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Sample records for abordar peligros graves

  1. ?Cuales son las amenazas o peligros volcanicos?

    Science.gov (United States)

    Myers, Bobbie; Brantley, Steven R.; Stauffer, Peter; Hendley, James W.

    2000-01-01

    Los volcanes son capaces de producir numerosos peligros geologicos e hidrologicos. Los cientificos del Servicio Geologico de los EE. UU. (USGS, por sus siglas en ingles) y de otras instituciones alrededor del mundo estan estudiando los peligros de muchos de los centenares de volcanes activos y potencialmente activos del mundo. Estos cientificos vigilan muy de cerca la actividad de algunos de los volcanes mas peligrosos, por lo que estan preparados para alertar a las autoridades y/o a la poblacion en caso de que aumente sustancialmente la probabilidad de que ocurra una erupcion u otro evento peligroso.

  2. Cinco paradigmas para abordar lo real

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    Eva Pasek de Pinto

    2006-01-01

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

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

    OpenAIRE

    Gustavo Rodríguez García

    2008-01-01

    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 p...

  4. [Graves' ophthalmopathy].

    Science.gov (United States)

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

    2016-04-01

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

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

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    Gustavo Rodríguez García

    2008-01-01

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

  6. Un nuevo enfoque para abordar el desplazamiento forzado en Colombia

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    Olga Lucía López Jaramillo

    2005-01-01

    Full Text Available Este artículo propone un nuevo enfoque para abordar un fenómeno como el desplazamiento forzado en Colombia: el enfoque de la resiliencia, con base en las teorías del estrés familiar. Se hace una reflexión acerca de la doble condición de la población más a

  7. Los peligros volcánicos del Arenal

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    Sjöbohm Castillo, Linda Marie

    2007-06-01

    Full Text Available Este estudio fue realizado con el fin de establecer los riesgos asociados al volcán Arenal y la realización y utilización de los mapas de peligros volcánicos en la planificación de las áreas circundantes. Contiene información histórica de la actividad del volcán. Presenta los objetivos fundamentales de la producción de los mapas. Identifica los tipos de peligros que presenta el volcán en la actualidad y finalmente, informa sobre la construcción de los mapas de peligros volcánicos, tanto el de corto plazo como el de largo plazo This study was developed with the purpose of establishing the risks related to the Arenal Volcano and the development and use of volcanic danger maps in the planning of the areas around. It includes historic information about the volcano activity. It presents the main objective of doing the maps. It identifies the types of dangers the volcano presents in these days. Finally, it informs about the development of volcanic dangers maps, at short and long term

  8. Graves disease (image)

    Science.gov (United States)

    Graves disease is an autoimmune disorder that involves overactivity of the thyroid gland (hyperthyroidism). Hallmarks of the condition are bulging eyes (exophthalmos), heat intolerance, increased energy, difficulty sleeping, diarrhea, and anxiety.

  9. Graves' ophthalmopathy: interdisciplinary approach

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    O I Vinogradskaya

    2010-12-01

    Full Text Available Graves' ophthalmopathy constitutes a major therapeutic challenge, so specialists of various disci-plines have to combine their forces. According to the last consensus of EUGOGO (European Group On Graves' Orbitopathy the treatment of choice for Graves' ophthalmopathy is pulses of glucocorticoid (GC. Evidence for the superiority of any of the different intravenous (iv glucocorticoid schedules is lacking. Objective: to evaluate the efficacy of two different methylprednisolone pulse therapy schedules in Graves' ophthalmopathy. Materials and Methods: 30 Graves' patients with Graves' ophthalmopathy were subcategorized into two groups: Group A subjects (n = 14 were given iv glucocorticoid daily for 5 days (total 5 g and Group B patients (n = 16 were given iv glucocorticoid weekly for 5 weeks (total 5 g. All patients were examined by the ophthalmologist before and in 1 and 12 weeks after the treatment. Results: We found that in group A visual acuity was significantly higher than in group B at 12 weeks. By 12 week proptosis, diplopia had improved as well as CAS had fallen in two groups but there were no significant differences between the two groups. Conclusion: Both schedules are effective on proptosis, soft tissue swelling. Daily pulse therapy appeared to be more effective on visual acuity. Thereby in case of active Graves' ophthalmopathy associated with impairment of visual acuity, daily pulse therapy is a treatment of choice. But, in spite of improvement, strabismus, diplopia, proptosis have a marked negative effect on quality of life, disturb a lifestyle. In these cases surgery should be considered. After end of our research two patients (3 orbits had bone decompression with a good result. We consider that eye muscle surgery is next needed to restore their binocular vision.

  10. Modeling Graves' Orbitopathy in Experimental Graves' Disease.

    Science.gov (United States)

    Banga, J P; Moshkelgosha, S; Berchner-Pfannschmidt, U; Eckstein, A

    2015-09-01

    Graves' orbitopathy (GO), also known as thyroid eye disease is an inflammatory disease of the orbital tissue of the eye that arises as a consequence of autoimmune thyroid disease. The central feature of the disease is the production of antibodies to the thyrotropin hormone receptor (TSHR) that modulate the function of the receptor leading to autoimmune hyperthyroidism and GO. Over the years, all viable preclinical models of Graves' disease have been incomplete and singularly failed to progress in the treatment of orbital complications. A new mouse model of GO based upon immunogenic presentation of human TSHR A-subunit plasmid by close field electroporation is shown to lead to induction of prolonged functional antibodies to TSHR resulting in chronic disease with subsequent progression to GO. The stable preclinical GO model exhibited pathologies reminiscent of human disease characterized by orbital remodeling by inflammation and adipogenesis. Inflammatory lesions characterized by CD3+ T cells and macrophages were localized in the orbital muscle tissue. This was accompanied by extensive adipogenesis of orbital fat in some immune animals. Surprisingly, other signs of orbital involvement were reminiscent of eyelid inflammation involving chemosis, with dilated and congested orbital blood vessels. More recently, the model is replicated in the author's independent laboratories. The pre-clinical model will provide the basis to study the pathogenic and regulatory roles of immune T and B cells and their subpopulations to understand the initiation, pathophysiology, and progression of GO.

  11. EPISTEMOLOGIA EDUCAŢIEI – O ABORDARE INTERDISCIPLINARĂ

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    Florentina Olimpia AVRAM

    2015-12-01

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

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

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    Frank Babinger

    2012-01-01

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

  13. Digging One's Own Grave

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    Arvo Krikmann

    2007-01-01

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

  14. Determination of grave disability.

    Science.gov (United States)

    Wilbert, D E; Jorstad, V; Loren, J D; Wirrer, B

    1976-01-01

    There is a historical dilemma concerning the civil rights of psychiatric patients who are believed to need a protected status because of incompetency. California's Lanterman-Petris-Short Act provides a mechanism for putting the patient under the care of a conservator if the patient is unable to provide for his own personal needs of food, clothing, and shelter. If successful, this legislation will likely be the model for the country. Fifty-one patients for whom the clinical staff desired to initiate conservatorship proceedings were given a test consisting of behavioral tasks specifically designed to be appropriate to the legal definition of grave disability. The natural groupings were: chronic organic brain syndrome, chronic schizophrenia, and other. We found that the grave disability of the organic brain syndrome patients was fairly predictable from their mental status examination, while the grave disability of the chronic schizophrenic patients was unpredictable from their mental status examination and required the application of the behavioral test for an appropriate determination of their ability to perform the functions specified in the law: The Lanterman-Petris-Short Act to provide for personal needs of food, clothing, and shelter. When the method or the proceedings were applied to patients of other diagnostic categories, they were found to be inappropriate. At this writing, our method of evaluation is being recognized and requested by public and legal agencies in our area. It has been used as evidence in court. The procedure is clear, relevant, and easily taught to new workers. The results, given in plain English and in essay form, are readily understood by physician, social worker, judge, and jury alike. We began our study with vexation, ambiguous criteria, and a chronic medical and legal problem; we conclude with a practical and relevant answer.

  15. Prevention of Graves' ophthalmopathy.

    Science.gov (United States)

    Bartalena, Luigi

    2012-06-01

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

  16. Infancia en peligro tóxico. Experiencia y negación

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    Javier Auyero

    2010-07-01

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

  17. Fisiopatologia da asma grave

    OpenAIRE

    Todo-Bom, Ana; Mota-Pinto, Anabela

    2006-01-01

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

  18. Aes grave iz Jesenica

    OpenAIRE

    Bonačić Mandinić, Maja

    2009-01-01

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

  19. Graves opthalmopathy and psychoendocrinopathies

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    Ghanem Asaad

    2010-01-01

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

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

    OpenAIRE

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

    2009-01-01

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

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

    OpenAIRE

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

    2011-01-01

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

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

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    Yexenia Viltres-Milán

    2014-10-01

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

  3. [Orbital decompression for Graves' ophthalmopathy].

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    Boulétreau, P; Breton, P; Freidel, M

    2005-04-01

    Graves' ophthalmopathy is a complex orbital condition with a controversial pathogenesis. It is the clinical expression of a discordance between the inextensible orbit and hypertrophic muscular and fatty elements within the orbit responding to immunological stimulation. The relationship between the orbital and its content can be improved by surgical expansion which increases the useful volume of the orbit. This procedure can be combined with lipectomy to decrease the volume of the orbital contents. We briefly recall the history of surgical decompression techniques and present our experience with Graves' ophthalmopathy patients.

