C-14 dating ones obtained from bone collagens of the mummies. The majority of the ages is related to the eighteenth century. The gamma-ray spectroscopy was used to evaluate natural radioisotope concentrations in the samples, and by using these concentrations the annual dose rates, from 3.0 to 5.3 Gy/kyr, were obtained. Neutron activation analysis was performed and the radioisotope contents results are in agreement with those obtained by gamma-ray spectroscopy. The contents of U, Th and Ce elements were higher than those found in usual sediments.Este artigo apresenta os resultados de datação por TL e OSL de solos, e fragmentos de tijolos de um túmulo, que foi ocupado por duas freiras mumificadas encontradas no Mosteiro da "Luz", localizado no Estado de São Paulo, Brasil. As idades encontradas por TL e OSL foram comparadas às obtidas a partir de C-14 dos colágenos contidos em amostras de osso das múmias. A maioria das idades obtidas são do século XVIII. A espectroscopia de radiação-gama foi utilizada para avaliar concentrações de radioisótopos naturais nas amostras e para calcular as taxas de dose anual que resultaram em 3,0 a 5,3 Gy/kano. As concentrações radioativas são próximas daquelas obtidas através de Análise por Ativação de Nêutrons. Os conteúdos de elementos U, Th e Ce são superiores aos encontrados na maioria dos sedimentos.

  18. Evaluation of the dose absorbed by the thyroid of patients undergoing treatment of Graves disease;Avaliacao da dose absorvida pela tireoide de pacientes submetidos ao tratamento da doenca de Graves

    Costa, Tiago L.; Filho, Joao A. [Universidade Catolica de Pernambuco (UNICAP), Recife, PE (Brazil). Dept. de Fisica; Silva, Jose M.F. da [Universidade Federal de Pernambuco (DEN/UFPE), Recife, PE (Brazil). Dept. de Energia Nuclear

    2009-07-01

    The radioiodine is used as complementary treatment of thyroid cancer and as first choice for the treatment of Graves' disease, being efficient, safe and easy administration, but without there is a protocol defined. This work was evaluated the thyroid absorbed dose from its mass and maximum uptake of I-131 obtained in the examination of diagnostic radiology of radiotherapeutic patients undergoing treatment of Graves' disease. Based on the results, it is observed that the thyroid absorbed dose, as much in terms of mass as the maximum uptake of I-131 for different values of administered activity, varies significantly. The analysis of these parameters is an excellent indicator for the pre-define quantity of radionuclide that is administered to the patient in terms of the radiation dose required to achieve an efficient therapeutic treatment. Moreover, it was observed that the thyroid absorbed dose depends on the degree of pathology of the disease, its mass and of the maximum uptake of I-131. (author)

  19. Proposta de metodologia para tratamento individualizado com iodo-131 em pacientes portadores de hipertireoidismo da doença de Graves Proposal of a methodology for individualized iodine-131 therapy for Graves' disease in patients with hyperthyroidism

    Francisco de Araujo

    2007-12-01

    Full Text Available OBJETIVO: Diferentes métodos são usados para determinar atividade do radioiodo para tratamento de hipertireoidismo (doença de Graves. Alguns não consideram a dose absorvida pela tireóide ou os parâmetros necessários para este cálculo. A relação entre dose absorvida e atividade administrada depende da meia-vida efetiva, da captação do iodo e da massa da tireóide de cada paciente. O objetivo deste trabalho é propor uma metodologia para tratamento individualizado com 131I em pacientes portadores de hipertireoidismo da doença de Graves. MATERIAIS E MÉTODOS: Usou-se um simulador de tireóide-pescoço desenvolvido no Instituto de Radioproteção e Dosimetria contendo solução de 131I, para calibração da gama-câmara e sonda cintilométrica do Serviço de Medicina Nuclear do Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro. RESULTADOS: O campo de visão colimador-detector apresentou valores compatíveis com o tamanho da glândula para as distâncias de 25 cm (sonda de captação e 45,8 cm (gama-câmara. Os fatores de calibração (cpm/kBq foram 39,3 ± 0,78 e 4,3 ± 0,17, respectivamente. O intervalo entre 14 e 30 horas da curva de retenção permite o cálculo de atividade entre dois pontos, para determinação da meia-vida efetiva do iodo na tireóide. CONCLUSÃO: A utilização de equipamentos usualmente disponíveis em serviços de medicina nuclear é viável, tornando esta metodologia simples, eficaz e de baixo custo.OBJECTIVE: Several methods are utilized for determining the radioiodine activity in the treatment of Graves' disease (hyperthyroidism. Some of this methods do not take into consideration the thyroid absorbed dose or the necessary parameters for this estimation. The association between absorbed dose and administered activity depends on effective half-life, iodine uptake and thyroid mass of each patient. The present study was aimed at developing a methodology for individualized

  20. Experimental model of severe acute pancreatitis in rabbits Modelo experimental de pancreatite aguda grave em coelhos

    Alberto Goldenberg

    2007-10-01

    Full Text Available PURPOSE: To develop an experimental model of severe acute pancreatitis in rabbits through a pancreatic ductal injection of sodium taurocholate. METHODS: Twenty-four albino rabbits of the New Zealand lineage were distributed into four groups of six animals (A, B, C and S. The rabbits of three experimental groups (A, B and C were submitted to a laparatomy and received a pancreatic ductal injection of 1ml/kg sodium taurocholate 5%. Also, they were submitted to further laparatomies after 4h, 8h and 12h, respectively. The control group (S was subdivided into two groups of three animals: in subgroup S1 only the pancreatic duct catheterization was performed whereas in subgroup S2 the pancreatic duct catheterization as well as an injection of 1ml/kg physiologic solution 0.9% were carried out. After 12 hours, the rabbits were evaluated. In the re-intervention, blood was collected to determine the amylasemia and a pancreatectomy was carried out to investigate interstitial infiltration, steatonecrosis and necrosis of the organ, using an optical microscope. RESULTS: There was an elevation of amylase in all groups thus proving the existence of acute pancreatitis. The size of the interlobular septum increased progressively with a greater variation between group S1 (0.13 and group C (0. 53 (p=0.035. While all the animals in group A exhibited focal cellular necrosis, it was more intense in the rabbits of group B and culminated with a high proportion of severe pancreatic necrosis in group C animals. The difference in the intensity of cellular necrosis showed statistic significance (p=0.001. CONCLUSION: The proposed experimental model demonstrated its reproducibility and effectiveness in producing severe acute pancreatitis in rabbits.OBJETIVO: Desenvolver modelo experimental de pancreatite aguda grave em coelhos por meio da injeção de taurocolato de sódio no ducto pancreático. MÉTODOS: Vinte e quatro coelhos albinos da linhagem Nova Zelândia foram distribu

  1. Nutrición y anemias en pacientes graves Nutrition and anaemias in critical illness

    F. Gallardo

    2010-02-01

    Full Text Available Introducción: Realizamos un estudio clínico original sobre nutrición en pacientes graves, que incluye a un grupo heterogéneo típico de pacientes críticos, con/sin anemias, que nos han ingresado en la Unidad de Cuidados Intensivos, UCI. Es difícil individualizar y generalizar la relativa importancia de todos los factores que pueden contribuir a estas anemias en la admisión en la Unidad, incluyendo las deficiencias nutricionales, las alteraciones inflamatorias, la respuesta a las agresiones, las modificaciones inmunitarias y las complejas relaciones existente entre estos procesos clínicos. Objetivo: Valoración indirecta de la situación nutricional y anemias, en un grupo heterogéneo típico de pacientes críticos. Método/Resultados: Se estudian 202 pacientes ingresados en la UCI, de variada y heterogénea procedencia, y clasificándolos en 3 grupos: control, postoperados y sépticos, realizándose la valoración indirecta de la situación nutricional en base a: la Valoración Global Subjetiva, (VGS, y las determinaciones analíticas nutricionales pronosticas de linfocitos totales, albúmina, y transferrina. También se realizo hemograma y determinaciones de sideremia y ferritinemia a todos ellos. En un 57% de los pacientes, se observo cifras de hemoglobina inferior a 12.5 gr/dl, básicamente en el grupo de postoperados, (68 pacientes y sépticos, (10 pacientes. Y con cifras inferiores a 10 g/dl de hemoglobina, en 25 pacientes mas, (12,3%. Hubo 87 pacientes, 23 de ellos en el grupo control, 58 en los postoperados y 5 sépticos, cuya cifra de hemoglobina era superior a 12,5 g/dl. En cuanto a los indicadores pronósticos nutricionales, (VGS + perfil nutricional, en el grupo control no presentaban anemia ni desnutrición clínico analítica, en los postoperados, anemia y desnutrición leve y en los sépticos, anemia y desnutrición ligera-moderada. Había diferencias significativas entre los pacientes del grupo control y los grupos

  2. Un nuevo modelo para abordar el protocolo familiar

    Rodríguez Zapatero, M.; Rodríguez Jiménez, Magdalena; Rodríguez Alcaide, J.J.

    2014-01-01

    Entender y gestionar la singularidad de la empresa familiar es determinante para mejorar las posibilidades de transmisión de la misma a generaciones futuras. Las estadísticas, año tras año, vienen a confirmar bajos índices de supervivencia en el traspaso generacional de la empresa familiar; Es por ello que desarrollar herramientas, que permitan y faciliten la comprensión y gestión de dicha singularidad, generará sin duda un fuerte valor añadido y ventaja competitiva para la familia empresaria...

  3. Interleukin-2 receptor α and Graves' disease%白细胞介素2受体α与Graves病

    徐雅萍; 孟凤苓

    2012-01-01

    白细胞介素2受体α (IL-2Rα)是白细胞介素2受体(IL-2R)的α链,属低亲和力IL-2R,它主要参与T淋巴细胞的活化与增殖,在多种自身免疫性疾病中发挥作用.通过对IL-2Rα与Graves病之间关系的研究,进一步探讨Graves病的发病机制,并为本病的诊断与治疗提供新思路.%Interleukin-2 receptor a (IL-2Rα) is a chain of the interleukin-2 receptor (IL-2R) which belongs to low-affinity IL-2R. IL-2Rα participates in the activation and reduplication of T lymphocyte and plays a role in many autoimmune diseases. To further explore the pathogenesis and provide the new idea with the diagnosis and treatment of Graves' disease, we study the relationship between the IL-2Rα and Graves' disease.

  4. Diagnostic accuracy of short-time inversion recovery sequence in Graves' ophthalmopathy before and after prednisone treatment

    Tortora, Fabio; Belfiore, Maria Paola; Romano, Francesco; Cappabianca, Salvatore; Cirillo, Sossio [' ' F. Magrassi-A. Lanzara' ' Second University, Naples (Italy). Dept. of Clinical and Experimental Medicine and Surgery; Prudente, Mariaevelina [Second University, Naples (Italy). Medicine Dept.; Vita Salute San Raffaele Univ., Milan (Italy). Dept. of Neuroradiology; Cirillo, Mario [Second University, Naples (Italy). Neuroradiological Services; Elefante, Andrea [Federic II Univ., Naples (Italy). Neuroradilogical Dept.; Carella, Carlo [Polidiagnostic Center Check-Up, Salerno (Italy)

    2014-05-15

    In Graves' Ophthalmopathy, it is important to distinguish active inflammatory phase, responsive to immunosuppressive treatment, from fibrotic unresponsive inactive one. The purpose of this study is, first, to identify the relevant orbital magnetic resonance imaging signal intensities before treatment, so to classify patients according to their clinical activity score (CAS), discriminating inactive (CAS < 3) from active Graves' Ophthalmopathy (GO) (CAS > 3) subjects and, second, to follow post-steroid treatment disease. An observational study was executed on 32 GO consecutive patients in different phases of disease, based on clinical and orbital Magnetic Resonance Imaging parameters, compared to 32 healthy volunteers. Orbital Magnetic Resonance Imaging was performed on a 1.5 tesla Magnetic Resonance Unit by an experienced neuroradiologist blinded to the clinical examinations. In pre-therapy patients, compared to controls, a medial rectus muscle statistically significant signal intensity ratio (SIR) in short-time inversion recovery (STIR) (long TR/TE) sequence was found, as well as when comparing patients before and after treatment, both medial and inferior rectus muscle SIR resulted significantly statistically different in STIR. These increased outcomes explain the inflammation oedematous phase of disease, moreover after steroid administration, compared to controls; patients presented lack of that statistically significant difference, thus suggesting treatment effectiveness. In our study, we proved STIR signal intensities increase in inflammation oedematous phase, confirming STIR sequence to define active phase of disease with more sensibility and reproducibility than CAS alone and to evaluate post-therapy involvement. (orig.)

