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
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...
Eva Pasek de Pinto
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.
Eckstein, A; Dekowski, D; Führer-Sakel, D; Berchner-Pfannschmidt, U; Esser, J
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
Gustavo Rodríguez García
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.
Florentina Olimpia AVRAM
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
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.
Ghanem Asaad; Amr Mostafa; Araafa Lamiaa
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...
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.
Altıncık, Ayça; Gençpınar, Pınar; Demir, Korcan; Çatlı, Gönül; Abacı, Ayhan; Böber, Ece
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 ...
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
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.
Bonačić Mandinić, Maja
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...
Todo-Bom, Ana; Mota-Pinto, Anabela
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...
Umar, Husaini; Muallima, Nur; Adam, John M F; Sanusi, Harsinen
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
Rubio Cremades, Enrique
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.
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.
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.
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
Garc??a G??mez, Rodrigo Juan; Gonz??lez Jim??nez, M?? Antonia; Espinosa Mart??nez, Raquel
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...
Segarra Alberú, M.; Huerta Romero, V.; Ortiz Flores, M.
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...
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
El Fassi, Daniel; Nielsen, Claus; Hegedüs, Laszlo
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...
Patiño Villa, Milena
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...
Juan Manuel Torres Rojo; Grodecz Alfredo Ramírez Fuentes; Octavio S. Magaña Torres
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...
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 ...
Judith Ley García; Fabiola Maribel Denegri de Dios; Guadalupe Sánchez Contreras
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, ...
Perros, Petros; Žarković, Miloš; Azzolini, Claudio;
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...
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
Arpella Villalpando, Miguel Ángel; Yañez López María de Lourdes
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...
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
P. Etxeberria, J.M. Edeso, A. Brazaola
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.
Salvi, M; Campi, I
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
Al-Bakri, Moug; Rasmussen, Åse Krogh; Thomsen, Carsten;
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...
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.
Judith Ley García
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.
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
Virya Bravo Durán; Elba de la Cruz Malavassi; Gustavo Herrera Ledezma; Fernando Ramírez Muñoz
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...
Thompson, C J; Baylis, P. H.
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.
Martínez-Antolino, María Teresa
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...
Hortensia Hernández Fernández
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.
Sánchez-Migallón, S. (Sergio)
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.
Ilich Silva Peña
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.
Kim, Sun Hwa; Kim, Hee Young; Jung, Kwang Yoon; Choi, Dong Seop; Kim, Sin Gon
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...
Karolien Termote; Brigitte Decallonne; Ilse Mombaerts
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 ...
... 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....
... 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....
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
Sawicka-Gutaj, Nadia; Budny, Bartłomiej; Zybek-Kocik, Ariadna; Sowiński, Jerzy; Ziemnicka, Katarzyna; Waligórska-Stachura, Joanna; Ruchała, Marek
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
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
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)
Jesús Valdés González
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.
Virya Bravo Durán
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.
Cronin, C C
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.
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)
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
Jianhua Yan; Zhongyao Wu
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.
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...
Ruggeri, R M; Imbesi, S; Saitta, S; Campennì, A; Cannavò, S; Trimarchi, F; Gangemi, S
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
Scola Rosana Herminia
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.
Nero, Callistus; Aning, Akwasi Acheampong; Danuor, Sylvester K.; Noye, Reginald M.
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.
Samer El-Kaissi; Wall, Jack R
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...
Z Shahmoradi; Afshin Darougheh; S Misaghian
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
Esselstyn, C.B. Jr.; Schumacher, O.P.; Eversman, J.; Sheeler, L.; Levy, W.J.
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.
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)
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
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...
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
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)
Puerta, Fernando Alonso de la
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...
Samia Abdulla Bokhari
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.
Prunty, Jeremy J; Heise, Crystal D; Chaffin, David G
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
Sérgio, M.; Godinho, C; Guerra, L; Agapito, A; Fonseca, F.; Costa, C.
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...
Segui Aznar, Juana Mª
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...
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 Â«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.
Carlos Henrique de Toledo Magalhães
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
... 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...
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
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...
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.
... 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...
... 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...
Lic. Paula Morales
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.
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
García Alicia Irene
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 ...
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.
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)
Ashley, Paul; Muse, Anthony
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.
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.)
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)
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
Yang, Hua; Bi, Xiaojuan; Tang, Hong; Zeng, Juanhua; Cong, Yilei; Wu, Tengfei; Chen, Qiuye
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...
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)
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
John, Mathew; Sundrarajan, Rajasree; Gomadam, S Sridhar
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
Mazuch, Marian; Hladík, Marek
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
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
Licea Sánchez José Enrique
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.
Canto, Abigail U.; Dominguez, Paulette N.; Jimeno, Cecilia A.; Obaldo, Jerry M.; Ogbac, Ruben V.
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...
Yi, Hyon-Seung; Kim, Ji Min; Ju, Sang Hyeon; Lee, Younghak; Kim, Hyun Jin; Kim, Koon Soon
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...