  4. Conocimientos maternos sobre signos de peligro en diarrea aguda en el marco de la estrategia AIEPI

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    Mario Francisco Delgado

    2006-12-01

    Full Text Available Antecedentes: La Atención Integrada de las Enfermedades Prevalentes en la Infancia (AIEPI es una estrategia que busca disminuir la mortalidad por enfermedades prevalentes en menores de cinco años. En la enfermedad diarreica aguda (EDA, una de sus actividades es promocionar los conocimientos maternos sobre signos de peligro, la búsqueda oportuna de atención y las prácticas adecuadas de hidratación.Objetivo: Establecer los conocimientos maternos sobre signos de peligro en EDA en menores de 5 años y determinar prácticas de hidratación. Métodos: Estudio descriptivo por medio de una encuesta. Se aplicó un instrumento de investigaciones operativas de AIEPI, a 204 cuidadores elegidos consecutivamente que asistieron por primera vez a la consulta de crecimiento y desarrollo de un hospital de nivel I en Popayán, Colombia. Se midieron variables: edad materna, sexo, edad del niño, área (rural-urbana, estrato socioeconómico, vínculo al Sistema Nacional de Seguridad Social en Colombia, escolaridad, número de hijos, convivencia con compañero, convivencia con abuela del menor. La variable conocimientos se determinó de una manera dicotómica: la madre conocía si sabía por lo menos dos signos de peligro en EDA. Se establecieron proporciones y medias para caracterizar la población.Resultados: Del total de las madres, 54% conocen como mínimo dos signos de peligro en EDA. En caso de EDA se emplean líquidos caseros 49%, SRO 49%, suero casero 23%. El convivir con la abuela del niño se asoció significativamente con los conocimientos maternos (p <0.05.Conclusión: La mitad de las madres no conocen signos de peligro y esto hace necesario intervenciones educativas en EDA y difundir la estrategia AIEPI. En estas intervenciones es necesario incluir a las abuelas y a las madres que no conviven con ellas.

  5. Clinical evaluation of Graves ophthalmopathy

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    Janićijević-Petrović Mirjana A.

    2012-01-01

    Full Text Available Introduction. Graves ophthalmopathy is an autoimmune disease, which is the consequence of thyroid dysfunction. Ocular manifestations occur in 50% of patients with Graves disease. The changes occur due to the inflammatory cell infiltration of retrobulbar fat tissue and extraocular muscles. Ultrasonography of eye orbit provides important information about the condition of retrobulbar adipose tissue and the thickness of extraocular muscles. Objective. The aim of our study was to show the clinical significance of orbital ultrasonography in the diagnostics and follow-up of patients with Graves disease. Methods. The authors examined 154 patients with Graves ophthalmopathy at the Clinic of Ophthalmology of the Clinical Centre in Kragujevac during the period 2008–2010. Ophthalmological examination included visual acuity testing (Snellen chart, biomicroscopy and applanation tonometry, direct and indirect ophthalmoscopy, dry eye testing and exophthalmometry (Hertel. Orbital ultrasonography examination and extraorbital muscle measurement was done by ultrasound B-scan. Results. The disease was more frequent in women (79.87% aged from 36–45 years. Most patients had hyperthyreoidism (54.55%. In relation to the duration of the disease, the most frequent clinical signs were bilateral ptosis, conjunctival chemosis and periorbital edema. According to our data the highest number of patients had enlarged medial straight muscle. Conclusion. Graves ophthalmopathy is the most frequent sign of thyroid disease. By orbital ultrasonography we detected extended echogram and measured the thickness of the extraocular muscle. Computerized tomography and magnetic resonance scan were utilized for cases of insufficiently manifested clinical signs of the disease. The advantages of ultrasonography lie in easy handling, patients’ comfort, short time of examination and possibilities of repetition.

  6. Índice de peligro de incendios forestales de largo plazo

    OpenAIRE

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

    2007-01-01

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

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

    OpenAIRE

    Patiño Villa, Milena

    2015-01-01

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

  8. Infancia en peligro tóxico. Experiencia y negación

    OpenAIRE

    Javier Auyero

    2010-01-01

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

  9. Antepartal nursing management of Grave's disease.

    Science.gov (United States)

    Karacic, B

    1986-01-01

    The signs and symptoms of Grave's disease may be difficult to distinguish from the normal thyroid changes that occur in pregnancy. A brief review of thyroid physiology, thyroid changes during pregnancy, the effect of Grave's disease during pregnancy on the woman and fetus, and an assessment tool for use during the antepartal period is presented. Recommendations of specific areas of need seen in the pregnant Grave's patient during the antepartal period are also outlined. PMID:3635591

  10. Mamíferos mexicanos en peligro de extinción

    OpenAIRE

    Arpella Villalpando, Miguel Ángel; Yañez López María de Lourdes

    2011-01-01

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

  11. Un primitivo Notonychopidae (Litopterna del Paleoceno inferior de Punta Peligro, Chubut, Argentina

    Directory of Open Access Journals (Sweden)

    Morales, J.

    1997-12-01

    Full Text Available The discovery of a new ungulate species, Requisia vidmari gen. nov., nov. sp. in the lower Paleocene of Punta Peligro, Chubut (Argentine represents the earliest known record of Litopterna. The dental morphology of this new genus is very similar to that known for Notonychops powelli Soria, 1989, differing mainly by its more primitive M3, which is less elongated and less selenodont. Requisia vidmari, together with Wainka tshotshe Simpson, 1948, can be included in the family Notonychopidae, which appear to represent an ancestral grade in the evolution of Litopterna. Because cladogenesis of South American ungulates clearly took place prior to the Punta Peligro fauna and was apparently rapid, phylogenetic interpretation is difficult.Se comunica un nuevo ungulado con dentición pre-selenodonta del Paleoceno inferior, Peligrense, de Patagonia, Argentina. Su morfología dentaria es muy similar a la de Notonychops powelli Soria, 1989, pero con caracteres más primitivos. La morfología de las cúspides, el tipo de desgaste y los caracteres crescentiformes del M3 indican que Requisia vidmari gen. nov., sp. nov. presenta fuertes evidencias del desarrollo de caracteres selenodontos, por lo que se lo considera como el más primitivo representante del orden Litopterna. Requisia vidmari y probablemente Wainka tshotshe Simpson, 1948, son primitivos en relación a Notonychops, pero su similitud morfológica justificaría su inclusión en la misma familia Notonychopidae. Se considera que la radiación adaptativa de los ungulados paleocenos de América del Sur fue precoz, eventualmente rápida, lo que dificulta encontrar un modelo filogenético suficientemente explicativo.

  12. PREGO (presentation of Graves' orbitopathy) study

    DEFF Research Database (Denmark)

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

    2015-01-01

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

  13. Graves disease and atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Bello-Espinosa Ariel

    2010-06-01

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

  14. [Differential diagnosis of Graves' orbitopathy. Case report].

    Science.gov (United States)

    Erdei, Annamária; Steiber, Zita; Gazdag, Annamária; Bodor, Miklós; Berta, Eszter; Szász, Róbert; Szántó, Antónia; Ujhelyi, Bernadett; Barna, Sándor; Berényi, Ervin; Nagy, V Endre

    2016-02-21

    Graves' orbitopathy is the extrathyroidal manifestation of Graves' disease, which is the most common cause of exophthalmos. As eye symptoms usually coincide with the development of thyrotoxicosis, the diagnosis of the disease is rarely difficult. The aim of the authors was to summarize the differential diagnosis of Graves' orbitopathy based on literature review and presentation of their own four problematic cases on this topic. They conclude that symptoms similar to endocrine orbitopathy are present in other disorders. Endocrinologists need to be aware of these other conditions to avoid treatment failures.

  15. Mass Graves, Landscapes of Terror

    Directory of Open Access Journals (Sweden)

    Ferrándiz, Francisco

    2009-06-01

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

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

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

    Directory of Open Access Journals (Sweden)

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

    2005-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Judith Ley García

    2016-01-01

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

  18. Orbital Volumetry in Graves' Orbitopathy

    DEFF Research Database (Denmark)

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

    2014-01-01

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

  19. Bronze Statuettes in Roman Graves

    Directory of Open Access Journals (Sweden)

    Margherita Bolla

    2014-02-01

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

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

    Directory of Open Access Journals (Sweden)

    Jobst Wurl

    2015-01-01

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

  1. Peligro de aluviones en el departamento Pocito, provincia de San Juan

    Directory of Open Access Journals (Sweden)

    L.P. Perucca

    2005-03-01

    Full Text Available Los aluviones repentinos representan uno de los principales peligros geológicos que afectan el departamento Pocito. Las aguas de lluvias torrenciales ocurridas durante los meses de verano, pueden dar lugar, en sólo algunas horas, a violentos aluviones caracterizados por su alta velocidad, poca profundidad, gran carga de sedimentos y detritos. El fenómeno se agrava cuando se reduce el índice de infiltración debido a lluvias previas. Estos torrentes se generan en la zona montañosa, con fuerte pendiente. La extensión del área de las unidades activas en el piedemonte de la sierra de Zonda se determinó a través del estudio de fotografías aéreas y de mapas con la topografía de la zona. Las áreas activas se ubicaron topográficamente por debajo de las unidades más antiguas del piedemonte. En la planicie aluvial pedemontana, donde se encuentra la zona urbana y rural, los aluviones se han restringido a las calles 13 y 15, orientadas paralelas a la dirección de flujo. Durante las lluvias torrenciales, estas calles se convierten en verdaderos cauce fluviales, mientras que en las calles orientadas perpendicularmente a las anteriores, los daños son mayores.En este trabajo se realiza la evaluación de los aspectos hidrológicos de una cuenca de régimen torrencial, como es la del arroyo La Lechuza, causante de la mayoría de los daños en el departamento. Los efectos de estos eventos pueden ser minimizados a través del establecimiento de un sistema de predicción y alerta, de la educación pública y toma de medidas estructurales.

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

    OpenAIRE

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

    2013-01-01

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

  3. Asymptomatic Graves' disease during lithium therapy.

    OpenAIRE

    Thompson, C J; Baylis, P. H.

    1986-01-01

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

  4. Bilateral carpal tunnel syndrome in Graves' disease.

    Science.gov (United States)

    Manganelli, P; Pavesi, G; Salaffi, F

    1987-01-01

    Carpal tunnel syndrome (CTS) may be associated with endocrinopathies, such as hypothyroidism and acromegaly. A direct relationship between CTS and hyperthyroidism has recently been suggested. We now report a case in which bilateral CTS developed after treatment of Graves' disease, thus, questioning the possibility of a relationship between these two disease processes.