  5. Methimazole, but not betamethasone, prevents 131I treatment-induced rises in thyrotropin receptor autoantibodies in hyperthyroid Graves' disease

    The effects of methimazole or betamethasone therapy on the TSH receptor antibody response to radioiodine therapy were compared in a prospective randomized study of 60 patients with hyperthyroidism due to Graves' disease. The patients were followed for 1 yr after treatment with 131I. Twenty-three patients received 131I alone, 17 were treated with methimazole for 2 months before and 3 months after 131I therapy, and 20 patients were treated with betamethasone for 3 weeks before and 4 weeks after 131I therapy. 131I induced a transient rise in the mean serum level of TSH receptor autoantibodies, measured as TSH binding inhibitory immunoglobulin (TBII), but in patients receiving methimazole treatment, no such rise occurred. In the betamethasone-treated patients, TBII increased similarly to that in patients treated with 131I alone. In addition, in patients given betamethasone, there was an early decrease in total serum immunoglobulin G, which persisted throughout the follow-up period. In the other 2 groups, no changes in total immunoglobulin G were found. The results demonstrate that in hyperthyroid Graves' disease, TBII production is influenced by therapy. Methimazole abolished the 131I-induced increase in TBII, whereas betamethasone did not have such an inhibitory effect

  6. Celiac disease, iron deficiency anaemia, grave's disease, osteopenia and short stature in single patient

    Celiac disease is an intestinal immune mediated disorder, triggered by ingestion of gluten-containing diet in genetically susceptible individuals. The genetic pre-disposition is related to human leukocyte antigen (HLA) class II genes, especially HLA-DQ2 positive patients. The prevalence of celiac disease in high worldwide and it has been estimated to be 1-26% in Western countries. Many auto-immune diseases can be associated with celiac disease including auto-immune thyroid disease; hashimoto thyroiditis and grave's disease. The opposite also appears to be true, celiac disease is found on persons with auto-immune thyroid disorders at high rates than the general population. Celiac disease is also associated with other extraintestinal diseases other the auto-immune diseases like anemia, short stature, metabolic bone disease and others. Screening for celiac disease should be considered in patients with auto-immune thyroid disease, anemia, short stature and metabolic bone disease. The life-long adherence to gluten-free diet is the only cure in celiac disease and can improve the quality of patients life and prevent future complications. This report describes a case of Grave's disease, Iron deficiency anemia, Short stature, Osteopenia, diagnosed to have Celiac disease. (author)

  7. EXPRESSION OF T CELL RECEPTOR Vα GENE FAMILIES IN INTRATHYROIDAL T CELLS OF CHINESE PATIENTS WITH GRAVES' DISEASE

    2000-01-01

    Objective. Patients with Graves' disease (GD) have marked lymphocytic infiltration in their thyroid glands. We examined the gene for the variable regions of the α-chain of the Chinese T-cell receptor( Vα gene) in intrathyroidal Tcells to determine the role of T cells in the pathogenesis of GD and offer potential for the development of immunothera-peutic remedies for GD. Methods. We used the reverse transcription and polymerase chain reaction(RT-PCR) to amplify complementary DNA(cDNA) for the 18 known families of the Vα gene in intrathyroidal T cells from 5 patients with Graves' disease.The findings were compared with the results of peripheral blood T cells in the same patients as well as those in normalsubjects. Results. We found that marked restriction in the expression of T cell receptor Vα genes by T cells from the thyroidtissue of Chinese patients with GD(P < 0.001). An average of only 4.6 ± 1.52 of the 18 Vα genes were expressed insuch samples, as compared with 10.4 ± 2.30Vα genes expressed in peripheral blood T cells from the same patients.The pattem of expressed Vα genes differed from patient to patient with no clear predominance. Condusions. Expression of intrathyroidal T cell receptor Vα genes in GD is highly restricted suggesting the prima-cy of T cells in causing the disorders.

  8. In vivo and in vitro studies into the immunological changes following iodine 131 therapy for Graves' disease

    Wilson, R.; McKillop, J.H.; Jenkins, C.; Thomson, J.A. (Glasgow Univ. (UK). Dept. of Medicine)

    1991-04-01

    Radio-iodine therapy for Graves' disease is followed by immunological changes in addition to effects on thyroid hormone production. The present study examined these changes and the mechanisms responsible for them. Of the 15 patients enrolled in the study, 10 became hypothyroid in the first year after iodine 131 therapy. Patients who became hypothyroid had a tendency to show a rise in serum thyrotropin receptor antibody levels (30{plus minus}14 to 40{plus minus}9; NS) and a significant rise in immunoglobulin production (324{plus minus}153 to 740{plus minus}200 ng/ml; P<0.0005) from mitogen-stimulated peripheral blood lymphocytes (a measure of B-cell activity) 2 months after iodine 131 therapy. The increases were not seen in the patients who remained euthyroid at 1 year. In vitro studies suggested that the rise in B-cell activity is due to a fall in suppressor T cell numbers, a change shown to occur following iodine 131 therapy in previous studies. Our results indicate that immunological changes do arise after iodine 131 therapy for Graves' disease but appear to be confined to patients who subsequently became hypothyroid. It is not possible from this study to determine whether the immunological changes appear as a consequence of thyroidal destruction leading to hypothyroidism or whether they contribute directly to it. (orig.).

  9. Corticosteroides no tratamento da miastenia grave. Estudo de 12 casos com revisão da literatura

    José Lamartine de Assis

    1975-03-01

    Full Text Available Foram estudados os resultados do tratamento da miastenia grave em 12 pacientes, sendo 10 com a forma generalizada severa, um com a forma generalizada moderada e um com miastenia acentuada associada a polimiosite. Sete pacientes foram previamente timectomizados e somente um apresentava timoma. Todos estavam em uso de doses elevadas de drogas anticolinesterásicas com resposta terapêutica pobre ou nula. Um paciente foi tratado com dexametaxona, outro com dexametazona seguida de prednisona e os restantes com prednisona, sempre em doses altas inicialmente (100 mg por dia ou em dias alternados e com redução gradativa ulterior até doses de manutenção. Os corticosteróides foram administrados sempre pela via oral, por períodos que variaram de duas semanas até dois anos e meio. Em conclusão, 75% de 12 pacientes com miastenia grave generalizada foram influenciados favoravelmente com este método terapêutico. Deste grupo apenas um apresentava timoma e não respondeu a qualquer tratamento. Outro paciente apresentava polimiosite associada e teve excelente resposta terapêutica. Dois miastênicos sem timoma tiveram a sintomatologia exacerbada durante o tratamento. Nenhum efeito colateral importante foi observado, mesmo nos pacientes tratados a longo prazo.

  10. Graves' disease and radioiodine therapy. Is success of ablation dependent on the choice of thyreostatic medication?

    Kobe, C.; Weber, I.; Eschner, W.; Sudbrock, F.; Schmidt, M.; Dietlein, M.; Schicha, H. [Dept. of Nuclear Medicine, Univ. of Cologne (Germany)

    2008-07-01

    Aim: this study was performed to analyse the impact of the choice of antithyroid drugs (ATD) on the outcome of ablative radioiodine therapy (RIT) in patients with Graves' disease. Patients, material, methods: a total of 571 consecutive patients were observed for 12 months after RIT between July 2001 and June 2004. Inclusion criteria were the confirmed diagnosis of Graves' disease, compensation of hyperthyroidism and withdrawal of ATD two days before preliminary radioiodine-testing and RIT. The intended dose of 250 Gy was calculated from the results of the radioiodine test and the therapeutically achieved dose was measured by serial uptake measurements. The end-point measure was thyroid function 12 months offer RIT; success was defined as elimination of hyperthyroidism. The pretreatment ATD was retrospectively correlated with the results achieved. Results: relief from hyperthyroidism was achieved in 96% of patients. 472 patients were treated with carbimazole or methimazole (CMI) and 61 with propylthiouracil (PTU). 38 patients had no thyrostatic drugs (ND) prior to RIT. The success rate was equal in all groups (CMI 451/472; PTU 61/61; ND 37/38; p = 0.22). Conclusion: thyrostatic treatment with PTU achieves excellent results in ablative RIT, using an accurate dosimetric approach with an achieved post-therapeutic dose of more than 200 Gy. (orig.)

  11. Remission of anorexia nervosa after thyroidectomy: A report of two cases with Graves' disease and anorexia nervosa

    Noguchi Hitoshi

    2011-12-01

    Full Text Available Abstract We report two patients with anorexia nervosa and Graves' disease who received subtotal thyroidectomy for Graves' disease and concomitantly experienced remission from anorexia nervosa. Both were young women (aged 20 and 26 at the time of surgery. Both had well controlled thyroid function and eating behavior at the time of surgery. Both were followed for over five years without relapse of anorexia nervosa or hyperthyroidism. These cases suggest the existence of an endocrine factor originating from the thyroid gland that is involved in the pathogenesis of anorexia nervosa. Since patients of thyroidectomy can remain in good health with supplement of thyroxine alone, it can be hypothesized that this anorexigenic endocrine factor is an evolutionary relic not necessary for the normal function of humans and does not have physiological effects unless secreted beyond normal levels. Given that, it implies the existence of a creature in the animal kingdom for which such an anorexigenic hormone is essential for survival. Migrating birds eat beyond their caloric expenditure before migration and become anorexic for the duration of their flight. It is also known that their thyroid function is elevated during migration. The normal physiology of migration is a complex mechanism involving the hypothalamic, pituitary, thyroid, adrenal and reproductive hormones. The mechanism of disease, however, can be simpler. A review of the literature is presented that suggest a heretofore unreported thyroid hormone, which is involved in the regulation of migration behavior, may be the responsible factor behind anorexia nervosa.

  12. A USE-WEAR ANALYSIS OF THE KNAPPED LITHIC GRAVE GOODS FROM GRUTA DO MORGADO SUPERIOR (TOMAR, PORTUGAL

    Ana Cruz

    2015-12-01

    Full Text Available The Morgado Superior cave is a karst cave located in the municipality of Tomar (Santarém, Portugal. As other caves of the same area, it has provided stratigraphic data and votive deposits falling within the Holocene, more precisely in a diachronic time range that extends from the Neolithic to the early Bronze Age. In the Morgado Superior cave there are multiple burials with a few votive objects like jars, bone artefacts and lithic tools (blades, arrowheads etc., beads, pendants, and other decorative items in association with more than 8,000 human bones: the number of the grave goods elements is low if compared with the number of individuals buried in the cave. Concerning the use-wear study, we analyzed the grave goods in order to understand both their meaning in this funerary context and their function in the economy of this prehistoric society. We focused on the most representative elements of the grave goods: arrowheads and knapped lithic artefacts. This study led us to understand that the majority of the grave goods were everyday objects but with a strong symbolic value. Since in the Morgado Superior Cave there are a lot of grave goods showing prior breaks, their symbolic value does not seem to be lost even if the objects were broken. Thus, the use-wear analysis of the grave goods from the Morgado Superior Cave allowed us to identify the strong symbolic value of these elements for that human community, but at the same time to hypothesize a funerary practice that did not provide a special respect for the body and the grave goods of those dead previously buried in the cave. For these reasons we hypothesize a progressive spoliation (probably ritual of the previous grave goods. Through the use-wear study of the knapped lithic assemblage of the Morgado Superior Cave it was possible to reconstruct part of the ritual activities that were carried out in the site: the 90% of the lithic artefacts are used objects, all of the artefacts have been

  13. BENTUK KERJASAMA PUBLIC-PRIVATE PEMBANGUNAN GRAVING DOCK DAN MANAJEMEN GALANGAN KAPAL DENGAN METODE ANALYTICAL HIERARCHI PROCESS (AHP