Klevn?s, Alison Margaret
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 ...
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.
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.)
Nwatsock, J F; Taieb, D; Tessonnier, L; Mancini, J; Dong-A-Zok, F; Mundler, O
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
Elaiz Aparecida Mensch Buffon
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
Carle, A.; Bülow Pedersen, I.; Knudsen, N.; Perrild, H.; Ovesen, L.; Rasmussen, Lone Banke; Jørgensen, T.; Laurberg, P.
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...
González Cases, Juan Carlos
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...
Bansal, A S; Hayman, G R
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
Jakubas, Beata; Kostecka-Matyja, Marta; Darczuk, Andrzej; Gil, Justyna
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
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)
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...
Fernández-Trujillo, J. Pablo
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.
Snyder, Samuel; Govednik, Cara; Lairmore, Terry; Jiang, Da-Shu; Song, Juhee
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
Brix, T H; Kyvik, K O; Christensen, Kaare; Hegedüs, L
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...
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
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)
... 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...
... 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...
... 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...
... 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...
... 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...
... 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...
... 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...
Leary, A C
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.
Yang, Yeoree; Hwang, Seawon; Kim, Minji; Lim, Yejee; Kim, Min-Hee; Lee, Sohee; Lim, Dong-Jun; Kang, Moo-Il; Cha, Bong-Yun
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...
Baier, Waltraud; Rando, Carolyn
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
Suzuki, Yuji; Ishida, Kazuyuki; Takahashi, Hiroshi; Koeda, Norihiko; Kakisaka, Keisuke; Miyamoto, Yasuhiro; Suzuki, Akiko; Takikawa, Yasuhiro
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
Karen Glazer Peres
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.
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
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.)
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
Lakmichi, Mohamed Amine; Jarir, Redouane; Sadiki, Bader; Zehraoui,; Bentani,; Wakrim, Bader; Dahami, Zakaria; Moudouni,; Sarf, Ismail
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...
Wu, Albert Y; Chapman, William B; Witterick, Ian J; Deangelis, Dan D
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
Piantanida, E; Lai, A; Sassi, L; Gallo, D; Spreafico, E; Tanda, M L; Bartalena, L
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
Querol Palau, Maia; Bonil, Josep; Pujol, Rosa M.
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...
... 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...
van der Kaay, Daniëlle C M; Wasserman, Jonathan D; Palmert, Mark R
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
Campi, Irene; Vannucchi, Guia; Salvi, Mario
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
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)
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.
John J Clague
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.
Takamatsu, J.; Hosoya, T.; Naito, N.; Yoshimura, H.; Kohno, Y.; Tarutani, O.; Kuma, K.; Sakane, S.; Takeda, K.; Mozai, T.
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.
Molina, C. M.; Hernandez, O.; Pringle, J.
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.
Full Text Available The Hazard Analysis and Critical Control Point (HACCP is a preventive system which serves for ensuring consumerâs 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 âspecially 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.
Vogel, Asmus; Elberling, Tina V; Hørding, Merete;
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....
Scussiato, Louise Aracema
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...
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...
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
Ozawa, Yasunori; Migita, Masayoshi; Watanabe, Tomoji; Okuda, Itsuko; Takeshita, Akira; Takagi, Akio; Shishiba, Yoshimasa (Toranomon Hospital, Tokyo (Japan))
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).
JIANG Li-hong; WEI Rui-li
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.
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.)
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
Echeburúa, Enrique; Fernández Montalvo, Javier; Corral, Paz de
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...
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...
Chen, Chun-Rong; Hubbard, Paul A.; Salazar, Larry M.; McLachlan, Sandra M.; Murali, Ramachandran; Rapoport, Basil
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...
Ginsberg, J; von Westarp, C
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...
Hülya Yalçın; Bülent Akçora; Ali Balcı
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...
Indgjerd, Hallvard Rübner
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...
Yang, Yeoree; Hwang, Seawon; Kim, Minji; Lim, Yejee; Kim, Min Hee; Lee, Sohee; Lim, Dong Jun; Kang, Moo Il; Cha, Bong Yun
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
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.
Khalilzadeh, O; Anvari, M; Esteghamati, A; Momen-Heravi, F; Mahmoudi, M; Rashidi, A; Amiri, H M; Ranjbar, M; Tabataba-Vakili, S; Amirzargar, A
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
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
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.)
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
Inaba, Hidefumi; De Groot, Leslie J; Akamizu, Takashi
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
Lakmichi, Mohamed Amine; Jarir, Redouane; Sadiki, Bader; Zehraoui; Bentani; Wakrim, Bader; Dahami, Zakaria; Moudouni; Sarf, Ismail
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
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
Márcia Lait Morse
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.
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.
Cheon, Chong Kun; Kim, Su Yung; Yoo, Jae-Ho
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
Zhu-fang Tian; Bing-yin Shi; Xiao-yan Wu; Li Xu
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.