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

    Directory of Open Access Journals (Sweden)

    Hortensia Hernández Fernández

    2015-03-01

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

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

    Directory of Open Access Journals (Sweden)

    Ilich Silva Peña

    2014-01-01

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

  7. Analysis of CT scatnning for Graves'ophthalmopathy%Graves'眼病的CT扫描分析

    Institute of Scientific and Technical Information of China (English)

    傅德生; 许雪亮; 向前; 鲍捷; 杨春霖; 易文殊; 丁凤奎

    2003-01-01

    目的探讨CT扫描在Graves'眼病诊断中的应用价值.方法回顾性分析191例Craves,眼病CT影像资料.结果CT扫描显示眼外肌肥厚151例,眼球突出74例,眶尖密度增高50例,视神径增粗17例,筛骨纸板压迫征4例,结论因CT阳性发现率高,可作为Graves'眼病诊断的常规方法.

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

    OpenAIRE

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

    2013-01-01

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

  9. Tratamiento de la osteoporosis grave con teriparatide

    Directory of Open Access Journals (Sweden)

    Marcelo A. Sarli

    2013-10-01

    Full Text Available El objetivo de este trabajo retrospectivo fue evaluar el tratamiento de la osteoporosis grave con teriparatide (PTH y comparar nuestros resultados con los publicados en la literatura médica. Se incluyeron cuarenta y seis pacientes, cuarenta y dos mujeres y cuatro varones, edad: 69.15 ± 9.43 años. Seis eran vírgenes de tratamiento y cuarenta tratados previamente con bisfosfonatos. Treinta y dos pacientes habían tenido 93 fracturas de las cuales 86 vertebrales. Cuarenta y seis recibieron PTH 6 meses, 29 pacientes durante 12 meses y 20 completaron los 18 meses sugeridos. La densidad mineral ósea (DMO de columna lumbar aumentó significativamente desde el primer control a los 6 meses (p < 0.0001. La DMO de cuello de fémur alcanzó un incremento significativo al final del tratamiento (p = 0.002. La osteocalcina aumentó significativamente al mes, seguido por el ß crosslaps (beta-CTx, prueba en suero al tercer mes y la fosfatasa alcalina ósea, regresando los marcadores de recambio óseo a niveles basales a los 18 meses. Las calcemias y las calciurias no se modificaron significativamente, pero 8 pacientes tuvieron hipercalcemias leves y tres hipercalciurias asintomáticas. El tratamiento fue bien tolerado y no se registraron efectos adversos graves que requirieran suspender el tratamiento. En conclusión, la PTH es una alternativa útil y segura para el tratamiento de la osteoporosis grave. Nuestros resultados concuerdan con los previamente publicados en la literatura médica.

  10. 75 FR 65030 - Native American Graves Protection and Repatriation Review Committee: Nomination Solicitation

    Science.gov (United States)

    2010-10-21

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

  11. 75 FR 13140 - Native American Graves Protection and Repatriation Review Committee: Nomination Solicitation

    Science.gov (United States)

    2010-03-18

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

  12. Current insights into animal models of Graves' disease and orbitopathy.

    Science.gov (United States)

    Wiesweg, B; Johnson, K T M; Eckstein, A K; Berchner-Pfannschmidt, U

    2013-08-01

    Graves' disease (GD) is a systemic autoimmune disease that is characterized by hyperthyroidism, orbitopathy and in rare cases dermopathy. Graves' orbitopathy (GO) is an inflammatory disease of eye and orbit which occurs in about 30-60% of patients. Hyperthyroidism occurs due to the presence of stimulating TSHR-autoantibodies (TRAbs) leading to increased serum levels of thyroid hormones. Attempts to induce Graves' disease in mice by immunization against the hTSHR or its variants have resulted in production of TRAbs that stimulate thyroid follicular cells to increase thyroid hormone secretion. Graves' like orbital changes, such as inflammation, adipogenesis and muscle fibrosis are more difficult to induce. In this review we summarize different methods used to induce murine Graves'-like disease and their impact on murine orbits.

  13. Nicotinamide phosphoribosyltransferase leukocyte overexpression in Graves' opthalmopathy.

    Science.gov (United States)

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

    2016-08-01

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

  14. Outcome of Very Long-Term Treatment with Antithyroid Drugs in Graves' Hyperthyroidism Associated with Graves' Orbitopathy

    NARCIS (Netherlands)

    L. Elbers; M. Mourits; W. Wiersinga

    2011-01-01

    Background: It is still debated which treatment modality for Graves' hyperthyroidism (GH) is most appropriate when Graves' orbitopathy (GO) is present. The preference in our center has been always to continue antithyroid drugs for GH (as the block-and-replace [B-R] regimen) until all medical and/or

  15. Identificación de peligros químicos en cuencas de abastecimiento de agua como instrumento para la evaluación del riesgo

    Directory of Open Access Journals (Sweden)

    Karen Alejandra Bueno-Zabala

    2014-06-01

    Full Text Available Las cuencas de abastecimiento son la primera y principal barrera de los sistemas de abastecimiento de agua potable (SAAP y, por lo tanto, la identificación de peligros es un instrumento clave para apoyar la evaluación y gestión de los riesgos que puedan comprometer la calidad del agua potable. Este estudio identificó los peligros químicos presentes en la cuenca alta del río Cauca (Colombia, apoyándose en la construcción de matrices de priorización y en la caracterización de agua y sedimentos. De acuerdo con los usos del suelo se identificaron cinco sustancias prioritarias a controlar y 14 plaguicidas. La caracterización de los peligros químicos en agua y sedimentos mostró la presencia de algunos metales pesados y sustancias de interés sanitario que podrían representar riesgos a la salud, si los SAAP que se abastecen de esta fuente en el tramo evaluado, no cuentan con barreras de tratamiento adecuadas.

  16. Radiotherapy in the management of Graves` ophthalmopathy

    Energy Technology Data Exchange (ETDEWEB)

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

    1998-06-01

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

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

    Directory of Open Access Journals (Sweden)

    Virya Bravo Durán

    2013-03-01

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

  18. La imprescriptibilidad de la acción y la sanción disciplinaria por graves violaciones a los derechos humanos e infracciones graves al derecho internacional humanitario

    Directory of Open Access Journals (Sweden)

    Tania Milena Daza-Márquez

    2010-06-01

    Full Text Available El artículo presenta un análisis respecto a la problemática de la imprescriptibilidad de la acción y la sanción disciplinarias por graves violaciones e infracciones a los Derechos Humanos y el Derecho Internacional Humanitario, cometidos por servidores públicos, en especial, por miembros de las Fuerzas Militares y la Policía Nacional. En este estudio se abordará la regulación de la prescripción de la acción disciplinaria por estas graves conductas en los Regímenes Disciplinarios aplicables a la Fuerza Pública en los últimos treinta años y en el actual Código Único Disciplinario. Para esto se tendrá en cuenta las consecuencias de orden jurídico, político, social y económico, a nivel nacional e internacional, que puede ocasionar la declaratoria de prescripción, bien sea por la ineficiencia o el desinterés por parte de los agentes estatales en adelantar los respectivos procesos disciplinarios tendientes a evitar no sólo la impunidad en materia administrativa sancionadora, por la comisión de infracciones atroces, sino también ante la necesidad de preservar el buen nombre y la buena marcha de la administración, y a su vez, cumplir con los estándares internacionales trazados sobre la materia. Finalmente se propone una reforma legal extendiendo el término de prescripción de manera razonable, para preservar los derechos de las víctimas y los disciplinados y asegurar el cumplimiento eficaz de las obligaciones del Estado colombiano, para garantizar el cumplimiento de los compromisos internacionales sobre la materia, en defensa de los derechos humanos y del derecho internacional humanitario.

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

    LENUS (Irish Health Repository)

    Cronin, C C

    2012-02-03

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

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

    Data.gov (United States)

    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...

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

    Institute of Scientific and Technical Information of China (English)

    Jianhua Yan; Zhongyao Wu

    2003-01-01

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

  2. Successful treatment of Graves disease in pregnancy with Lugol's iodine.

    Science.gov (United States)

    Jamieson, A; Semple, C G

    2000-02-01

    We report a case of Grave's disease in pregnancy complicated by intolerance of standard antithyroid drug therapy. We describe the success of prolonged use of organic iodine as a primary treatment prior to surgical intervention. PMID:10765530

  3. Miastenia grave distal: relato de caso

    Directory of Open Access Journals (Sweden)

    Scola Rosana Herminia

    2003-01-01

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

  4. Delineation of graves using electrical resistivity tomography

    Science.gov (United States)

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

    2016-03-01

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

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

    OpenAIRE

    Z Shahmoradi; Afshin Darougheh; S Misaghian

    2005-01-01

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

  6. Hyperparathyroidism after radioactive iodine therapy for Graves disease

    Energy Technology Data Exchange (ETDEWEB)

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

    1982-11-01

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

  7. Preclinical models of Graves' disease and associated secondary complications.

    Science.gov (United States)

    Moshkelgosha, Sajad; So, Po-Wah; Diaz-Cano, Salvador; Banga, J Paul

    2015-01-01

    Autoimmune thyroid disease is the most common organ-specific autoimmune disorder which consists of two opposing clinical syndromes, Hashimoto's thyroiditis and Graves' (hyperthyroidism) disease. Graves' disease is characterized by goiter, hyperthyroidism, and the orbital complication known as Graves' orbitopathy (GO), or thyroid eye disease. The hyperthyroidism in Graves' disease is caused by stimulation of function of thyrotropin hormone receptor (TSHR), resulting from the production of agonist antibodies to the receptor. A variety of induced mouse models of Graves' disease have been developed over the past two decades, with some reproducible models leading to high disease incidence of autoimmune hyperthyroidism. However, none of the models show any signs of the orbital manifestation of GO. We have recently developed an experimental mouse model of GO induced by immunization of the plasmid encoded ligand binding domain of human TSHR cDNA by close field electroporation that recapitulates the orbital pathology in GO. As in human GO patients, immune mice with hyperthyroid or hypothyroid disease induced by anti-TSHR antibodies exhibited orbital pathology and chemosis, characterized by inflammation of orbital muscles and extensive adipogenesis leading to expansion of the orbital retrobulbar space. Magnetic resonance imaging of the head region in immune mice showed a significant expansion of the orbital space, concurrent with proptosis. This review discusses the different strategies for developing mouse models in Graves' disease, with a particular focus on GO. Furthermore, it outlines how this new model will facilitate molecular investigations into pathophysiology of the orbital disease and evaluation of new therapeutic interventions.