    Hartono Hartono

    2012-08-01

    Full Text Available In paper Development of port infrastructure in Indonesia is now no longer the responsibility of centralgovernment, along with limited funds and the government's insistence seaport infrastructure needs. Toaccelerate economic growth, the government issued Government Regulation as a legal umbrella. The purpose ofthis study was to examine public-private partnership opportunities in the construction of graving dock andshipyard management. Targets do is review, the criteria are prioritized cooperation and cooperationpriorities.This study used qualitative and quantitative approach, a descriptive qualitative approach throughinterviews used to assess the normative aspect. The quantitative approach used to assess the priority criteriaforms of cooperation and public-private partnership in development graving dock and shipyard management byusing the Analytical Hierarchy Process (AHP. Based on the AHP analysis can be concluded that the expertsdisagree about the priority criteria of cooperation, where the majority of them choose the duration as the maincriterion. As for the analysis of priorities of the cooperation of all experts choose Built-Operate-Transfer (BOT,which is deemed suitable for long-term investment of up to 30 years. BOT puts private partners to more freely tofinance, construct, operate, anticipated rate of return on capital (rate of return and the risks of commercial andregulatory aspects

  14. Radiometric evaluation of graves of victims of the accident with Cesium 137 in Goiania, GO, Brazil: 25 years after

    Twenty-five years after the radiation accident in Goiania, this study aims to evaluate the radiological situation in the area demarcated by the graves of the victims of the accident with cesium-137. Radiometric survey was carried out on the surface that encompasses the four graves and vicinity, from a pre-established mesh. Dose rate measurements were carried out, using the IdentFINDER equipment, positioned at 1 m height from the ground. The values of dose rates at the points measured ranged from 0.03 to 0.07 μSv/h. This variation of dose rate is less than those obtained in the local graveyard and are in the range of background radiation observed in Goiania. Considering the results obtained 25 years after the accident, it was concluded that engineering barriers adopted at that time are effective, stating the place absolutely safe from a radiological point of view, both for the individual from the public as to the environment

  15. From Stone Graves to Churchyards. Burial traditions in the Late Prehistoric and Early Medieval Island of Saaremaa

    Marika Mägi

    2004-10-01

    Full Text Available Even though pre-historic burials have been the favourite topic of research of Estonian archaeologists at least for the past century, the focus has been on their appearance, chronology, ethnic context and objects discovered in them. Burial tradition, as it reflects in the archaeological remnants, has hardly been studied. Research in the field over the past few years, as well as osteological analysis of bone material, which was first carried out in the 1990s, has introduced new findings in the funeral customs of our ancestors. The article examines funeral customs on the island of Saaremaa, and the ideology behind it. The main focus is on the final centuries of the prehistoric period and the beginning of the Middle Ages – more specifically, on changes brought along by Christianity, although the study also provides an overview of earlier customs. A separate chapter discusses the partial distribution of bones and objects in graves, objects determining the boundaries of graves, and traces of funeral rituals. This evidently reflects a set of traditions, and thus also conceptions about the otherworld, composed of multiple layers and differing considerably from the modern funeral tradition. Christianisation of the population of Saaremaa in the 13th century changed these conceptions beyond recognition over a very short period of time.

  16. Technetium uptake predicts remission and relapse in Grave's disease patients on antithyroid drugs for at least 1 year in South Indian subjects

    Singhal, Neha; Praveen, V. P.; Bhavani, Nisha; Menon, Arun S.; Menon, Usha; Abraham, Nithya; Kumar, Harish; JayKumar, R. V.; Nair, Vasantha; Sundaram, Shanmugha; Sundaram, Padma

    2016-01-01

    Context: Most of the information on remission related factors in Grave's disease are derived from Western literature. It is likely that there may be additional prognostic factors and differences in the postdrug treatment course of Grave's disease in India. Aim: To study factors which predict remission/relapse in Grave's disease patients from South India. Also to establish if technetium (Tc) uptake has a role in predicting remission. Subjects and Methods: Records of 174 patients with clinical, biochemical, and scintigraphic criteria consistent with Grave's disease, seen in our Institution between January 2006 and 2014 were analyzed. Patient factors, drug-related factors, Tc-99m uptake and other clinical factors were compared between the remission and nonremission groups. Statistical Analysis Used: Mann–Whitney U-test and Chi-square tests were used when appropriate to compare the groups. Results: Fifty-seven (32.7%) patients attained remission after at least 1 year of thionamide therapy. Of these, 11 (19.2%) patients relapsed within 1 year. Age, gender, goiter, and presence of extrathyroidal manifestations were not associated with remission. Higher values of Tc uptake were positively associated with remission (P- 0.02). Time to achievement of normal thyroid function and composite dose: Time scores were significantly associated with remission (P - 0.05 and P - 0.01, respectively). Patients with lower FT4 at presentation had a higher chance of remission (P - 0.01). The relapse rates were lower than previously reported in the literature. A higher Tc uptake was found to be significantly associated with relapse also (P - 0.009). Conclusion: The prognostic factors associated with remission in Graves's disease in this South Indian study are not the same as that reported in Western literature. Tc scintigraphy may have an additional role in identifying people who are likely to undergo remission and thus predict the outcome of Grave's disease. PMID:27042408

  17. Technetium uptake predicts remission and relapse in Grave's disease patients on antithyroid drugs for at least 1 year in South Indian subjects

    Neha Singhal

    2016-01-01

    Full Text Available Context: Most of the information on remission related factors in Grave's disease are derived from Western literature. It is likely that there may be additional prognostic factors and differences in the postdrug treatment course of Grave's disease in India. Aim: To study factors which predict remission/relapse in Grave's disease patients from South India. Also to establish if technetium (Tc uptake has a role in predicting remission. Subjects and Methods: Records of 174 patients with clinical, biochemical, and scintigraphic criteria consistent with Grave's disease, seen in our Institution between January 2006 and 2014 were analyzed. Patient factors, drug-related factors, Tc-99m uptake and other clinical factors were compared between the remission and nonremission groups. Statistical Analysis Used: Mann–Whitney U-test and Chi-square tests were used when appropriate to compare the groups. Results: Fifty-seven (32.7% patients attained remission after at least 1 year of thionamide therapy. Of these, 11 (19.2% patients relapsed within 1 year. Age, gender, goiter, and presence of extrathyroidal manifestations were not associated with remission. Higher values of Tc uptake were positively associated with remission (P- 0.02. Time to achievement of normal thyroid function and composite dose: Time scores were significantly associated with remission (P - 0.05 and P - 0.01, respectively. Patients with lower FT4 at presentation had a higher chance of remission (P - 0.01. The relapse rates were lower than previously reported in the literature. A higher Tc uptake was found to be significantly associated with relapse also (P - 0.009. Conclusion: The prognostic factors associated with remission in Graves's disease in this South Indian study are not the same as that reported in Western literature. Tc scintigraphy may have an additional role in identifying people who are likely to undergo remission and thus predict the outcome of Grave's disease.

  18. Increased microRNA-155 and decreased microRNA-146a may promote ocular inflammation and proliferation in Graves' ophthalmopathy.

    Li, Kaijun; Du, Yi; Jiang, Ben-Li; He, Jian-Feng

    2014-01-01

    Graves' ophthalmopathy is an inflammatory autoimmune disease of the orbit, characterized by inflammation and proliferation of the orbital tissue caused by CD4+T cells and orbital fibroblasts. Despite recent substantial findings regarding its cellular and molecular foundations, the pathogenesis of Graves' ophthalmopathy remains unclear. Accumulating data suggest that microRNAs play important roles in the pathophysiology of autoimmunity and proliferation. Specifically, microRNA-155 (miR-155) can promote autoimmune inflammation by enhancing inflammatory T cell development. In contrast to miR-155, microRNA-146a (miR-146a) can inhibit the immune response by suppressing T cell activation. Furthermore, miR-155 and miR-146a are involved in cell proliferation, differentiation, and many other life processes. Thus, miR-155 and miR-146a, with opposite impacts on inflammatory responses carried out by T lymphocytes, appear to have multiple targets in the pathogenesis of Graves' ophthalmopathy. Our previous work showed that the expression of miR-146a was significantly decreased in peripheral blood mononuclear cells from Graves' ophthalmopathy patients compared with normal subjects. Accordingly, we proposed that the expression of miR-155 increased and the expression of miR-146a decreased in the target cells (CD4+T cells and orbital fibroblasts), thus promoting ocular inflammation and proliferation in Graves' ophthalmopathy. The proposed hypothesis warrants further investigation of the function of the differentially expressed microRNAs, which may shed new light on the pathogenesis of Graves' ophthalmopathy and lead to new strategies for its management. PMID:24743332

  19. Percepción del peligro por intensa sequía en provincia de Camagüey, punto de partida para la educación ambiental.Perceptions of intensive drought hazard in Camaguey province, start point for environmental education.

    Oscar Leopoldo Parrado Alvarez

    2013-08-01

    Full Text Available Resumen.Se presentan los resultados del estudio de la percepción del peligro, por inundaciones, intensas lluvias, penetraciones del mar y afectaciones por fuertes vientos, según la metodología propuesta por el Grupo Nacional de Evaluación de Riesgos que coordina la Agencia de Medio Ambiente (AMA del CITMA. Las unidades de análisis fueron: los municipios. En el procesamiento estadístico de los datos fueron utilizados los software: Excel, SPSS y Data Entry. La muestra de 1509 personas representa el 0,20 % de la población de la provincia. Los resultados de la encuesta realizada determina que el nivel de percepción del peligro por parte de la población es predominantemente medio (una percepción cercana a la realidad en la mayoría de los encuestados (85% independientemente de las vulnerabilidades estructurales, funcionales, económicas y ecológicas, existiendo comportamientos particulares a nivel de los Consejos Populares de cada municipio. Se discuten las diferencias observadas de acuerdo a las variables sociodemográficas estudiadas y se plantean las recomendaciones para el empleo de esta información en los procesos de educación ambiental. Abstract.The results of the study of the perception of the intensive drought hazard are presented, according to the methodology proposed by the National Group of Evaluation of Risks that coordinates by the Environment Agency (AMA of the CITMA. The analysis units were: the municipalities. For the statistical analysis of data they were used the software: Excel, SPSS and Data Entry. The sample of 1 509 people, represents 0,20% of the province population. The results of survey determines that the level of perception of the hazard on the part of the population is mainly medium (a near perception to the reality in most of those interviewed (85 % independently of the structural, functional, economic and ecological vulnerabilities, existing peculiar manners to level of the Popular Council of each

  20. Uso do sulfato de magnésio venoso para tratamento da asma aguda grave da criança no pronto-socorro

    Tânia Mara Baraky Bittar; Sérgio Diniz Guerra

    2012-01-01

    A asma aguda grave é uma emergência médica que deve ser diagnosticada e tratada rapidamente. O tratamento inicial inclui broncodilatadores e corticosteróides sistêmicos. Em casos graves, com fraca resposta ao tratamento padrão, o sulfato de magnésio venoso surge como opção terapêutica. O objetivo deste artigo foi revisar a literatura sobre o uso do sulfato de magnésio venoso na asma aguda em crianças no pronto-socorro no que se refere a eficácia, indicação, dosagem, efeitos adversos e contrai...

  1. Saint Sisoes above the grave of Alexander the Great. A monastic theme of post-Byzantine art and its examples from the 17th century Serbian painting

    Živković Miloš

    2013-01-01

    The depiction of St. Sisoes above the grave of Alexander the Great was formulated at the end of the 15th century. The image in question is a visual interpretation of a short song («I see you, grave»), and it was often painted in the churches throughout the Balkans during the next two centuries. With references to the textual basis of this iconographic theme, as well as its meaning, the article is devoted to insufficiently studied Serbian examples of frescoe...

  2. Radiotherapy of Graves' ophthalmopathy. State of the art and review of the literature; Radiotherapie der endokrinen Orbitopathie. State of the Art und Literaturuebersicht

    Eich, H.T. [Klinikum der Univ. Koeln (Germany). Klinik und Poliklinik fuer Strahlentherapie; Micke, O. [Franziskus-Hospital Bielefeld (Germany). Klinik fuer Radioonkologie und Strahlentherapie; Seegenschmiedt, M.H. [Alfried-Krupp Krankenhaus Essen (Germany). Klinik fuer Radioonkologie und Strahlentherapie

    2007-07-01

    Graves' ophthalmopathy (GO), the most frequent extrathyroidal manifestation of Graves' disease, is a disorder of autoimmune origin, the pathogenic mechanisms of which are still incompletely understood. Although GO is severe in only 3-5% of affected individuals, quality of life is severely impaired even in patients with mild GO. The role of radiotherapy in the management of GO is discussed controversially. However, recent randomized clinical trials have, with one exception, confirmed that orbital radiotherapy is an effective and safe therapeutic procedure for GO. This article describes the sequences, dosages and fractionation schemes as well as the risks and side effects of the radiotherapy. (orig.)