Smith, D. M.; Dutta, S.; Ahmed, F.; Thaha, M. A.
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
B. García Vila; Grau, T
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...
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)
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)
Meinert, Lotte; Willerslev, Rane; Seebach, Sophie Hooge
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...
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?
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.
Enrique Echeburúa; Javier Fernández-Montalvo; Paz de Corral
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...
de las Heras Vives, Luis
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...
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%
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
Luiz Augusto Casulari; Myrian Wesgueber; Ricardo Cassiano B. Silva; Henrique F. Soares; Lucilia Domingues
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...
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
Mukasa, Koji; Yoshimura Noh, Jaeduk; Kouzaki, Ai; Ohye, Hidemi; Kunii, Yo; Watanabe, Natsuko; Yoshihara, Ai; Matsumoto, Masako; Suzuki, Miho; Ito, Koichi
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
Smith, Terry J; Hegedüs, Laszlo; Douglas, Raymond S
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...
Banga, J Paul; Nielsen, Claus H; Gilbert, Jacqueline A;
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....
Bové, Kira Bang; Watt, Torquil; Vogel, Asmus Mejling;
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...
María Mercedes Di Virgilio
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
... 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...
... 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...
... 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,...
... 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...
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)
Yunusa, Garba H; Kotze, Tessa; Brink, Anita
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
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...
Eckstein, Anja; Loesch, Christian; Glowacka, Diana; Schott, Matthias; Mann, Klaus; Esser, Joachim; Morgenthaler, Nils G
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...
El Fassi, Daniel; Nielsen, Claus H; Bonnema, Steen J; Hasselbalch, Hans C; Hegedüs, Laszlo
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...
Matthews, David C; Syed, Akheel A
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
Paulo E. Marchiori; Milberto Scaff; Wilson Cossermelli; J. Lamartine de Assis
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.
Paulo E. Marchiori
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.
Seung Min Song
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.
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)
El Fassi, Daniel; Nielsen, Claus H; Bonnema, Steen J; Hasselbalch, Hans K; Hegedüs, Laszlo
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...
Yi, Hyon-Seung; Kim, Ji Min; Ju, Sang Hyeon; Lee, Younghak; Kim, Hyun Jin; Kim, Koon Soon
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
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)
Štefan, I.; Stránská, Petra; Vondrová, H.
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
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....
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.
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
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
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
Nielsen, Claus H; El Fassi, Daniel; Hasselbalch, Hans K;
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...
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.
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
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.
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.
Ahmed, Zulfiqar; Mai, Christine L; Elder, Badrea; Rodriguez, Samuel; Yaster, Myron
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
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
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
Banga, J Paul; Nielsen, Claus H; Gilbert, Jacqueline A; El Fassi, Daniel; Hegedus, Laszlo
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...
Vos, Xander G; Endert, Erik; Zwinderman, A H; Tijssen, Jan G P; Wiersinga, Wilmar M
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
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...
Cheon, Chong Kun; Kim, Su Yung; Yoo, Jae-Ho
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...
Sohn, Myung Hee; Jeong, Hwan Jeong; Kim, Dong Wook; Lim, Seok Tae [Chonbuk National University Medical School, Jeonju (Korea, Republic of)
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
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)
Rohrs, Henry J.; Silverstein, Janet H.; Weinstein, David A.; Amdur, Robert J.; Haller, Michael J.
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 ...
Cury, Adriano N; Meira, Verônica T; Monte, Osmar; Marone, Marília; Scalissi, Nilza M; Kochi, Cristiane; Calliari, Luís E P; Carlos A. Longui
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...
Cibulka, R.; Fabian, Marián
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
Heyma, P; Harrison, L C
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...
Elvira Barbosa Abreu
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.
Jang, Sun Young; Shin, Dong Yeob; Lee, Eun Jig; Choi, Young Joon; Lee, Sang Yeul; Yoon, Jin Sook
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...
Jones, BM; Kung, AWC
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...
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
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...
Vogel, Asmus; Elberling, Tina V; Hørding, Merete;
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...
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)
Dandung Budi Yuwono
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’.
Breese McCoy Sarah J
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...
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
Noguchi Hitoshi; Murakami Tsukasa; Uchino Shinya; Yamashita Hiroto; Noguchi Shiro
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...
Kung, AWC; Yau, CC; Cheng, A
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...
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)
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)
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
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)
Kawamura, Juichi; Tobisu, Kenichi; Sanada, Shingo (Kyoto Univ. (Japan). Faculty of Medicine)
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.
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
Marina Verçoza Viana
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.
Tomislav M. Pavlović
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.
Centanni, M; Viceconti, N; Luisi, S; Reis, F M; Gargano, L; Maiani, F; Franchi, A; Canettieri, G; Petraglia, F
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
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
Fernando Márquez Ercia
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.
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
Prasek, Karolina; Płazińska, Maria Teresa; Królicki, Leszek
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