  8. La construcción social del peligro y el género en los jornaleros agrícolas del poblado Miguel Alemán, México

    Directory of Open Access Journals (Sweden)

    José E. Calvario Parra

    2016-01-01

    Full Text Available El objetivo de la presente investigación es analizar los discursos y prácticas de jornaleros agrícolas de una localidad en Sonora, el poblado Miguel Alemán, en torno a la construcción social del peligro y el género. Por medio de un estudio de corte cualitativo, se analizan y discuten los relatos de los entrevistados respecto a las actividades de trabajo, sus definiciones sobre el peligro y sus prácticas de cuidado. Se advierten diferencias en la división del trabajo entre varones y mujeres, y con ello las prácticas y discursos sobre el peligro. Se conjugan normativas de género y condiciones laborales (deficiencia en la organización, presencia de fauna nociva y exposición a clima extremo para la construcción social del peligro. Se concluye que existen atisbos de modelos de género que estarían influyendo en la percepción del peligro, ya sea para prevenir o realizar acciones osadas.

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

    OpenAIRE

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

    2015-01-01

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

  10. Color-flow Doppler sonography in Graves disease: "thyroid inferno".

    Science.gov (United States)

    Ralls, P W; Mayekawa, D S; Lee, K P; Colletti, P M; Radin, D R; Boswell, W D; Halls, J M

    1988-04-01

    Graves disease is a common diffuse abnormality of the thyroid gland usually characterized by thyrotoxicosis. We performed color-flow Doppler sonography in 16 patients with Graves disease and compared the results with those in 15 normal volunteers and 14 patients with other thyroid diseases (eight with multinodular goiter, four with focal masses, and two with papillary thyroid carcinoma). All 16 Graves disease patients exhibited a pulsatile pattern we call "thyroid inferno." This pattern consists of multiple small areas of intrathyroidal flow seen diffusely throughout the gland in both systole and diastole. In systole, both high-velocity flow (color coded white) and lower velocity flow (color coded red and blue) were noted. In diastole, fewer areas of flow and lower velocity flow were noted. Patients with Graves disease also exhibited color flow around the periphery of the gland. The inferno pattern did not occur in normal subjects or in patients with other thyroid diseases. On occasion, focal areas of intrathyroidal flow were detected in patients with multinodular goiter and focal thyroid masses. High-resolution gray-scale images did not show the small vascular channels from which the flow signal originated. Color-flow Doppler sonography shows promise as a cost-effective, noninvasive technique for diagnosing Graves disease.

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

    Directory of Open Access Journals (Sweden)

    Samia Abdulla Bokhari

    2016-01-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

  13. Comparative evaluation of oculometric variables in graves' ophthalmopathy

    Directory of Open Access Journals (Sweden)

    Hélio Amante Miot

    2009-01-01

    Full Text Available OBJECTIVES: To estimate oculometric parameters of Graves' ophthalmopathy in comparison to healthy eyes using digital photography and digital image analysis. INTRODUCTION: Graves' ophthalmopathy is the main cause of eye proptosis. Because these protrusions cause clinically perceived distortions in orbital architecture, digital photographs can be used to detect and quantify these changes. METHODS: We carried out a cross-sectional study comprising 12 healthy volunteers and 15 Graves' ophthalmopathy patients with the purpose of evaluating the use of simple, non-invasive digital photography to estimate oculometric parameters of Graves' ophthalmopathy and compare them with the parameters of unaffected eyes. Facial photographs of cases and controls were taken in a standardized manner. Oculometric parameters were compared between the groups and then correlated to proptometer measures. RESULTS: All estimated oculometric variables showed significant differences between the groups, in particular with regard to mediopupilar aperture, lateral height, distance from the iris edge to the lateral boundary of the palpebral fissure, and distance from the higher point of the iris to the lateral limit of the palpebral fissure. The product of medial aperture and horizontal palpebral fissure also revealed greater discrepancy between the groups. Proptometer measures showed significant linear correlation between the distance from the iris edge to the lateral boundary of the palpebral fissure and between the distance from the higher point of the iris to the lateral limit of palpebral fissure (p<0.05. CONCLUSIONS: Comparative analysis of oculometric parameters in Graves' ophthalmopathy suggests that eye proptosis is related to an asymmetric increase in lateral oculometric measures. Standardized digital photographs can be used in clinical practice to objectively estimate oculometric parameters of Graves' ophthalmopathy patients.

  14. TSH Anti-Receptor Antibodies in Graves' Disease

    OpenAIRE

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

    1996-01-01

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

  15. Messiniense: compleja y grave crisis ecologica

    Directory of Open Access Journals (Sweden)

    Aguirre, E.

    2003-08-01

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

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

    Directory of Open Access Journals (Sweden)

    Carlos Henrique de Toledo Magalhães

    2008-04-01

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

  17. 78 FR 22292 - Native American Graves Protection and Repatriation Review Committee: Notice of Nomination...

    Science.gov (United States)

    2013-04-15

    ... 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...

  18. 77 FR 65406 - Native American Graves Protection and Repatriation Review Committee: Notice of Nomination...

    Science.gov (United States)

    2012-10-26

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

  19. Selenium and the Course of Mild Graves' Orbitopathy

    NARCIS (Netherlands)

    C. Marcocci; G.J. Kahaly; G.E. Krassas; L. Bartalena; M. Prummel; M. Stahl; M.A. Altea; M. Nardi; S. Pitz; K. Boboridis; P. Sivelli; G. von Arx; M.P. Mourits; L. Baldeschi; W. Bencivelli; W. Wiersinga

    2011-01-01

    Background Oxygen free radicals and cytokines play a pathogenic role in Graves' orbitopathy. Methods We carried out a randomized, double-blind, placebo-controlled trial to determine the effect of selenium (an antioxidant agent) or pentoxifylline (an antiinflammatory agent) in 159 patients with mild

  20. Radiotherapy for Graves' orbitopathy : randomised placebo-controlled study

    NARCIS (Netherlands)

    Mourits, MP; van Kempen-Harteveld, ML; Garcia, MBG; Koppeschaar, HPF; Tick, L; Terwee, CB

    2000-01-01

    Background The best treatment (steroids, irradiation, or both) for moderately severe Graves' orbitopathy, a self-limiting disease is not known. We tested the efficacy of external beam irradiation compared with sham-irradiation. Methods In a double-blind randomised clinical trial, 30 patients with mo

  1. Measuring disease activity to predict therapeutic outcome in Graves' ophthalmopathy

    NARCIS (Netherlands)

    Terwee, C.B.; Prummel, M.F.; Gerding, M.N.; Kahaly, G.J.; Dekker, F.W.; Wiersinga, W.M.

    2005-01-01

    OBJECTIVE: The concept of disease activity in Graves' ophthalmopathy (GO) might explain why as many as one-third of patients do not respond to immunosuppressive treatment, because only patients in the active stage of disease are expected to respond. The hypothesis was adopted that a parameter used t

  2. 78 FR 21410 - Native American Graves Protection and Repatriation Review Committee: Meetings

    Science.gov (United States)

    2013-04-10

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

  3. 78 FR 5205 - Native American Graves Protection and Repatriation Review Committee Findings Related to the...

    Science.gov (United States)

    2013-01-24

    ... National Park Service Native American Graves Protection and Repatriation Review Committee Findings Related...: National Park Service, Interior. ACTION: Native American Graves Protection and Repatriation Review... responsibilities pursuant to the Native American Graves Protection and Repatriation Act (25 U.S.C. 3006 (g))....

  4. 77 FR 23196 - Native American Graves Protection and Repatriation Act Regulations

    Science.gov (United States)

    2012-04-18

    ... 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 Graves... implementing the Native American ] Graves Protection and Repatriation Act for purposes of factual accuracy...

  5. 77 FR 65407 - Native American Graves Protection and Repatriation Review Committee: Notice of Nomination...

    Science.gov (United States)

    2012-10-26

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

  6. 75 FR 62320 - Safety Zone; Fireworks for USS GRAVELY Commissioning Ceremony, Cape Fear River, Wilmington, NC

    Science.gov (United States)

    2010-10-08

    ... SECURITY Coast Guard 33 CFR Part 165 RIN 1625-AA00 Safety Zone; Fireworks for USS GRAVELY Commissioning..., NC in support of the Fireworks for the USS GRAVELY Commissioning Ceremony. This action is necessary... area. Basis and Purpose On November 19, 2010, the USS GRAVELY Commissioning Committee will sponsor...

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

    OpenAIRE

    García Alicia Irene

    2010-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Lic. Paula Morales

    2000-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Virya Bravo-Durán

    2015-07-01

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

  10. Future Prospects for the Treatment of Graves' Hyperthyroidism and Eye Disease.

    Science.gov (United States)

    Neumann, S; Place, R F; Krieger, C C; Gershengorn, M C

    2015-09-01

    Although there are adequate therapies for Graves' hyperthyroidism, mild to moderate Graves' orbitopathy (GO) is usually treated symptomatically whereas definitive therapy is reserved for severe, vision-threatening GO. Importantly, none of the treatment regimens for Graves' disease used today are directed at the pathogenesis of the disease. Herein, we review some aspects of what is known about the pathogenesis of these 2 major components of Graves' disease, specifically the apparent important roles of the TSH and IGF-1 receptors, and thereafter describe future therapeutic approaches directed at these receptors. We propose that targeting these receptors will yield effective and better tolerated treatments for Graves' disease, especially for GO.