  3. Avaliação nutricional em pacientes graves Nutritional assessment of the severely ill patient

    Anahi Ottonelli Maicá

    2008-09-01

    Full Text Available Considerando a importância e as dificuldades inerentes à avaliação do estado nutricional, assim como da interpretação dos resultados, além da inexistência de diretrizes específicas e validadas quanto aos métodos aplicados ao paciente crítico, o objetivo deste estudo foi contribuir para a análise e recomendação de métodos eficazes, passíveis de utilização e fidedignos do ponto de vista da interpretação no contexto do paciente grave. A presença de edema e alterações inespecíficas nas concentrações plasmáticas de proteínas; variáveis antropométricas alteradas, refletindo muito mais o rearranjo da água corporal total do que modificações do estado nutricional; estudos pouco conclusivos com a bioimpedância elétrica; ausência de dados relativos à aplicação da avaliação subjetiva global; indicadores bioquímicos alterados como conseqüência das mudanças metabólicas, entre outros, indicam as várias limitações dos métodos a esses pacientes. Na ausência de estudos que os validem, existem recomendações baseadas em evidências clínicas, observação e fundamentação nas alterações fisiopatológicas. Independentemente dos métodos, a observação clínica pela equipe de saúde é imprescindível em todas as etapas. Há necessidade de maiores estudos que identifiquem claramente os métodos e sua especificidade para a detecção, avaliação de risco ou monitorização.Considering the importance and the difficulties inherent to nutritional state assessment, as well as the results interpretation and the inexistence of specific and validated guidelines related to applied methods to the severely ill patient, the present revision aims to contribute to the analysis and recommendation of efficient methods, which are suitable to use and reliable in terms of interpretation in the context of the severely ill patient. The presence of edema and unspecific alterations in the plasmatic concentrations of proteins

  4. Dosimetric comparison between fixed and individualized activity in Graves' disease treatment with 131{sub I}; Comparacion dosimetrica entre actividad fiija y actividad individualizada en el tratamiento de la enfermedad de Graves con 131{sub I}

    Melgar Perez, J.; Orellana Salas, A.; Santaella Guardiola, Y.; Arrocha Acevedo, J. F.

    2013-07-01

    A patient-especific method has been used to calculate the therapeutic {sup 1}'3{sup 1} I activity to administer to patients with Graves disease in order to obtain the optimal thyroid dose. The aim of this study was to analyze the dose variation in contrast to the fixed a ctivity regimen. In 30 patients, biokinetic and morfological parameters were estimated from planar scintigraphic images obtained at 4, 24 and 96 hours after injection of {sup 123} I and {sup 131} I activities were calculated to deliver 120 Gy to the thyroid. Comparative dose calculations were carried out assuming that the individual patients had been treated according to 370 MBq activity administration. Activity (or dose) was reduced by an average factor of 2.4 and up to a factor 4.9 for an individual patient. The implemen ted method seeks a balance among the accuracy of the calculations, resource consumption and patient comfort. (Author)

  5. A possible method using baseline hormonal levels to prescribe the appropriate oral therapeutic radioiodine dosage for Graves' disease

    The purpose of this study was to retrospectively examine the correlations of hormonal ratios with radioiodine I-131 therapeutic parameters and the potentiality of prescribing the therapeutic I-131 target dosage for an individual patient with Graves' disease using baseline serum levels of thyroid hormones. Serum T3, T4, and FT4 levels 6 and 12 months after I-131 therapy/baseline levels (hormonal ratios) were calculated for a total of 68 therapeutic courses in 57 patients with Graves' disease. The therapeutic parameters were absorbed dose (Gy), dose concentration (μCi/g) and oral dose (mCi). Linear regression analysis was performed for correlating hormonal ratios (X) and therapeutic parameters (Y). Significant (P<0.05) negative correlations of the hormonal ratios were observed with absorbed dose (R -0.50 for T3, -0.61 for T4, and -0.46 for FT4 at 6 months, and -0.29 for T3, -0.44 for T4 at 12 months) and dose concentration (R -0.57 for T3, -0.58 for T4, and -0.49 for FT4 at 6 months and -0.27 for T3, -0.27 for T4 at 12 months), but not with oral dose at 6 months and 12 months or the absorbed dose and dose concentration for FT4 at 12 months. The correlations were higher at 6 months than at 12 months and in serum T4 than in serum T3 and FT4. The formulae for serum T4 at 6 months were as follows: Y (Gy)=109-53X and Y (μCi/g)=109-52X. These results suggest that the hormonal ratios are significantly correlated with the absorbed dose and dose concentration. The formulae for serum T4 at 6 months may serve to prescribe the individual oral dosage for Graves' disease, although the correlation coefficients are about -0.6. (author)

  6. Prueba de caminata de carga progresiva (shuttle test en enfermedad pulmonar obstructiva crónica grave

    Martín Sívori

    2010-08-01

    Full Text Available La prueba de caminata de carga progresiva (shuttle test, PCCP tiene escaso uso en nuestro país. Este estudio comparó diferentes variables de la PCCP con la de caminata de 6 minutos (PC6M y el consumo de oxígeno (VO2max en enfermedad pulmonar obstructiva crónica (EPOC grave. A 21 pacientes con EPOC grave estable (estadios GOLD III-IV, se les realizó PC6M, PCCP, y VO2max. Se evaluaron frecuencia cardíaca, saturación de oxígeno y escala de disnea (Borg. Se realizaron espirometría, gases en sangre y cuestionario de calidad de vida (CRQ. Se utilizaron prueba t de Student para datos apareados y coeficiente de correlación de Pearson (significación < 0.05. La media de edad fue 65.27 ± 12.72 años y la obstrucción al flujo aéreo fue grave, (FEV1: 33.23 ± 4.94%. La respuesta al ejercicio para PC6M 297.85 ± 173.24 metros; PCCP: 318.8 ± 42.42 metros y VO2max 14.7 ± 5.44 ml/kg/min. El coeficiente de correlación del metraje caminado entre PC6M y PCCP fue r: 0.52 (p = 0.00085; entre PCCP y VO2max (l/min: r: 0.78 (p = 0.00079, y PCCP y VO2max (ml/kg/min: r: 0.81 (p = 0.00065. Se observó correlación moderada en la frecuencia cardíaca final (r: 0.41, p = 0.00091, escala de disnea máxima (r: 0.47, p = 0.00099, y alta en la saturación de oxígeno final (r: 0.81, p = 0.00087 entre PCCP y VO2max. No hubo correlación entre PCCP y FEV1 entre PCCP y calidad de vida. En conclusión, la PCCP como prueba de ejercicio de campo máxima es sencilla y de bajo costo, su correlación con la prueba de VO2max es alta, constituyendo una herramienta útil en lugares donde no existe disponibilidad de aparatos más costosos.

  7. Bases técnicas para la aplicación del sistema de análisis de peligro y puntos críticos de control (haccp desde la granja de ponedoras hasta la recepción y distribución de huevos para el consumo.

    Yanetsy Pérez Pérez; Alcides Pérez Bello.-

    2006-10-01

    Full Text Available Pérez Pérez, Yanetsy; Suárez Fernández, Yolanda; CuraRESUMENPara garantizar alimentos de calidad, y sinriesgos para la salud pública, debenemplearse sistemas de producción dealimentos seguros, "desde el productorhasta el consumidor", lo que reduce loscostos de producción por concepto deinspección y decomiso de productoscontaminados o deteriorados, y elconsiguiente impacto económico, político ysocial. Es con este objetivo que se realizaun estudio de identificación y análisis deriesgos biológicos, químicos y físicos enuna granja avícola de ponedoras y elcentro de acopio y distribución de huevoscomerciales de la provincia Villa Clara; loque permitió la determinación de losriegos, los Puntos Críticos de Control(PCC, sus correspondientes LímitesCríticos (LC y las posibles desviaciones deestos últimos, los procedimientos devigilancia y monitoreo y la propuesta demedidas o acciones correctivas queconstituyen las bases técnicas para laimplementación del Sistema de Análisis dePeligro y Puntos Críticos de Control(HACCP, en la producción de huevoscomerciales; previa decisión de lasautoridades empresarialescorrespondientes.Palabras claves:

  8. Endangered languages: Heritage of humanity in dire need of protection Four approaches which support their preservation and maintenance Lenguas en peligro: una herencia de la humanidad en gran necesidad de protección Cuatro acercamientos para apoyar su preservación y mantenimiento

    M.A Enrique Uribe-Jongbloed

    2007-12-01

    Full Text Available The purpose of this paper is to present and discuss four approaches which support actions in favor of endangered language preservation and maintenance. Preservation, on the one hand, refers to the process of documenting and storing information which can later on be accessed by the public; whereas maintenance, on the other, implies a support for the users of the language to prevent its disappearance by encouraging its use. Each of the approaches is assessed on its priority in one or the other form of language protection, drawing on their justifications and main goals. Finally, conclusions are brought forth regarding the potential uses of the different approaches.El propósito de este artículo es presentar y discutir cuatro aproximaciones que apoyan las acciones en favor de la preservación y mantenimiento de los idiomas en peligro de extinción. La preservación se entiende como el proceso de documentar y almacenar información que pueda ser posteriormente accesible por el público general, mientras que mantenimiento, por otro lado, implica el apoyo a los usuarios del idioma para prevenir la desaparición y promover la continuación de su uso. Cada una de las aproximaciones es evaluada con respecto a su prioridad como forma de proteger el idioma, obtenidas a partir de su justificación y objetivos. Por último, las conclusiones se presentan hacia su uso potencial de las distintas aproximaciones.

  9. Waste minimization/pollution prevention at R ampersand D facilities: A cradle-to-grave tracking and information system for Sandia National Laboratories

    Critical information required for Environment, Safety, and Health (ES ampersand H) protection can be acquired with a comprehensive cradle-to-grave tracking and information system. The cradle-to-grave concept makes two initial assumptions. First, it is more effective to gather information at the origination of a process or entry point of a material and maintain that information during the rest of its life-cycle than to collect data on an ad hoc basis. Second, the information needs of the various ES ampersand H programs have many commonalties. A system which adheres to a methodology based upon these assumptions requires a significant technical and administrative commitment; however, this investment, will in the long-term, reduce the effort and duplication of ES ampersand H programs, improve the efficiency of ES ampersand H and line personnel, and increase the scope and accuracy of ES ampersand H data. The cradle-to-grave system being developed at Sandia National Laboratories (SNL) is designed to provide useful information on materials, personnel, facilities, hazards, wastes, and processes to fulfill the mission of pollution prevention, risk management, industrial hygiene, emergency preparedness, air/water quality, and hazardous and radioactive waste management groups. SNL is currently linking system modules, which are at various stages of development and production, to realize a cradle-to-grave tracking and information system that is functional for a large research and development laboratory

  10. Clinical Observation on Sanhuang Yikang (三黄抑亢) CapsuleSupplemented with Small Dosage of Tapazole in Treating Graves Disease

    2000-01-01

    The authors used Sanhuang Yikang (三黄抑亢, SHYK) capsule supplemented with small dosage of tapazole in treating 62 Graves disease patients from January 1992 to December 1997, and compared the results with that in treating 35 patients with routine dosage of tapazole, and now it is reported as follows.

  11. Self-reactive CD4+ T cells and B cells in the blood in health and autoimmune disease: increased frequency of thyroglobulin-reactive cells in Graves' disease

    Nielsen, Claus H; Moeller, Ane Christine; Hegedüs, Laszlo; Bendtzen, Klaus; Leslie, R Graham Q

    2006-01-01

    (+) T cells and B cells were found in patients with Graves' disease. Notably, both patient groups and healthy controls exhibited higher proliferative responses to thyroglobulin than to a foreign recall antigen, tetanus toxoid. Our results suggest that self-tolerance can be broken by exposure of...