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

    DEFF Research Database (Denmark)

    Carle, A.; Bülow Pedersen, I.; Knudsen, N.;

    2013-01-01

    . CONCLUSIONS: Moderate alcohol consumption is associated with a considerable reduction in the risk of Graves' disease with hyperthyroidism - irrespective of age and sex. Autoimmune thyroid disease seems to be much more dependent on environmental factors than hitherto anticipated.......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...... with 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...

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

    Energy Technology Data Exchange (ETDEWEB)

    Ashley, Paul; Muse, Anthony

    2008-02-01

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

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

    International Nuclear Information System (INIS)

    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.)

  14. Mixoma atrial gigante simulando estenose mitral grave em paciente jovem

    Directory of Open Access Journals (Sweden)

    Eric Paiva Vilela

    2010-10-01

    Full Text Available Homem de 20 anos, previamente hígido, com quadro clínico de dispneia paroxística noturna e cansaço aos médios esforços com evolução em torno de dez dias, apresentou, ao exame ecocardiográfico, mixoma em átrio esquerdo funcionando como estenose mitral grave.

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

    Science.gov (United States)

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

    2015-01-01

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

  16. Hyperparathyroidism after radioactive iodine therapy for Graves' disease

    International Nuclear Information System (INIS)

    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)

  17. Insuficiencia mitral grave posvalvuloplastia mitral percutánea

    Directory of Open Access Journals (Sweden)

    Julio C. Echarte Martínez

    2010-01-01

    Full Text Available RESUMENIntroducciónLa valvuloplastia mitral percutánea es en la actualidad el tratamiento de elección en pacientesportadores de estenosis mitral de etiología reumática si la anatomía es apropiada.La insuficiencia mitral grave posvalvuloplastia continúa siendo un desafío.ObjetivoDeterminar las causas de insuficiencia mitral grave posvalvuloplastia mitral.Material y métodosSe realizaron 110 valvuloplastias mitrales percutáneas en forma consecutiva en 107 pacientes(3 repetidas por reestenosis en el Instituto de Cardiología y Cirugía Cardiovascular deCuba, entre el 17 de junio de 1998 y el 30 de junio de 2004 (106 por el método de Inoue y 4por Multitrack; el tiempo de evolución promedio fue de 24,6 meses (máximo 72 y mínimo1,93 meses. La insuficiencia mitral se clasificó por ecocardiografía Doppler en leve si elárea regurgitante era menor de 4 cm2, moderada si era de 4-8 cm2. y grave si era > 8 cm2 ypor ventriculografía izquierda según los criterios de Sellers. Para lograr correlación entre laclasificación por ecocardiografía Doppler color de tres grados y la de Sellers (cuatro gradosla insuficiencia mitral 1+ se consideró leve, 2+ y 3+ moderada y 4+, grave.ResultadosSe produjeron cinco insuficiencias mitrales graves posprocedimiento (4,54% del total. Tresde ellas necesitaron reemplazo valvular mitral por rotura de la valva anterior. Las dos restantesse encuentran bajo tratamiento médico.ConclusiónLos mecanismos de producción de la insuficiencia mitral posvalvuloplastia mitral percutáneason multifactoriales. Puede ocurrir en manos expertas.REV ARGENT CARDIOL 2010;78:222-227.

  18. Análisis de los principales peligros naturales y antrópicos que inciden en el turismo del sector Bahía de Vita-Bahía de Samá, Holguín, Cuba

    Directory of Open Access Journals (Sweden)

    José Enrique Licea Sánchez

    2008-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Licea Sánchez José Enrique

    2008-12-01

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

  20. Como abordar os efeitos de um tratamento ofertado em um serviço de psicanálise no âmbito público

    Directory of Open Access Journals (Sweden)

    Claudia Maria de Sousa Palma

    2011-06-01

    Full Text Available A inserção da psicanálise no âmbito público convida ao estabelecimento de novos dispositivos, próprios à condução de um tratamento psíquico, isto é, à criação de procedimentos que respondam a uma clientela específica no cenário público. Nessa via, propomos uma técnica de avaliação, orientada pelos princípios do método psicanalítico, visando abordar os efeitos terapêuticos e analíticos desses procedimentos clínicos sobre a subjetividade. A técnica de avaliação foi utilizada em uma proposta de tratamento ofertada a adultos atendidos pelo Serviço de Psicanálise do Ambulatório de Psiquiatria do Hospital das Clínicas da Unicamp. Com o estudo, objetivamos destacar a pertinência desta técnica de avaliação em uma prática clínica exercida sob novos dispositivos em instituições públicas.How to take the effects of a treatment offered in a Department of Psychoanalysis in the public institution. The insertion of psychoanalysis in the public establishment invites for the new mechanisms, in order to drive to appropriate psychological treatment, i.e., the definition of procedures to respond to a specific public scenario customer. Following this path, we propose an evaluation technique, guided by the principles of the psychoanalytic method, looking for the therapeutic and analytical effects in the clinical procedures above/on subjectivity. The evaluation technique was used in a proposal for a treatment offered to adults by the Psychoanalysis Service of the Psychiatry Ambulatory of the Clinical Hospital of Unicamp. This study aims to highlight the relevance of this technique in a clinical evaluation conducted under new arrangements in public institutions.

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

    OpenAIRE

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

    2016-01-01

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

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

    OpenAIRE

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

    2016-01-01

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

  3. Treatment of severe Graves eye disease%严重Graves眼病的治疗

    Institute of Scientific and Technical Information of China (English)

    吕新生

    2000-01-01

    @@ Graves眼病分型 Graves眼病是一种眼眶内的眼外肌和眶后脂肪结缔组织受累的自身免疫性疾病,是导致眼球突出的常见疾病.Hall等将Graves眼病分为Graves病眼型(Graves' ophthalmopathy)和眼型Graves病(ophthalmopathy Graves' disease,orbital Graves' disease).

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

    Directory of Open Access Journals (Sweden)

    Elaiz Aparecida Mensch Buffon

    2015-12-01

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

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

    Science.gov (United States)

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

    2012-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Kahraman YAĞIZ

    2009-06-01

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

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

    Directory of Open Access Journals (Sweden)

    Fernández-Trujillo, J. Pablo

    2007-12-01

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

  8. Graves-Basedow disease after allogeneic bone marrow transplantation

    International Nuclear Information System (INIS)

    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)

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

    OpenAIRE

    González Cases, Juan Carlos

    2012-01-01

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

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

    Science.gov (United States)

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

    2013-12-01

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

  11. Is Recombinant Human TSH a Trigger for Graves' Orbitopathy?

    Science.gov (United States)

    Daumerie, C; Boschi, A; Perros, P

    2012-07-01

    The pathogenesis of Graves' orbitopathy (GO) remains unknown. The hypothesis of a causal relationship between autoimmunity against the TSH receptor (TSHR) and GO is supported by clinical studies. Radioiodine treatment is associated with worsening or new onset of GO, possibly via antigen shedding or by inducing hypothyroidism. The coexistence of thyroid cancer with Graves' disease (GD) and GO is rare. Here we report 3 cases of reactivation of GO in patients who underwent treatment with recombinant human TSH (rhTSH) and radioiodine ablation. In each case, a thyroidectomy was performed to treat the GD, and an incidental thyroid cancer was discovered. In all 3 cases, reactivation of GO was observed 3-6 weeks after administration of rhTSH, despite maintaining euthyroidism, which was unaccompanied by a rise in serum TSHR antibodies after radioiodine and despite steroids in 1 of the 3 patients. These observations suggest that binding of either TSH or TSHR antibodies to the TSHR, independently of thyroid status, may be causally related to deterioration of GO. Clinicians should be aware of a possible association between rhTSH administration and reactivation of GO, which should be taken into account before prescribing rhTSH in patients with GO. Prophylactic steroids may need to be considered for patients at high risk of exacerbation of GO. PMID:24783004

  12. The 2016 European Thyroid Association/European Group on Graves' Orbitopathy Guidelines for the Management of Graves' Orbitopathy.

    Science.gov (United States)

    Bartalena, Luigi; Baldeschi, Lelio; Boboridis, Kostas; Eckstein, Anja; Kahaly, George J; Marcocci, Claudio; Perros, Petros; Salvi, Mario; Wiersinga, Wilmar M

    2016-03-01

    Graves' orbitopathy (GO) is the main extrathyroidal manifestation of Graves' disease, though severe forms are rare. Management of GO is often suboptimal, largely because available treatments do not target pathogenic mechanisms of the disease. Treatment should rely on a thorough assessment of the activity and severity of GO and its impact on the patient's quality of life. Local measures (artificial tears, ointments and dark glasses) and control of risk factors for progression (smoking and thyroid dysfunction) are recommended for all patients. In mild GO, a watchful strategy is usually sufficient, but a 6-month course of selenium supplementation is effective in improving mild manifestations and preventing progression to more severe forms. High-dose glucocorticoids (GCs), preferably via the intravenous route, are the first line of treatment for moderate-to-severe and active GO. The optimal cumulative dose appears to be 4.5-5 g of methylprednisolone, but higher doses (up to 8 g) can be used for more severe forms. Shared decision-making is recommended for selecting second-line treatments, including a second course of intravenous GCs, oral GCs combined with orbital radiotherapy or cyclosporine, rituximab or watchful waiting. Rehabilitative treatment (orbital decompression surgery, squint surgery or eyelid surgery) is needed in the majority of patients when GO has been conservatively managed and inactivated by immunosuppressive treatment. PMID:27099835

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

    OpenAIRE

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

    2015-01-01

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

  14. 75 FR 12377 - Native American Graves Protection and Repatriation Act Regulations-Disposition of Culturally...

    Science.gov (United States)

    2010-03-15

    ... Interior 43 CFR Part 10 Native American Graves Protection and Repatriation Act Regulations-- Disposition of... Part 10 RIN 1024-AD68 Native American Graves Protection and Repatriation Act Regulations--Disposition... rule with request for comments. SUMMARY: This final rule implements the Native American...

  15. 78 FR 27078 - Native American Graves Protection and Repatriation Act Regulations

    Science.gov (United States)

    2013-05-09

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

  16. 76 FR 69282 - Native American Graves Protection and Repatriation Review Committee: Meeting

    Science.gov (United States)

    2011-11-08

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

  17. 76 FR 12132 - Native American Graves Protection and Repatriation Review Committee: Meeting

    Science.gov (United States)

    2011-03-04

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

  18. 75 FR 9429 - Native American Graves Protection and Repatriation Review Committee: Meetings

    Science.gov (United States)

    2010-03-02

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

  19. 75 FR 70028 - Native American Graves Protection and Repatriation Review Committee: Meeting 2253-665

    Science.gov (United States)

    2010-11-16

    ... National Park Service Native American Graves Protection and Repatriation Review Committee: Meeting 2253-665... Federal Advisory Committee Act, 5 U.S.C. Appendix (1988), of a meeting of the Native American Graves..., in order to effect the agreed-upon disposition of Native American human remains determined to...

  20. 77 FR 7180 - Native American Graves Protection and Repatriation Review Committee: Meeting

    Science.gov (United States)

    2012-02-10

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

  1. 77 FR 53228 - Native American Graves Protection and Repatriation Review Committee: Meeting

    Science.gov (United States)

    2012-08-31

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

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

    LENUS (Irish Health Repository)

    Leary, A C

    2012-02-03

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

  3. 38 CFR 38.631 - Graves marked with a private headstone or marker.

    Science.gov (United States)

    2010-07-01

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

  4. Padrao epidemiologico das oclusopatias muito graves em adolescentes brasileiros

    Directory of Open Access Journals (Sweden)

    Karen Glazer Peres

    2013-12-01

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

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

    Directory of Open Access Journals (Sweden)

    John J Clague

    2012-09-01

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

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

    Directory of Open Access Journals (Sweden)

    PABLO POLICZER

    2012-01-01

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

  7. Estrategias pedagógicas utilizadas por profesionales vinculados al equipo territorial de salud pública de Usme para abordar la atención primaria en salud

    OpenAIRE

    Mora Torres, Milena Margoth

    2013-01-01

    Este trabajo investigativo describe las estrategias pedagógicas que utilizan los profesionales del Equipo Territorial de salud pública de Usme, para abordar la APS en la localidad, el fenómeno se aborda desde el método descriptivo transversal. La muestra estuvo conformada por 7 profesionales del Equipo de Respuesta Inicial de ciencias de la salud y Equipo de Respuesta Complementaria de áreas de ciencias de la salud , ciencias humanas, y de la salud ambiental del plan de intervenciones colecti...

  8. Changes of Regulatory T Cells in Graves' Disease

    Institute of Scientific and Technical Information of China (English)

    WANG Hongxiang; ZHAO Shi; TANG Xiaoqiong; LI Jingyuan

    2006-01-01

    The immune mechanism of Graves' diseases (GD) and the roles of regulator T cells were investigated. In 32 patients with GD (GD group) and 20 healthy volunteers (control group), flow cytometry was used to detect the proportion of CD4+CD25+ cells, MACS to isolate CD4+ CD25+ cells,RT-PCR to assay the expression of FOXP3, and ELISA to test the level of IL-10, respectively. It was found that there was no significant change in the proportion of CD4+CD25+ T cells between GD group and control group (P>0.05), while secretion of IL-10 and expression of FOXP3 in GD group were lower than control group (P<0.01 and P<0.05, respectively). In conclusion, though the proportion of regulatory T cells of peripheral blood lymphocytes in the patients with GD, the functions of them were significantly weakened, which might be a pathogenic factor in GD.

  9. [The necklace from the 660 grave in Megara Iblea].

    Science.gov (United States)

    Verger, Stéphane

    2011-01-01

    The article analyzes the 660 grave in Megara Iblea, a Greek colony in Sicily, in which a woman has been buried. On her breast a magnificent neckless was found, made of amulets recalling the travel of the sun during the summer solstice. Some objects allude to solar cults (a cock; round pendants), others seem to came from Gallia and Macedonia (summer far West and East), others recall archeological contexts such as tombs in Marvinci, in the Vardar Valley, and allude to relations with female practices of medicine and magic and to female roles characterized by extraordinary powers, due to being descendants of the Sun god. These solar symbols, joint with the discovery of many little objects, typical of children burials, allow to hypotize a relation with the cult of Mater Matuta and seem to point out a difficult or anomalous pregnancy or birth.

  10. Hypothyroidism caused by 131I treatment for Graves disease

    International Nuclear Information System (INIS)

    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

  11. Management plan and delivery of care in Graves' ophthalmopathy patients.

    Science.gov (United States)

    Yang, Morgan; Perros, Petros

    2012-06-01

    Most patients with Graves' orbitopathy have mild disease that requires no or minimal intervention. For the minority of patients with moderate or severe disease, multiple medical and surgical treatments may be required at different stages. It is crucial that such patients are monitored closely and treatments applied with care in the right sequence. Medical treatments should be used as early as possible and only during the active phase of the disease. Rehabilitative surgery is indicated in the inactive phase of the disease and should follow the sequence: surgical decompression followed by eye muscle surgery, followed by lid surgery. Delivery of care in a coordinated fashion that makes use of best available expertise is important and best implemented through a Combined Thyroid Eye clinic. PMID:22632367

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

    Science.gov (United States)

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

    2011-01-01

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

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

    Science.gov (United States)

    Campi, Irene; Vannucchi, Guia; Salvi, Mario

    2016-09-01

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

  14. Anxiety and depression are more prevalent in patients with graves' disease than in patients with nodular goitre

    DEFF Research Database (Denmark)

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

    2014-01-01

    BACKGROUND AND OBJECTIVE: Graves' disease has been associated with an increased psychiatric morbidity. It is unclarified whether this relates to Graves' disease or chronic disease per se. The aim of our study was to estimate the prevalence of anxiety and depression symptoms in patients with Grave...

  15. 76 FR 39007 - Native American Graves Protection and Repatriation Act Regulations- Definition of “Indian Tribe”

    Science.gov (United States)

    2011-07-05

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1988-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Alvarruiz, A.

    2003-03-01

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

  18. The Role of Oxidative Stress on the Pathogenesis of Graves' Disease

    Directory of Open Access Journals (Sweden)

    Miloš Žarković

    2012-01-01

    Full Text Available Graves' disease is a most common cause of hyperthyroidism. It is an autoimmune disease, and autoimmune process induces an inflammatory reaction, and reactive oxygen species (ROSs are among its products. When balance between oxidants and antioxidants is disturbed, in favour of the oxidants it is termed “oxidative stress” (OS. Increased OS characterizes Graves' disease. It seems that the level of OS is increased in subjects with Graves' ophthalmopathy compared to the other subjects with Graves' disease. Among the other factors, OS is involved in proliferation of orbital fibroblasts. Polymorphism of the 8-oxoG DNA N-glycosylase 1 (hOGG1 involved in repair of the oxidative damaged DNA increases in the risk for developing Grave's disease. Treatment with glucocorticoids reduces levels of OS markers. A recent large clinical trial evaluated effect of selenium on mild Graves' ophthalmopathy. Selenium treatment was associated with an improved quality of life and less eye involvement and slowed the progression of Graves' orbitopathy, compared to placebo.

  19. Los animales en peligro de extinción y la protección de la biodiversidad en educación infantil: una investigación

    OpenAIRE

    Astudillo García, Laura

    2016-01-01

    Este documento responde a la investigación realizada con el objetivo de averiguar los conocimientos que tienen padres, docentes en activo de Educación Infantil y estudiantes del Grado en Educación Infantil sobre los animales en peligro de extinción y la protección del medio ambiente. La investigación se ha llevado a cabo utilizando un cuestionario de preguntas abiertas de elaboración propia. Los resultados obtenidos demuestran que la mayoría de los participantes en la investigación no conoce ...

  20. Several clinical hot topics of Graves' disease during pregnancy%妊娠期Graves'病的几个临床热点问题

    Institute of Scientific and Technical Information of China (English)

    李昭英

    2011-01-01

    @@ 妊娠期Graves' 病的发生率国内外报道基本一致,大约为0.1%~0.4%[1].妊娠期Graves' 病控制不当不仅影响妊娠过程与结局,而且影响胎儿的正常发育.因此,Graves'病孕前临床治疗方法的选择、妊娠期Graves'病的鉴别诊断、甲状腺功能的判定、抗甲状腺药物的选择以及胎儿甲状腺功能的控制等都是临床医师经常遇到且非常棘手的问题.因此,对妊娠期Graves'病特殊性的探讨具有重要的临床实用价值.

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

    OpenAIRE

    Scussiato, Louise Aracema

    2013-01-01

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

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

    DEFF Research Database (Denmark)

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

    2007-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1994-09-01

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

  4. [Graves' disease: ultrasonographic, color Doppler and histological aspects].

    Science.gov (United States)

    Messina, G; Viceconti, N; Trinti, B

    1997-11-01

    The aim of the present work was to study the relationship between thyroid low echogenicity, the thyroid blood flow by color-Doppler (CD) and histological features in patients with Graves' disease (GD). Thyroid ultrasonography and CD was performed on 28 patients with GD. In 5 patients has been compared CD with histology. The thyroid volume was higher in 100% of patients with GD at the onset rather than in euthyroidism. Diffuse hypoechogenicity of the thyroid was discovered in 100% of patients with GD at the onset and it persisted in 57.1% of patients that became euthyroid after therapy. Qualitative CD resulted in different patterns that were classified as follow: pattern A ("thyroid inferno") in 17 patients (60.7%); pattern B (mildly increased of parenchymal blood flow) in 11 patients (39.3%). In the 5 histological proven cases, in the pattern A (3 cases) there was a diffuse microfollicular hyperplasia with functional activation notes. There was lymphocytic infiltration. While in the pattern B (two cases) there were a non-follicular hypercellular nodule with pseudocapsule and rare colloid. We conclude that there are two different histological types with different CD patterns in GD.