  12. The early changes of thyroid hormone concentrations after 131I therapy for graves' hyperthyroidism - the role of pretreatment with methimazole

    Full text: 131I therapy may cause exacerbation of hyperthyroidism due to leakage of previously formed thyroid hormones from damaged thyroid cells in Graves' patients. To avoid this complication pretreatment with antithyroid drugs is recommended. Otherwise, the use of antithyroid drugs prior to 131I therapy may diminish the success of 131I therapy and should therefore be discontinued. The aim of our prospective clinical study was to compare early changes of thyroid hormone concentrations after 131I therapy in Graves' patients, pretreated or not pretreated with methimazole. 92 consecutive Graves' patients, 84 females and 8 males, aged 17 to 80 were treated with 555 MBq of 131I. Absorbed dose of 131I was calculated. In the first group of 22 patients treatment with methimazole (20 mg/day) was discontinued 7 days before 131I therapy, the second group of 33 patients received methimazole until the day of 131I therapy and the third group of 37 patients was not pretreated with methimazole before 131I therapy. 7 and 2 days before 131I therapy and 2, 5, 12 and 30 days after serum free T4 (fT4) and free T3 (fT3) concentrations were measured. In the first group a significant increase of fT4 and fT3 was observed 7 days after discontinuation of methimazole (fT4 14.60 ± 4.10 vs. 18.25 ± 7.16; fT3 5.45 ± 1.44 vs. 7.79 ± 5.27 pmol/l), while gradual decrease of fT4 and fT3 was observed after 131I therapy. In the second group a significant increase of fT4 and fT3 after 131I therapy peaking on day 5 was observed (fT4 20.91 ± 13.70 vs. 27.85 ± 18.17; fT3 7.81 ± 5.21 vs. 9.42 ± 6.21 pmol/l). In the third group significant decrease of fT4 and fT3 concentrations was observed after 131I therapy (fT4 36.12 ± 18.55 vs. on day 12th 27.49 ± 15.20; fT3 12.66 ± 7.04 vs. on day 12th 8.31 ± 4.92 pmol/l). No correlation between absorbed dose of 131I and changes of fT4 and fT3 concentrations was observed. Therefore, our results indicate that not 131I application itself but discontinuation

  13. Procalcitonina como biomarcador de prognóstico da sepse grave e choque séptico

    José Raimundo Araujo de Azevedo

    2012-12-01

    Full Text Available OBJETIVO: Avaliar a tendência da concentração plasmática e do clearance de procalcitonina (PCT-c como biomarcadores de prognóstico de pacientes com sepse grave e choque séptico, comparado a um outro marcador precoce de prognóstico representado pelo número de critérios de SIRS no momento do diagnóstico da sepse. MÉTODOS: Estudo de coorte prospectivo observacional onde foram incluídos pacientes com sepse grave e choque séptico. A concentração sérica de procalcitonina foi determinada no momento do diagnóstico da sepse e após 24 e 48 horas. Foram coletados dados demográficos, escore APACHE IV, escore SOFA na chegada, número de critérios de SIRS no momento do diagnóstico, sitio da infecção e resultados microbiológicos. RESULTADOS: Vinte e oito pacientes foram incluídos, 19 clínicos e nove cirúrgicos. Em 13 (46,4% a fonte da sepse foi pulmonar, em sete abdominal (25,0%, em cinco urinária (17,9% e de partes moles em três casos (10,7%. Quinze pacientes tinham sepse grave e 13 choque séptico. A mortalidade global foi cinco pacientes (17,9%, três deles com choque séptico. Vinte e oito determinações de PCT foram realizadas no momento do diagnóstico da sepse, 27 após 24 horas e 26 após 48 horas. A concentração inicial não se mostrou expressivamente diferente entre os grupos sobreviventes e não sobreviventes, mas as diferenças entre os dois grupos após 24 e 48 horas alcançaram significância estatística expressiva. Não se observou diferença em relação ao número de critérios de SIRS. O clearance de procalcitonina de 24 horas mostrou-se expressivamente mais elevado no grupo de sobreviventes (-3,0 versus -300,0, p=0,028. Embora o clearance de procalcitonina de 48 horas tenha mostrado resultado mais elevado no grupo de sobreviventes comparado aos não sobreviventes, a diferença não alcançou significância estatística. CONCLUSÃO: Concentrações persistentemente elevadas de procalcitonina no plasma, assim

  14. Thyroid stimulating immunoglobulins in Graves' disease with goitre growth, low thyroxine and increasing triiodothyronine during PTU treatment

    Hegedüs, Laszlo; Hansen, J M; Bech, K; Kampmann, J P; Jensen, K; Andersen, E; Hansen, P; Karstrup, S; Bliddal, H

    1984-01-01

    +/- SD) to 40 +/- 9 nmol/l after 6 weeks of PTU treatment and continued to be below the normal range during the next 4 months. In group 2 serum T4 decreased from 190 +/- 35 to 88 +/- 47 nmol/l and stayed in the normal range. Serum T3 was normalized in both groups after 6 weeks but increased to values......In 50 consecutive patients with Graves' disease treated with PTU, 7 (group 1) developed increasing goitre in spite of unmeasurable TSH. Thyroid variables were compared with those from 10 controls with an ordinary response to PTU (group 2). Serum T4 decreased in group 1 from 246 +/- 47 nmol/l (mean...

  15. Changes in TSH-binding inhibitor immunoglobulins and human thyroid stimulator activities in Graves' disease after radioiodine treatment

    The changes in the activities of TSH-binding inhibitor immunoglobulins (TBII) and human thyroid stimulator (HTS) were studied after I-131 treatment of Graves' disease. TBII were measured by the radioreceptor assay of TSH and HTS was measured by the increase in cyclic AMP in cultured human thyroid adenoma cells. Before the treatment TBII were positive in 10 out of 14 patients and mean activity was 79.2%, while only 1 out of 12 were positive in HTS. Three months after the treatment, TBII were positive in 11 out of 12, mean activity being 58.1% (p < 0.05). HTS was positive in 7 out of 11 (p < 0.02). Subsequently, both of these activities showed gradual decrease to the pretreatment level. Changes of TBII and HTS in 5 patients were not parallel, indicating heterogeneity in TSH-receptor related antibodies

  16. TL, OSL and C-14 dating results of the sediments and bricks from mummified nuns' grave

    Tudela, Diego R.G.; Tatumi, Sonia H.; Yee, Marcio; Brito, Silvio L.M., E-mail: tatumi@fatecsp.br [Faculdades de Tecnologia de Sao Paulo (FATECs/CEETEPS/UNESP), Sao Paulo, SP (Brazil). Centro Estadual de Educacao Tecnologica Paula Souza; Morais, Jose L.; Morais, Daisy de; Piedade, Silvia C. [Universidade de Sao Paulo (USP), SP (Brazil). Museu de Arqueologia e Etnologia; Munita, Casimiro S.P.; Hazenfratz, Roberto [Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Sao Paulo, SP (Brazil)

    2012-06-15

    This paper presents the results of TL and OSL dating of soil and fragments of bricks from a grave, which was occupied by two mummified nuns, found at 'Luz' Monastery, located in the state of Sao Paulo, Brazil. The TL and OSL ages were compared to C-14 dating ones obtained from bone collagens of the mummies. The majority of the ages is related to the eighteenth century. The gamma-ray spectroscopy was used to evaluate natural radioisotope concentrations in the samples, and by using these concentrations the annual dose rates, from 3.0 to 5.3 Gy/kyr, were obtained. Neutron activation analysis was performed and the radioisotope contents results are in agreement with those obtained by gamma-ray spectroscopy. The contents of U, Th and Ce elements were higher than those found in usual sediments. (author)

  17. Comportement de chaussées expérimentales à assises en graves non traitées calcaires

    EL ABD, A; HORNYCH, P; Breysse, D.; Denis, A.; DEBLEECKER, P

    2003-01-01

    Cet article présente les premiers résultats d'une expérimentation réalisée en charente Maritime, pour tester l'utilisation de graves non traitées issues de calcaires tendres (matériaux locaux à valoriser) dans les structures de chaussées. Une première étude en laboratoire a montré que ces matériaux calcaires, de faible résistance mécanique (coefficent Los Angeles et Micro-Deval élevés) présentaient de très bonnes caractéristiques mécaniques à l'essai triaxial (module élastique élevé, faibles ...

  18. Effect of thyroid auto-antibodies on hypothyroidism of adolescents with graves disease after 131I treatment

    To investigate the effect of TSH receptor antibody (TRAb) and thyroid peroxidase antibody (TPOAb) levels in adolescents with Graves disease (GD) before 131I treatment on the incidence of hypothyroidism after 131I therapy. The total 264 adolescent with GD were treated with 131I. All patients before the treatment were divided into A, B, C, D, E and F groups in accordance with the levels of TRAb and TPOAb in various combinations. The serum TSH, FT3, FT4, TRAb and TPOAb levels in all patients were measured after 131I treatment. The incidence of hypothyroidism within three years were observed in each group. The results showed that the incidence of hypothyroidism in TRAb negative group was higher than that of positive group (χ2=4.67, P2=4.10, 4.34, 5.66, P131I therapy. It could be cautious in treatment of GD adolescents of TRAb negative and TPOAb positive with 131I. (authors)

  19. Subcapsular hepatic hematoma. Serious complication during pregnancy Hematoma subcapsular hepático. Grave complicación del embarazo

    Viviana de la Caridad Sáez Cantero

    2010-12-01

    Full Text Available Subcapsular hepatic hematoma is a rare complication during pregnancy, but potentially lethal and usually related to severe pre-eclampsia or HELLP syndrome (hemolysis, elevated liver enzymes and diminished platelets. Maternal and perinatal mortality in these cases is high, hence the importance of early diagnosis and timely and multidisciplinary treatment. This paper is a review on the subject, held in Ebsco, Hinari and Sci databases.El hematoma subcapsular hepático es una complicación rara del embarazo, pero potencialmente letal, generalmente relacionada con pre-eclampsia grave o síndrome HELLP (hemólisis, enzimas hepáticas elevadas y plaquetas disminuidas. La mortalidad materna y perinatal en estos casos es elevada, de ahí la importancia del reconocimiento precoz y tratamiento oportuno y multidisciplinario. El presente trabajo constituye una revisión sobre el tema, realizada en las bases de dato Ebsco, Hinari y Scielo.

  20. Eficácia do sulfato de aminosidine na leishmaniose visceral grave, resistente ao tratamento com antimonial pentavalente

    Cleudson Castro

    1995-09-01

    Full Text Available Descreve-se um caso de calazar grave resistente a dez cursos de antimonial petitavalente (glucantime à base de 20mg de Sb5/kg/dia, que respondeu favoravelmente ao sulfato de aminosidine intramuscular na dose de 20mg/kg/dia por 20 dias, repetido após 20 dias. O parasitismo esplénico passou de 50 parasitos por campo a 3 parasitos em 10 campos logo após a primeira série de sulfato de aminosidine, tornando-se negativo depois de sete meses. A melhora clínica foi imediata, com redução gradual da hepatoesplenomegalia, e desaparecimento 26 meses após. Neste período aumentou 13 kg. Após o uso de aminosidine a reação de Monténégro tornou-se positiva e as células mononucleares responderam quando estimuladas com antígenos de leishmânia.A grave kala-azar infection in a 14 years old boy is described. The leishmanial infection failed to respond to ten interrupted courses of glucantime of variable duration (14-56 days at a dose of 20mg Sb5/kg/day. However a favorable response ocurred to intramuscular aminosidine sulphate (20mg/kg/day for 20 days. This same regimen was repeated 20 days later. After the first treatment splenic puncture parasite density fell from 50 amastigotes per oil immersion field to 3 amastigotes in 10 fields. A further splenic puncture 7 months after treatment was negative. The marked hepatoesplenomegaly gradually resolved over 26 months follow up and he gained 13 kilogramas in weight. After aminosidine sulphate therapy his Montenegro reaction become positive and his lymphocytes responded to leishmania antigens.