  5. Cradle-to-Grave Logistic Technologies for Exploration Missions

    Science.gov (United States)

    Broyan, James L.; Ewert, Michael K.; Shull, Sarah

    2013-01-01

    Human exploration missions under study are very limited by the launch mass capacity of exiting and planned vehicles. The logistical mass of crew items is typically considered separate from the vehicle structure, habitat outfitting, and life support systems. Consequently, crew item logistical mass is typically competing with vehicle systems for mass allocation. NASA is Advanced Exploration Systems (AES) Logistics Reduction and Repurposing (LRR) Project is developing four logistics technologies guided by a systems engineering cradle-to-grave approach to enable used crew items to augment vehicle systems. Specifically, AES LRR is investigating the direct reduction of clothing mass, the repurposing of logistical packaging, the processing of spent crew items to benefit radiation shielding and water recovery, and the conversion of trash to propulsion supply gases. The systematic implementation of these types of technologies will increase launch mass efficiency by enabling items to be used for secondary purposes and improve the habitability of the vehicle as the mission duration increases. This paper provides a description, benefits, and challenges of the four technologies under development and a status of progress at the mid ]point of the three year AES project.

  6. An unusual presenting symptom of graves' disease: myalgia.

    Science.gov (United States)

    Papanikolaou, N; Perros, P

    2013-01-01

    A 50-year-old female patient presented with severe myalgia involving her proximal muscles for 3-4 weeks. She also reported mild thyrotoxic symptoms over the same time period. Examination revealed mild thyrotoxicosis, a moderate diffuse goiter and no eye signs. The clinical picture was dominated by muscle pain and tenderness involving mainly her proximal arms and legs, her calves and her fingers, requiring opiate analgesia. Muscle power and tendon reflexes were normal. Laboratory evaluation revealed undetectable serum thyroid stimulating hormone (TSH) with raised FT4, FT3 and positive TSH receptor antibodies. Treatment with carbimazole was started. Additional laboratory investigations were negative (inflammatory markers, creatine kinase and antibodies to antinuclear antibodies, gastric parietal cell, smooth muscle, mitochondrial, dsDNA, centromere, extractable nuclear antigen (ENA) ribonucleoprotein, ENA Sm, ENA Ro, ENA Anti-La, ENA Scl70, ENA Jo-1, anti-CCP and rheumatoid factor). Further assessment in the rheumatology clinic confirmed there was no small joint tenderness or loss of range of movement of her limbs, but widespread and profound muscle tenderness of the common extensors of the forearms, biceps, trapezius, calves and thighs. She was treated symptomatically with analgesic medication and continued on carbimazole. A month later she was euthyroid and her myalgia had resolved. Hyperthyroidism has a profound effect on skeletal muscle and often leads to myopathy. Severe myalgia in association with Graves' disease is rare and resolves with the restoration of euthyroidism. PMID:24783030

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

    Institute of Scientific and Technical Information of China (English)

    JIANG Li-hong; WEI Rui-li

    2013-01-01

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

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

    OpenAIRE

    Cecilia Ljung

    2015-01-01

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

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

    OpenAIRE

    Indgjerd, Hallvard Rübner

    2014-01-01

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

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

    Science.gov (United States)

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

    2015-12-01

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

  11. Radioiodine therapy for Graves' disease: case selection and restrictions recommended to patients in North America.

    Science.gov (United States)

    Wartofsky, L

    1997-04-01

    Each of the three major therapies for Graves' disease has its own advantages, disadvantages, indications, and contraindications. Today, radioactive iodine (RAI) therapy is the most commonly employed means of therapy for Graves' disease in the United States, with approximately 70% of patients so treated after initial presentation and an additional fraction of arguably 10-15% treated with RAI after failure of antithyroid drugs or surgery. RAI therapy is acknowledged to have the clear-cut advantage of being safe, with low morbidity and cost. The indications for RAI therapy are clear and noncontroversial for most patients with Graves' disease. Moreover, RAI treatment is employed by some thyroidologists for subclinical thyrotoxicosis (normal T4 or T3 but immeasurable TSH), particularly in patients > age 45 due to risks of atrial fibrillation. RAI therapy is not considered indicated or is contraindicated during breast feeding and in pregnancy, subacute thyroiditis, postpartum thyroiditis, struma ovarii, pituitary (TSH-driven) hyperthyroidism, euthyroid, hyperthyroxinemia, and thyroid hormone resistance. Opinions vary on the use of RAI therapy in children with Graves' disease; generally, a lower age cutoff of 17 years is acceptable in most clinics. Even more controversial is whether RAI therapy in the presence of Graves' ophthalmology constitutes a risk for worsening ophthalmopathy. Resolution of this latter issue awaits more definitive studies, but RAI therapy is likely to remain the first choice for most patients with Graves' disease.

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

    Science.gov (United States)

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

    2016-01-01

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

  13. Current trends in the management of Graves' disease

    Energy Technology Data Exchange (ETDEWEB)

    Solomon, B.; Glinoer, D.; Lagasse, R.; Wartofsky, L. (Walter Reed Army Medical Center, Washington, DC (USA))

    1990-06-01

    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.

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

    Science.gov (United States)

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

    2010-09-01

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

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

    Directory of Open Access Journals (Sweden)

    L.P. Perucca

    2005-03-01

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

  16. Long-term sequential monitoring of controlled graves representing common burial scenarios with ground penetrating radar: Years 2 and 3

    Science.gov (United States)

    Schultz, John J.; Walter, Brittany S.; Healy, Carrie

    2016-09-01

    Geophysical techniques such as ground-penetrating radar (GPR) have been successfully used for forensic searches to locate clandestine graves and physical evidence. However, additional controlled research is needed to fully understand the applicability of this technology when searching for clandestine graves in various environments, soil types, and for longer periods of time post-burial. The purpose of this study was to determine the applicability of GPR for detecting controlled graves in a Spodosol representing multiple burial scenarios for Years 2 and 3 of a three-year monitoring period. Objectives included determining how different burial scenarios are factors in producing a distinctive anomalous response; determining how different GPR imagery options (2D reflection profiles and horizontal time slices) can provide increased visibility of the burials; and comparing GPR imagery between 500 MHz and 250 MHz dominant frequency antennae. The research site contained a grid with eight graves representing common forensic burial scenarios in a Spodosol, a common soil type of Florida, with six graves containing a pig carcass (Sus scrofa). Burial scenarios with grave items (a deep grave with a layer of rocks over the carcass and a carcass wrapped in a tarpaulin) produced a more distinctive response with clearer target reflections over the duration of the monitoring period compared to naked carcasses. Months with increased precipitation were also found to produce clearer target reflections than drier months, particularly during Year 3 when many grave scenarios that were not previously visible became visible after increased seasonal rainfall. Overall, the 250 MHz dominant frequency antenna imagery was more favorable than the 500 MHz. While detection of a simulated grave may be difficult to detect over time, long term detection of a grave in a Spodosol may be possible if the disturbed spodic horizon is detected. Furthermore, while grave visibility increased with the 2D

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

    Directory of Open Access Journals (Sweden)

    Márcia Lait Morse

    2011-06-01

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

  18. Severe gangrene by cold agglutinemia Gangrena grave causada por crioaglutinina

    Directory of Open Access Journals (Sweden)

    Perla Vicari

    2004-03-01

    crioaglutininemia deve ser confirmada e tratada prontamente em função da risco de possíveis complicações graves.

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

    Science.gov (United States)

    Linford, N.

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2009-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Alvarruiz, A.

    2002-09-01

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

  2. La nutrición enteral precoz en el enfermo grave

    OpenAIRE

    B. García Vila; Grau, T

    2005-01-01

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

  3. Pollen studies of textile from an Iron Age grave at Hammerum, Denmark

    DEFF Research Database (Denmark)

    Enevold, Renée

    2013-01-01

    was rewarded with a set of results which permitted detailed interpretation. Large amounts of pollen of crops and associated anthropogenic plants in the textile sample suggest that agricultural work was the primary source of the pollen embedded in the clothing. In contrast, the pollen assemblages from......This article presents the methods employed and the results obtained in pollen studies of a prehistoric grave, identifying a fascinating and productive context for pollen analyses: prehistoric textiles. The methods involved direct sampling from the grave during excavation and various measures aimed...... at minimizing the risk of contamination, thereby maximising the information gained about various aspects of contemporary prehistoric life. The example used was an Iron Age grave from Hammerum, Denmark which was found to contain very well preserved clothing. The clothing and surrounding sediment were block...

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

    International Nuclear Information System (INIS)

    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)

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

    International Nuclear Information System (INIS)

    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

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

    DEFF Research Database (Denmark)

    El Fassi, Daniel; Nielsen, Claus H; Bonnema, Steen J;

    2007-01-01

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

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

    OpenAIRE

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

    2001-01-01

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

  8. Spatial analysis and predictive modelling of clandestine graves from rearguard repression of the Spanish Civil War

    OpenAIRE

    Congram, Derek Reade

    2010-01-01

    Over 100,000 non-combatants lie in unmarked graves across Spain, victims of deliberate killings committed by the rearguard during the Spanish Civil War (1936-1939). The side of the conflict that is responsible for the killings, the “Nationalists”, won the war and set up a dictatorship that governed Spain until 1977, prohibiting investigations of the killings. In 2000, civil groups began locating and excavating the graves in an attempt to identify, repatriate and memorialize the victims. The p...