  1. Tratamento da miastenia grave mediante imunossupressão medicamentosa não esteróide

    José Lamartine de Assis

    1986-06-01

    Full Text Available São estudados 14 pacientes (doze dos quais eram mulheres com miastenia grave severa e resistente aos procedimentos terapêuticos habituais. Em um paciente a prednisona foi substituída pela imunossupressão com citotóxicos e em outro o emprego destes permitiu redução da dose do esferóide, que passou a ser bem tolerado. Nos dois casos o emprego dos citostáticos foi decorrência de complicações da prednisona. São empregadas azatioprina e ciclosfosfamida em programas em que estão associadas, na maioria dos casos, prednisona e plasmaférese. Todos os pacientes mantiveram o uso de anticolinesterásicos. A azatioprina é administrada pela via oral nas doses de 100-200mg/dia por período de 20 meses, enquanto a ciclofosfamida é empregada pela via oral nas doses de 100-200mg/dia por 6 meses ou lg pela via intravenosa a intervalos de 15-30 dias durante 6 meses. O período mais longo de observação até o momento é de 32 meses. Ocorreram melhoras importantes em 71,4% dos pacientes, sendo que em 8 (57% as melhoras começaram entre um e 6 meses após o início do tratamento. Efeitos colaterais foram infreqüentes e de pouca monta, não tendo ocorrido complicações graves dependentes diretamente das drogas até o momento.

  2. Abordaje quirúrgico de la elefantiasis escrotal a propósito de dos casos graves

    C. Recalde-Losada

    2014-06-01

    Full Text Available El linfedema puede afectar a cualquier parte del cuerpo, incluido el escroto y el pene. Esta alteración en el drenaje linfático provoca en ocasiones grandes deformidades que conocemos como elefantiasis. El linfedema genital causa graves limitaciones funcionales y emocionales en los pacientes que lo padecen, pues a menudo sufren dolor debido a la irritación crónica, infecciones recurrentes, incapacidad para asearse, disfunción sexual, deformidad estética, llegando incluso a limitar la movilidad o la deambulación. No existe un tratamiento médico o quirúrgico ideal para el linfedema genital masculino. En la literatura se hace referencia a colgajos fasciocutáneos de la cara interna de los muslos tras grandes resecciones de tejido escrotal, pero este tipo de cirugía altera la termorregulación testicular y puede producir esterilidad. También está descrito el uso de injertos laminares de piel, que no aportan una cobertura estable. Otra opción es la reconstrucción con colgajos perineales posteriores, que preservan los linfáticos perirrectales para proveer un drenaje linfático adecuado a la zona. Presentamos 2 casos de linfedema escrotal grave, elefantiásico, no infeccioso, en los cuales realizamos linfangiectomía, resección de todo el tejido linfedematoso y reconstrucción con colgajos perineales locales. En ambos pacientes los resultados fueron satisfactorios, mejorando significativamente su calidad de vida sin evidenciar signos de recurrencia 1 año después del tratamiento.

  3. The incidence of ophthalmopathy after radioiodine therapy for Graves` disease: Prognostic factors and the role of methimazole

    Kung, A.W.C. [Univ. of Hong Kong, Pokfulam (Hong Kong); Cheng, A. [Queen Mary Hospital, Pokfulam (Hong Kong)

    1994-08-01

    Radioactive iodine-131 (RAI) has been reported to be associated with a high incidence of development or exacerbation of Graves` ophthalmopathy (GO). This is thought to be associated with a surge of autoantibodies after RAI therapy. The role of methimazole (MMI), which possesses immunomodulatory action, in the prevention of GO was explored by studying 114 patients with Graves` disease. They were assigned randomly to receive either RAI alone or adjunctive antithyroid drugs, which consisted of MMI and L-T{sub 4} as a block-replacement therapy for 12 months and were followed for 2 yr. Thirty-five patients (30.7%) had GO at presentation. Twenty-one (18%) patients developed new GO, and six had worsening of preexisting GO. The development of hypothyroidism (P < 0.01) and an elevation of TSH (P < 0.05) were associated with increased risk of development or exacerbation of GO. The chance of development or exacerbation of GO is higher in those with no ophthalmopathy than in those with preexisting GO at presentation (P = 0.002). The incidence of development or exacerbation of GO was similar in the two treatment groups (RAI, 22.8%; adjunctive antithyroid drugs, 23.7%; P = NS). MMI was able to suppress the surge of TSH receptor antibody (TRAB) after RAI, but a surge in TRAB was not of prognostic significance for the development of GO after RAI. Patients who developed or had exacerbation of GO actually had lower TRAB at presentation (P = 0.02). The authors conclude that hypothyroidism with elevated TSH is an important adverse factor for the development or exacerbation of GO, and MMI was unable to prevent the development or exacerbation of GO after RAI. 35 refs., 4 tabs.

  4. Pretreatment with betamethasone of patients with Graves' disease given radioiodine therapy: thyroid autoantibody responses and outcome of therapy

    The effects of betamethasone on thyroid autoantibody responses and outcome of radioiodine therapy were determined over a period of 1 yr in a prospective randomized study of 40 patients with Graves' disease. Twenty patients were given placebo tablets, and 20 patients were treated with betamethasone from 3 weeks before until 4 weeks after 131I therapy. At the time of inclusion in the study, the mean serum concentrations of TSH receptor antibodies, thyroid peroxidase antibodies, and thyroglobulin antibodies (TgAb) were increased in both groups. Three weeks of treatment with betamethasone reduced the thyroid peroxidase antibody and TgAb titers as well as the serum concentrations of thyroid hormones. A decrease in the TSH receptor antibody level was not statistically significant. After radioiodine therapy, transient increases in thyroid autoantibody levels were observed. The titers of the different antibodies generally changed in parallel. In some patients a detectable level of a given antibody was found only after the radioiodine treatment, and in two cases, TgAb did not appear at all, although the two other antibodies increased temporarily. Betamethasone delayed, but did not abolish, the 131I-induced antibody peaks. Betamethasone also caused a reduction in the total serum immunoglobulin G, a reduction which persisted throughout the study period. When the study ended, 17 patients given placebo and 9 patients given betamethasone were receiving replacement therapy due to the development of hypothyroidism. These patients at this point in time had lower antibody levels than those not requiring T4. The results of this study demonstrate that betamethasone reduces and modifies the thyroid autoantibody responses as well as the outcome of radioiodine therapy in patients with Graves' disease

  5. Pretreatment with betamethasone of patients with Graves' disease given radioiodine therapy: thyroid autoantibody responses and outcome of therapy

    Gamstedt, A.; Karlsson, A. (Department of Internal Medicine, Orebro Medical Center Hospital (Sweden))

    1991-07-01

    The effects of betamethasone on thyroid autoantibody responses and outcome of radioiodine therapy were determined over a period of 1 yr in a prospective randomized study of 40 patients with Graves' disease. Twenty patients were given placebo tablets, and 20 patients were treated with betamethasone from 3 weeks before until 4 weeks after {sup 131}I therapy. At the time of inclusion in the study, the mean serum concentrations of TSH receptor antibodies, thyroid peroxidase antibodies, and thyroglobulin antibodies (TgAb) were increased in both groups. Three weeks of treatment with betamethasone reduced the thyroid peroxidase antibody and TgAb titers as well as the serum concentrations of thyroid hormones. A decrease in the TSH receptor antibody level was not statistically significant. After radioiodine therapy, transient increases in thyroid autoantibody levels were observed. The titers of the different antibodies generally changed in parallel. In some patients a detectable level of a given antibody was found only after the radioiodine treatment, and in two cases, TgAb did not appear at all, although the two other antibodies increased temporarily. Betamethasone delayed, but did not abolish, the {sup 131}I-induced antibody peaks. Betamethasone also caused a reduction in the total serum immunoglobulin G, a reduction which persisted throughout the study period. When the study ended, 17 patients given placebo and 9 patients given betamethasone were receiving replacement therapy due to the development of hypothyroidism. These patients at this point in time had lower antibody levels than those not requiring T4. The results of this study demonstrate that betamethasone reduces and modifies the thyroid autoantibody responses as well as the outcome of radioiodine therapy in patients with Graves' disease.

  6. Hashimoto's Thyroiditis and Graves' Disease in One Patient: The Extremes of Thyroid Dysfunction Associated with Interferon Treatment.

    Bishay, R H; Chen, R C Y

    2016-01-01

    Autoimmune thyroid disease associated with interferon therapy can manifest as destructive thyroiditis, Graves' Hyperthyroidism, and autoimmune (often subclinical) hypothyroidism, the latter persisting in many patients. There are scare reports of a single patient developing extremes of autoimmune thyroid disease activated by the immunomodulatory effects of interferon. A 60-year-old man received 48 weeks of pegylated interferon and ribavirin therapy for chronic HCV. Six months into treatment, he reported fatigue, weight gain, and slowed cognition. Serum thyroid stimulating hormone (TSH) was 58.8 mIU/L [0.27-4.2], fT4 11.1 pmol/L [12-25], and fT3 4.2 pmol/L [2.5-6.0] with elevated anti-TPO (983 IU/mL [antibodies. He commenced thyroxine with initial clinical and biochemical resolution but developed symptoms of hyperthyroidism with weight loss and tremor 14 months later. Serum TSH was TSH receptor (TRAb, 4.0 U/L [antibodies. Technetium scan confirmed Graves' Disease with bilateral diffuse increased tracer uptake (5.9% [0.5-3.5%]). The patient commenced carbimazole therapy for 6 months. Treatment was ceased following spontaneous clinical and biochemical remission (TSH 3.84 mIU/L, fT4 17pmol/L, fT3 4.5 pmol/L, and TRAb <1 U/L). This raises the need to monitor thyroid function closely in patients both during and following completion of interferon treatment. PMID:27042364

  7. Anti-thyrotropin receptor antibody levels after radioiodine therapy in patients of childbearing age with Graves' disease

    Following radioiodine therapy for Graves' disease, transient elevation of anti-thyrotropin receptor antibody (TRAb) is observed. Elevation of TRAb causes neonatal hyperthyroidism. Serum TRAb levels before radioiodine therapy, 2 months to 1 year, 1 to 2 years, 2 to 3 years, and 3 to 4 years after radioiodine therapy were retrospectively analyzed in 25 women of childbearing age with Graves' disease. The normal range for TRAb is ≤15%. The one patient with serum TRAb levels <10% before radioiodine therapy did not have TRAb levels ≥50% after radioiodine therapy. However, in patients with serum TRAb levels of 10% to 30% before radioiodine therapy (n=8), TRAb were ≥50% in 75.0% 2 months to 1 year after radioiodine therapy, in 25.0% 1 to 2 years after, and in 37.5% 2 to 4 years after. In patients with serum TRAb levels of 30% to 50% before radioiodine therapy (n=3), TRAb levels were ≥50% in 33.3% 2 months to 1 year after radioiodine therapy and in 0.0% 1 to 4 years after. In patients with serum TRAb levels of 50% to 70% before radioiodine therapy (n=6), TRAb were ≥50% in 83.3% 2 months to 1 year after radioiodine therapy, in 66.6% 1 to 2 years after, and in 33.3% 2 to 4 years after. In patients with serum TRAb levels ≥70% before radioiodine therapy (n=7), TRAb levels were ≥50% in 100% 2 months to 1 year after radioiodine therapy, in 85.7% 1 to 2 years after, in 71.4% 2 to 3 years after, and in 57.1% 3 to 4 years after. Serum TRAb levels are more likely to be 50% after radioiodine therapy in patients with high serum TRAb levels before radioiodine therapy. (author)

  8. Radiation therapy for Graves' ophthalmopathy: a systematic review and meta-analysis of randomized controlled trials

    Viani, Gustavo Arruda; Stefano, Eduardo Jose [Escola de Medicina de Marilia, SP (Brazil). Radiation Oncology Department; Boin, Andre Campiolo [Escola de Medicina de Marilia, SP (Brazil); De Fendi, Ligia Issa; Fonseca, Ellen Carrara [Escola de Medicina de Marilia, SP (Brazil). Department of Ophthalmology; Paula, Jayter Silva de [Universidade de Sao Paulo (USP), Ribeirao Preto, SP (Brazil). Escola de Medicina. Department of Ophthalmology

    2012-07-01

    Purpose: To evaluate the efficacy of radiotherapy (RT) with total dose of 20 Gy (RT 20 Gy) in the treatment of Graves' ophthalmopathy. Methods: A systematic review and meta-analysis of randomized controlled trials was performed comparing RT 20 Gy with or without glucocorticoid to clinical treatments for Graves' ophthalmopathy. The Medline, Embase, Cochrane Library databases and recent relevant journals were searched. Relevant reports were reviewed by two reviewers. Response to radiotherapy was defined as clinical success according to each trial. We also evaluated the quality of life and whether RT to produce fewer side effects than other treatments. Results: A total of 8 randomized controlled trials (439 patients) were identified. In the subgroup analysis, the overall response to treatment rates was better for: RT 20 Gy plus glucocorticoid vs glucocorticoids alone, OR=17.5 (CI95% 1.85-250, p=0.04), RT 20 Gy vs sham RT, OR= 3.15 (CI95% 1.59-6.23, p=0.003) and RT 20Gy plus intravenous glucocorticoid vs RT 20Gy plus oral glucocorticoid, OR=4.15(CI95% 1.34-12.87, p=0.01). There were no differences between RT 20 Gy versus other fractionations and RT 20 Gy versus glucocorticoid alone. RT 20 Gy with or without glucocorticoids showed an improvement in diplopia grade, visual acuity, optic neuropathy, lid width, proptosis and ocular motility. No difference was seen for costs, intraocular pressure and quality of life. Conclusion: Our data have shown that RT 20 Gy should be offered as a valid therapeutic option to patients with moderate to severe ophthalmopathy. The effectiveness of orbital radiotherapy can be increased by the synergistic interaction with glucocorticoids. Moreover, RT 20 Gy is useful to improve a lot of ocular symptoms, excluding intraocular pressure, without any difference in quality of life and costs. (author)

  9. Five different types of thyroid gammagraphics images in patients with Graves's illness dealt with 131I in Paraguay

    Thyroid disease is frequent in Paraguay, a country with a prevalence of goiter 48,6% in general population located in the center of South America. Grave's disease constitutes the most common thyroid hyper function observed whose treatment can be carried out with medication (propilthiouracil, metamizole, etc.), surgery or iodine 131(131I). We analyzed 70 patients this type of hyperthyroidism treated with the 131I, in its clinical aspect pre and post treatment, ultrasound and nuclear scan findings of the gland thyroid, the hormonal respond F4, T3, TSH, thyroid antibodies TPOab, TGab, TRab. Besides the diffuse classic image observed in the thyroid scan and by ultrasonography of the gland, in Grave's disease, 4 types of images were identified with nodules (multi nodular, hot nodule, cold nodule and miliar). The group with diffuse increase in size form was the most numerous (50%) continued by the variety multi nodular (30%), Marin-Lenhart's Sx (hot nodule) 14%, miliar 3%, and cold nodule 3%. Three months after the treatment with the radioiodine was observed the decrease of the size and thyroid volume in 68% of the patients, thyroid uptake with 131I diminished in 75%. All patients had an increase of weight of 20% and 87% of then were feminine. The signs and symptoms were normalized in 88,5% of the patients. The levels of FT4 were normalized in 73, 8%, T3 in 66%, TSH in 47,7%, TPOab in 83%, TGab in 90%, and TRab in 84%.A received a single dose of 131I was used it in 93% of the patient. The cost of the 131I in the Clinic Hospital was half of the cost of the surgery, and at private level the fourth part but cheap (au)

  10. Exceptional hyperthyroidism and a role for both major histocompatibility class I and class II genes in a murine model of Graves' disease.

    Sandra M McLachlan

    Full Text Available Autoimmune hyperthyroidism, Graves' disease, can be induced by immunizing susceptible strains of mice with adenovirus encoding the human thyrotropin receptor (TSHR or its A-subunit. Studies in two small families of recombinant inbred strains showed that susceptibility to developing TSHR antibodies (measured by TSH binding inhibition, TBI was linked to the MHC region whereas genes on different chromosomes contributed to hyperthyroidism. We have now investigated TSHR antibody production and hyperthyroidism induced by TSHR A-subunit adenovirus immunization of a larger family of strains (26 of the AXB and BXA strains. Analysis of the combined AXB and BXA families provided unexpected insight into several aspects of Graves' disease. First, extreme thyroid hyperplasia and hyperthyroidism in one remarkable strain, BXA13, reflected an inability to generate non-functional TSHR antibodies measured by ELISA. Although neutral TSHR antibodies have been detected in Graves' sera, pathogenic, functional TSHR antibodies in Graves' patients are undetectable by ELISA. Therefore, this strain immunized with A-subunit-adenovirus that generates only functional TSHR antibodies may provide an improved model for studies of induced Graves' disease. Second, our combined analysis of linkage data from this and previous work strengthens the evidence that gene variants in the immunoglobulin heavy chain V region contribute to generating thyroid stimulating antibodies. Third, a broad region that encompasses the MHC region on mouse chromosome 17 is linked to the development of TSHR antibodies (measured by TBI. Most importantly, unlike other strains, TBI linkage in the AXB and BXA families to MHC class I and class II genes provides an explanation for the unresolved class I/class II difference in humans.

  11. Colchicine in the treatment of the inflammatory phase of Graves' ophthalmopathy: a prospective and randomized trial with prednisone Colchicina no tratamento da fase inflamatória da oftalmopatia de Graves: um estudo prospectivo e randomizado com prednisona

    Francisco José da Cunha Stamato

    2006-12-01

    Full Text Available PURPOSE: To investigate if colchicine is valuable in the treatment of Graves' ophthalmopathy (GO, we compared its effect with prednisone in 22 patients during the inflammatory phase of GO. METHODS: All patients, similar in age, sex and smoking habits, were euthyroid for at least 3 months and randomly divided into two groups, one treated with colchicine (1.5 mg/day and the other treated with prednisone (0.75 mg/kg/day. They were monitored with ophthalmologic assessment (clinical activity score-CAS and magnetic resonance imaging, using a signal intensity ratio (SIR of the recti muscles in comparison to the cerebral substantia alba. RESULTS: Amelioration of CAS was seen in 68% of the orbits in both groups. SIR also had a significant reduction after treatment: the initial median of 1.14 in G1 and 1.27 in G2, evolved, after treatment, to 1.07 in G1 and 0.69 in G2. The variation between both groups after treatment was not significant (p=0.22. None of the patients treated with colchicine had side effects; on the other hand, side effects in G2 were weight gain, edema, gastric complaints, hirsutism, weakness, depression, and alterations in blood pressure. CONCLUSION: Colchicine had a beneficial effect on the inflammatory phase of GO without the side effects of prednisone.OBJETIVO: Investigar se a colchicina é eficaz no tratamento da oftalmopatia de Graves, nós comparamos o seu efeito com a prednisona em 22 pacientes tratados na fase inflamatória da doença. MÉTODOS: Todos os pacientes, similares quanto à idade, sexo e hábitos de tabagismo, estavam em eutiroidismo por pelo menos três meses e foram randomizados em dois grupos. O grupo 1 (G1 recebeu colchicina (1,5 mg/dia e o grupo 2 (G2 foi tratado com prednisona (0,75 mg/kg/dia. Os pacientes foram acompanhados com avaliação oftalmológica (escore de atividade clínica - CAS e de imagem por meio da ressonância magnética, usando a relação da intensidade de sinal (SIR dos músculos reto em

  12. Autoinmunidad tiroidea: Mecanismos patogénicos comunes y distintivos en tiroiditis de Hashimoto y enfermedad de Graves Thyroid Autoimmunity: Common and Distinctive Pathogenic Mechanisms in Hashimoto's Thyroiditis and Graves' Disease

    G Astarita

    2012-09-01

    Full Text Available Las enfermedades tiroideas autoinmunes (ETA son los desórdenes más frecuentes que llevan a la disfunción de la glándula tiroidea. Incluyen varias formas clínicas como Tiroiditis de Hashimoto (TH y Enfermedad de Graves (EG. La relación entre TH y EG ha sido objeto de debate por décadas. Si bien, muy diferentes en su clínica, algunos las consideran los lados opuestos de una misma moneda. En su patogénesis tienen aspectos en común, como la predisposición genética demostrado por la ocurrencia en una misma familia y en un mismo individuo. Sin embargo, diferencias en el microambiente local determinan la diferente expresión fenotípica o el viraje de una a otra patología. El objetivo de esta monografía es investigar similitudes y diferencias entre TH y EG en las distintas etapas que llevan al desarrollo de autoinmunidad. Los autores declaran no poseer conflictos de interés.Autoimmune thyroid disease (ATD is the most common disorder that leads to thyroid gland dysfunction. ATD manifests in various clinical forms, such as Hashimoto's Thyroiditis (HT and Graves' Disease (GD. The relation between HT and GD has been discussed for decades. Even if they greatly differ in their clinical features and treatment, some people believe they are the opposite sides of the same coin. In their pathogenesis, they share some mechanisms, such as genetic susceptibility, shown by the fact that they tend to occur both in the same person and within the same family. However, differences in the local micro-environment can determine the distinct phenotypic expression or the switch from one disease to the other. The aim of this monograph was to investigate similarities and differences between HT and GD at the diverse stages leading to the development of autoimmunity. No financial conflicts of interest exist.

  13. Influence of smoking associated with stress on the outcome of radioiodine therapy in patients with Graves' disease

    Full text of publication follows. Introduction: Graves' disease (GD) is characterized by activation of the immune system as a result of interactions between genetic predisposition and environmental factors such as iodine intake, stressful events or smoking. Currently, there are no sufficient data on influence of nicotine and other components of tobacco smoking on outcome of radioiodine therapy in GD. The aim of this study was to analyze a possible influence of cigarette smoking associated with stress on the outcome of radioiodine therapy (RIT) in the patients with Graves' disease. Patients and methods: the study included 29 patients (23 female) aged from 22 to 73 years, who were subjects of a follow-up within 12 months after RIT. The stressful events were presented in all patients prior to diagnosing the GD. Patients were divided into two groups: 1. smokers - 15 patients who smoked cigarettes before, at the moment and after RIT, and 2. non-smokers - 14 patients who were always non-smokers. Patients were treated using a sliding scale of fixed activity of radioiodine according to the goiter size. Antithyroid drugs were discontinued 7 days before radioiodine therapy. Therapy outcome was assessed by serum TSH and thyroid hormones levels, and clinical evaluation. A successful response (SR) to RIT was defined as euthyroidism and subclinical or clinical hypothyroidism, and unsuccessful response (UR) as persistent hyperthyroidism. Results: comparison of age (48.0±9.39 vs. 49.6±14.3 years, P=0.715), values of TRAb (2.25±0.91 vs. 2.75±1.32 U/l, P=0.560), administered activity of 131I-NaI (365±75.8 vs. 360±44.4 MBq, P=0.832), and duration of ATDs therapy before RIT (3.34±3.41 vs. 5.06±5.81 years, P=0.397) between smokers and non-smokers showed no significant difference. There was no significant influence of smoking on UR at 3., 6., 9. and 12. month compared with UR in patients who did not smoke (P=0.597, P=0.837, P=0.876, P=0.812, χ2 test). The cumulative

  14. Neumonía grave del adulto adquirida en la comunidad SEVERE COMMUNITY-ACQUIRED PNEUMONIA IN ADULTS

    Francisco Arancibia H.

    2005-04-01

    Full Text Available El paciente con neumonía grave adquirida en la comunidad es aquel que necesita de la vigilancia y monitorización de una Unidad de Cuidados Intensivos (UCI donde, si es necesario, puede recibir apoyo especializado con conexión a un ventilador mecánico y/o soporte hemodinámico. Los pacientes que requieren tratamiento en la UCI representan entre 10 y 30% de los pacientes hospitalizados por neumonía. En esta categoría, la tasa de complicaciones, estadía en el hospital y mortalidad son elevadas. Los criterios para neumonía grave de la Sociedad Americana de Tórax (American Thoracic Society-ATS son: criterios mayores: necesidad de ventilación mecánica y presencia de shock séptico; criterios menores: presión sistólica 20 mg/dl y confusión mental. En todos los pacientes con neumonía adquirida en la comunidad se recomienda evaluar la gravedad de la infección en el momento de su admisión al hospital. Esta evaluación es preferible realizarla junto a un médico con experiencia, y si presenta criterios de mal pronóstico se sugiere trasladar precozmente a la UCI. Son útiles para esta evaluación los criterios de la ATS y los criterios de la BTS modificados (CURB. En los pacientes con neumonía grave adquirida en la comunidad se recomienda solicitar los siguientes exámenes microbiológicos: tinción de Gram y cultivo de expectoración, hemocultivos, tinción de Gram y cultivo de líquido pleural, antígeno urinario de Legionella pneumophila, antígenos de virus influenza A y B (período epidémico de otoño-invierno, y serología para microorganismos atípicos (Mycoplasma pneumoniae y Chlamydia pneumoniaePatients with severe community acquired pneumonia (CAP need continuous surveillance and monitoring at intensive care units (ICU, where they can receive specialized support as mechanical ventilation and/or hemodynamic support. Patients that require ICU admittance represent 10 to 30% of all patients interned because a pneumonia. In this

  15. Melampodium sinuatum (Asteraceae endémica del extremo sur de la península de Baja California en peligro de extinción Melampodium sinuatum (Asteraceae, an endangered endemic species to the southernmost tip of the Baja California Peninsula

    Jose Luis Villaseñor

    2011-09-01

    Full Text Available Melampodium sinuatum Brandegee, especie endémica del extremo sur del estado de Baja California Sur, México, constituye una especie poco conocida debido a su rareza y distribución restringida. No se conoce de más de 5 sitios; todos ellos amenazados por las actividades humanas. El escaso número de individuos por población, así como la estrecha superficie que abarca su área de distribución la colocan como una especie en inminente peligro de extinción, por lo que es imperativo realizar acciones encaminadas a protegerla, las que sin lugar a dudas redundarán en beneficio de otras especies también endémicas de la región donde prospera M. sinuatum e igualmente en riesgo, debido al fuerte impacto antropocéntrico, sobre todo por actividades turísticas, y para las que no existe resguardo alguno.Melampodium sinuatum Brandegee, a species endemic to the southernmost tip of the state of Baja California Sur, Mexico, is poorly known, mostly due to its rarity and narrow geographic distribution range. Historically the species has been collected at only 5 localities and all of these are currently threatened by human activities. The scarce number of individuals per population and its narrow geographic distribution contribute to this species being critically endangered, and it is urgent to carry out activities to help it escape extinction. Without a doubt, such activities will also benefit other endemic species that grow in the vicinity and similarly lack conservation strategies to protect them from the impact of touristic activities in the region.

  16. Monoclonal antibodies to the thyrotropin receptor raised by an autoantiidiotypic protocol and their relationship to monoclonal autoantibodies from Graves' patients

    Monoclonal antibodies that bind to the TSH receptor were obtained by an autoantiidiotypic approach in which immunization of BALB/c mice was performed with mixtures of bovine (b) and human (h) TSH. Two of 28 positive wells were selected for cloning and characterization: D2 and 4G11. Their antiidiotypic character was evidenced by TSH-inhibitable binding to affinity-purified polyclonal anti-TSH. The specificity of D2 and 4G11 for the hormone-binding region of the TSH receptor was demonstrated by several findings: 1) they inhibited the binding of [125I]iodo-bTSH to receptor in a dose-dependent manner; 2) their binding to partially purified thyroid plasma membranes could be completely inhibited by bTSH and hTSH; and 3) they inhibited the TSH-dependent growth and adenylate cyclase stimulation in FRTL-5 cells in a dose-dependent manner. By Western blot analysis of bovine thyroid membranes, D2 bound to a polypeptide of 188,000-195,000 mol wt under nonreducing conditions and 54,000-59,000 mol wt after treatment of membranes with beta-mercaptoethanol; the 4G11 epitope was undetectable. Scatchard analysis of the binding of 125I-labeled antibodies to receptor showed that 4G11 bound to a single site with a Kd of 5.7 X 10(-9) M, whereas D2 showed complex binding characterized by high affinity (Kd = 1.74 X 10(-11) M) and low affinity (Kd = 1.3 X 10(-8) M) sites. Binding studies in which D2 and 4G11 competed with each other for the TSH receptor showed mutual but unequal inhibition. The data suggest that portions of the D2 and 4G11 epitopes overlap, but that there is a high affinity binding site(s) for D2 for which 4G11 competes less effectively. The binding of D2 and 4G11 to TSH receptor was inhibited by monoclonal antibodies secreted by Graves' heterohybridomas, showing that D2 and 4G11 share characteristics with autoantibodies of Graves' disease

  17. Enfermedad respiratoria grave en terapia intensiva durante la pandemia por el virus de influenza A (H1N1 2009

    José Aquino-Esperanza

    2010-10-01

    Full Text Available Se describen pacientes hospitalizados en una unidad de terapia intensiva por enfermedad respiratoria aguda grave con características de influenza durante los primeros meses de la pandemia por influenza A(H1N1 2009 en la Argentina. Evaluamos datos clínicos, scores de gravedad, pruebas de laboratorio, microbiología y radiología torácica al ingreso, evolución y mortalidad hospitalaria, comparando pacientes con y sin confirmación de H1N1 por test de reacción de polimerasa en cadena, transcriptasa reversa (RT-PCR. Entre junio y julio de 2009 se internaron 31 pacientes adultos con una mediana de edad de 54 años (percentilo 25-75: 33-66. Presentaron test positivo para H1N1, 17 pacientes. Tenían al menos una condición concurrente 16 pacientes. La expresión radiográfica más frecuente fue infiltrados intersticio-alveolares bilaterales en 20 casos; 5 tenían consolidación lobar unilateral. La coinfección bacteriana (aislamiento de bacterias o IgM positiva para infecciones bacterianas, se demostró en 21 pacientes. Requirieron ventilación mecánica 23 pacientes y 18 desarrollaron síndrome de distrés respiratorio agudo (SDRA. La linfopenia y elevación de creatinina-fosfoquinasa fue frecuente (83% y 65%, respectivamente. Los 6 pacientes que murieron (19% eran mayores de 75 años o tenían cáncer o inmunodepresión. El tratamiento antiviral temprano (≤ 48 horas se asoció a menor necesidad de ventilación mecánica (54% vs. 89%; p: 0.043. No hubo diferencia significativa en las variables analizadas entre el grupo H1N1 positivo y el negativo, lo que sugiere tener igual enfoque terapéutico frente a una epidemia. La infección por H1N1 determinó falla respiratoria aguda y SDRA. La mortalidad ocurrió en pacientes añosos o con co-morbilidades graves.

  18. Sustained long-term improvement with clozapine in schizophrenia Clozapina na esquizofrenia grave: melhora duradoura e sustentada

    RICARDO DE OLIVEIRA-SOUZA

    1999-03-01

    Full Text Available The present paper reports the long-term use of clozapine in a prospective sample of 46 chronic schizophrenics. In six months, 21 subjects had been excluded for a number of reasons. In four of them the reasons for exclusion were related to lack of response or adverse effects. The median daily clozapine dose was 400 mg in the remaining 25 patients. As a whole, there were remarkable improvements in core dimensions of psychopathology, global cognitive status, and level of functioning. We confirmed that clozapine is effective in a subgroup of schizophrenics with the severest forms of the disease. If tolerated after the first few months it leads to progressive gains in several domains of behavior. Clozapine should be tried in every patient with schizophrenia in whom positive symptoms, disorganization, or bizarre behavior are a matter of incapacitation despite efforts to keep them under control with other drugs.O presente estudo, prospectivo, relata o uso de longo-prazo da clozapina em 46 esquizofrênicos graves, com mais de cinco anos de doença. Com seis meses de uso da droga, 21 indivíduos haviam sido excluídos por diversas razões. Em quatro, a exclusão se deveu a efeitos adversos ou ausência de resposta. A dose mediana de clozapina foi de 400 mg nos demais 25 pacientes. No todo, observamos melhora em dimensões de psicopatologia, estado cognitivo global, e nível funcional. Concluímos que a clozapina é eficaz em um subgrupo de esquizofrênicos com formas graves da doença. Se tolerada depois dos primeiros meses, produz benefícios progressivos em diversos domínios do comportamento. Clozapina deve ser tentada em todo paciente com esquizofrenia incapacitado por sintomas positivos, desorganização, e/ou comportamentos bizarros, que persistem a despeito de esforços para mantê-los sob controle com outras drogas.

  19. Determination of the optimal minimum radioiodine dose in patients with Graves' disease: a clinical outcome study

    Howarth, D.; Tan, P.; Booker, J. [Pacific Medical Imaging, Newcastle, NSW (Australia); Epstein, M. [Dept. of Endocrinology, John Hunter Hospital, Newcastle, NSW (Australia); Lan, L. [High-Dependency Unit, St. George Hospital, Sydney, NSW (Australia)

    2001-10-01

    The study was performed under the auspices of the International Atomic Energy Commission, Vienna, Austria, with the aim of determining the optimal minimum therapeutic dose of iodine-131 for Graves' disease. The study was designed as a single-blinded randomised prospective outcome trial. Fifty-eight patients were enrolled, consisting of 50 females and 8 males aged from 17 to 75 years. Each patient was investigated by clinical assessment, biochemical and immunological assessment, thyroid ultrasound, technetium-99m thyroid scintigraphy and 24-h thyroid {sup 131}I uptake. Patients were then randomised into two treatment groups, one receiving 60 Gy and the other receiving 90 Gy thyroid tissue absorbed dose of radioiodine. The end-point markers were clinical and biochemical response to treatment. The median follow-up period was 37.5 months (range, 24-48 months). Among the 57 patients who completed final follow-up, a euthyroid state was achieved in 26 patients (46%), 27 patients (47%) were rendered hypothyroid and four patients (7%) remained hyperthyroid. Thirty-four patients (60%) remained hyperthyroid at 6 months after the initial radioiodine dose (median dose 126 MBq), and a total of 21 patients required additional radioiodine therapy (median total dose 640 MBq; range 370-1,485 MBq). At 6-month follow-up, of the 29 patients who received a thyroid tissue dose of 90 Gy, 17 (59%) remained hyperthyroid. By comparison, of the 28 patients who received a thyroid tissue dose of 60 Gy, 17 (61%) remained hyperthyroid. No significant difference in treatment response was found (P=0.881). At 6 months, five patients in the 90-Gy group were hypothyroid, compared to two patients in the 60-Gy group (P=0.246). Overall at 6 months, non-responders to low-dose therapy had a significantly larger thyroid gland mass (respective means: 35.9 ml vs 21.9 ml) and significantly higher levels of serum thyroglobulin (respective means: 597.6 {mu}g/l vs 96.9 {mu}g/l). Where low-dose radioiodine

  20. The rs1990760 polymorphism within the IFIH1 locus is not associated with Graves' disease, Hashimoto's thyroiditis and Addison's disease

    Seidl Christian

    2009-12-01

    Full Text Available Abstract Background Three genes have been confirmed as major joint susceptibility genes for endocrine autoimmune disease:human leukocyte antigen class II, cytotoxic T-lymphocyte antigen 4 and protein tyrosine phosphatase non-receptor type 22. Recent studies showed that a genetic variation within the interferon induced helicase domain 1 (IFIH1 locus (rs1990760 polymorphism is an additional risk factor in type 1 diabetes and Graves' disease (GD. Methods The aim of the present study was to investigate the role of the rs1990760 polymorphism within the IFIH1 gene in German patients with GD (n = 258, Hashimoto's thyroiditis (HT, n = 106, Addison's disease (AD, n = 195 and healthy controls (HC, n = 227 as well as in 55 GD families (165 individuals, German and 100 HT families (300 individuals, Italian. Furthermore, the interaction between rs1990760 polymorphism with human leukocyte antigen (HLA risk haplotype DQ2(DQA*0501-DQB*0201, the risk haplotypes DQ2/DQ8 (DQA*0301-DQB*0302 and the status of thyroglobulin antibody (TgAb, thyroid peroxidase antibody (TPOAb and TSH receptor antibody (TRAb in patients and families were analysed. Results No significant differences were found between the allele and genotype frequencies for rs1990760 IFIH1 polymorphism in patients with GD, HT, AD and HC. Also no differences were observed when stratifying the IFIH1 rs1990760 polymorphism for gender, presence or absence of thyroid antibodies (GD:TRAb and HT:TPOAb/TgAb and HLA risk haplotypes (DQ2:for GD and HT, DQ2/DQ8:for AD. Furthermore the transmission analysis in GD and HT families revealed no differences in alleles transmission for rs1990760 IFIH1 from parents with or without HLA risk haplotype DQ2 to the affected offspring. In contrast, by dividing the HT parents according to the presence or absence of thyroid Ab titers, mothers and fathers both positive for TPOAb/TgAb overtransmitted the allele A of IFIH1 rs1990760 to their HT affected offspring (61.8% vs 38.2%;p = 0