  9. The Roma: People without a Home or Grave

    Directory of Open Access Journals (Sweden)

    Vera Klopčič

    2010-12-01

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

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

    Directory of Open Access Journals (Sweden)

    María Mercedes Di Virgilio

    2012-04-01

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

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

    DEFF Research Database (Denmark)

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

    2012-01-01

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

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

    DEFF Research Database (Denmark)

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

    2008-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Seung Min Song

    2010-04-01

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

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

    Science.gov (United States)

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

    2016-02-01

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

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

    DEFF Research Database (Denmark)

    Sandvik, Kjetil; Christensen, Dorthe Refslund

    relations with the dead child and the (re)negotiating of parenthood. We understand media as a function of an object reflected in human practices and embedded and structured by the different materialities they are intertwined with. We argue that the use of media and materiality online and on the graves are...

  16. 78 FR 16295 - Native American Graves Protection and Repatriation Review Committee: Meeting

    Science.gov (United States)

    2013-03-14

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

  17. 77 FR 74874 - Native American Graves Protection and Repatriation Review Committee: Meeting

    Science.gov (United States)

    2012-12-18

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

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

    OpenAIRE

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

    2009-01-01

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

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

    DEFF Research Database (Denmark)

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

    2007-01-01

    patients with Graves' thyrotoxicosis. A control group of 34 individuals matched for age, education and premorbid intelligence was also included. At baseline all patients and control subjects were examined with psychiatric rating scales and a comprehensive neuropsychological battery. The effect of treatment...

  20. Educational Interventions Targeted at Minors in Situations of Grave Social Vulnerability and Their Families

    Science.gov (United States)

    de la Caba Collado, Mariangeles; Rojas, Isabel Bartau

    2010-01-01

    The aim of this article is to outline and assess an educational intervention programme targeted at improving the skills of families and the personal and social development of children living in situations of grave social vulnerability. The sample comprised 10 families during the first phase of the intervention and six during the second. The…

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

    DEFF Research Database (Denmark)

    El Fassi, Daniel; Nielsen, Claus H; Bonnema, Steen Joop;

    2007-01-01

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

  2. 48 CFR 352.242-72 - Native American Graves Protection and Repatriation Act.

    Science.gov (United States)

    2010-10-01

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

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

    International Nuclear Information System (INIS)

    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)

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

    DEFF Research Database (Denmark)

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

    2016-01-01

    of 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...

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

    Directory of Open Access Journals (Sweden)

    Paulo E. Marchiori

    1984-12-01

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

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

    OpenAIRE

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

    1984-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Jing Yu

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

  8. A randomized controlled trial of orbital radiotherapy versus sham irradiation in patients with mild Graves' ophthalmopathy

    NARCIS (Netherlands)

    Prummel, MF; Terwee, CB; Gerding, MN; Baldeschi, L; Mourits, MP; Blank, L; Dekker, FW; Wiersinga, WM

    2004-01-01

    Radiotherapy is often used in Graves' ophthalmopathy, but its efficacy has been doubted. We compared its efficacy with sham irradiation in mild ophthalmopathy. In a double-blind randomized trial, 44 patients received orbital irradiation, and 44 were sham-irradiated. The primary outcome was assessed

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

    DEFF Research Database (Denmark)

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

    2009-01-01

    Graves' disease (GD) is a common autoimmune disease (AID) that shares many of its susceptibility loci with other AIDs. The thyroid stimulating hormone receptor (TSHR) represents the primary autoantigen in GD, in which autoantibodies bind to the receptor and mimic its ligand, thyroid stimulating h...

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

    International Nuclear Information System (INIS)

    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

  11. The thickness of the retrobulbar portion of the optic nerve in Graves ophthalmopathy measured by ultrasound

    Directory of Open Access Journals (Sweden)

    Stefanović Ivan

    2009-01-01

    Full Text Available Introduction. The clinical diagnostic of Graves ophthalmopathy is based on the association of ocular signs and the disease of the thyroid gland. The evolution of the disease involves the development of eye globe protrusion, extraocular muscle thickening pressuring the optic nerve, which can result in its thickness. Objective. The aim of the paper is to find whether the retrobulbar optic nerve thickened and if there was a correlation between its possible thickening and the thickness of the muscles in Graves ophthalmopathy. We also wished to test the theory of compressive aetiology of such thickening using a 30-degree test. Methods. We examined 28 patients with Graves ophthalmopathy. The thickness of the retrobulbar optic nerve was measured by ultrasound on a B-scan using the Schraeder's method and by the largest thickness of the internal muscle. Results. The thickness of the retrobulbar portion of the optic nerve in the 52 analyzed eyes with signs of the disease ranged between 3.24 mm to 6.30 mm, with median of 5.13 mm, indicating that the majority of the patients had optic nerve thickening rating at this value. Forty-eight eyes had a marked retrobulbar optic nerve thickening, with the thickening over 4 mm, while in 4 eyes with signs of Graves ophthalmopathy the thickness of the optic nerve was within normal limits. We detected that 92.3% of the patients with muscular thickening also had a directly proportional thickening of the retrobulbar optic nerve. By using the 30-degree test we confirmed the diagnosis of compressive neuropathy. Conclusion. Patients with Graves ophthalmopathy and thickened muscles, also have a thickening of the retrobulbar optic nerve; the rate of the thickness directly depends on the degree of the muscular thickness. The word is of compressive neuropathy, i.e. the thickness of the optic nerve is the result of subarachnoid fluid stasis caused by the compression on the optic nerve.

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

    DEFF Research Database (Denmark)

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

    2007-01-01

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

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

    DEFF Research Database (Denmark)

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

    2007-01-01

    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......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...

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

    Directory of Open Access Journals (Sweden)

    Tara-Jane Sutcliffe

    2008-02-01

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

  15. 白细胞介素-4基因多态性与Graves'病的关系%Association of Interleukin-4 gene polymorphisms with Graves' disease

    Institute of Scientific and Technical Information of China (English)

    龚莹; 蒋玲; 江维岩; 张晓黎; 武传龙

    2003-01-01

    目的:探讨白细胞介素-4(Interleukin-4,IL-4)基因多态性与Graves'病(Graves'Disease GD)发病易感性的关系.方法:选择汉族GD患者和正常人各100例,采用序列特异性引物聚合酶链反应(PCR-SSP)检测等位基因和基因型.结果:GD组IL-4启动子区-590位置t等位基因频率明显低于对照组(8%对15.5%;P<0.05).GD组IL-4(-590)c/t杂合子基因型频率显著低于对照组(12%对25%;P<0.05).结论:在中国汉族人群中,GD患者和正常人之间存在IL-4(-590)等位基因和基因型频率分布的差异.GD患者IL-4启动子区-590位置t等位基因频率下降,可能使IL-4总的转录活性减低,通过免疫炎症反应导致GD发病.

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

    Energy Technology Data Exchange (ETDEWEB)

    Miller, J.L.

    1982-08-07

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

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

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

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

  18. GO-QOL--disease-specific quality of life questionnaire in Graves' orbitopathy.

    Science.gov (United States)

    Sawicka-Gutaj, Nadia; Bednarczuk, Tomasz; Daroszewski, Jacek; Waligórska-Stachura, Joanna; Miśkiewicz, Piotr; Sowiński, Jerzy; Bolanowski, Marek; Ruchała, Marek

    2015-01-01

    The main goal of therapy for Graves' orbitopathy (GO) is to restore visual function and to improve quality of life (QOL); therefore, the idea of self-assessment of eye changes by the patient has been developed. We developed a validated Polish version of the GO-QOL questionnaire (GO-QOLpl). As an original version we used the English version of GO-QOL, which consists of 15 questions summarised in two subscales. GO-QOLpl was translated and validated in accordance with standard principles for translation of patient-reported outcomes (PRO). GO-QOLpl is a linguistically validated version of the original GO-QOL questionnaire, which is recommended by the European Group of Graves' Orbitopathy (EUGOGO). We strongly support the use of GO-QOLpl for the assessment of QOL among Polish patients with GO in clinical practice.

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

    Institute of Scientific and Technical Information of China (English)

    李从心

    2013-01-01

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

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

    DEFF Research Database (Denmark)

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

    2008-01-01

    immunosuppression. The recent development of an induced model of experimental Graves' disease, although incomplete as it lacks the extrathyroidal manifestations, provided opportunities to investigate immune intervention strategies, including influence upon the autoreactive B and T cell players in the autoimmune...

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

    OpenAIRE

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

    2014-01-01

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

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

    OpenAIRE

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

    2012-01-01

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

  3. Espessamento do tendão muscular na oftalmopatia de Graves

    Directory of Open Access Journals (Sweden)

    Elvira Barbosa Abreu

    2011-12-01

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

  4. Management of patients with Graves' orbitopathy: initial assessment, management outside specialised centres and referral pathways.

    Science.gov (United States)

    Perros, Petros; Dayan, Colin M; Dickinson, A Jane; Ezra, Daniel; Estcourt, Stephanie; Foley, Peter; Hickey, Janis; Lazarus, John H; MacEwen, Caroline J; McLaren, Julie; Rose, Geoffrey E; Uddin, Jimmy; Vaidya, Bijay

    2015-04-01

    Graves' orbitopathy (GO) is uncommon, but responsible for considerable morbidity. A coordinated approach between healthcare professionals is required in order to meet the needs of patients. Early diagnosis can be achieved by a simple clinical assessment. Low-cost effective interventions can be initiated by generalists, which may improve outcomes. Moderate-to-severe GO should be referred to specialised centres. Recommendations for clinical diagnosis, initial management and referral pathways are highlighted. PMID:25824071

  5. The philosopher Socrates had exophthalmos (a term coined by Plato) and probably Graves' disease.

    Science.gov (United States)

    Papapetrou, Peter D

    2015-01-01

    According to a previously published theory, Socrates was afflicted with temporal lobe epilepsy since his childhood. Plato, Xenophon, and Aristoxenus described Socrates as having exophthalmos, probably diplopia, and some symptoms compatible with hyperthyroidism. Using these data, we theorize that Socrates had Graves' disease. In order to determine a cause of his temporal lobe epilepsy, we speculate that the philosopher also had autoimmune thyroiditis and Hashimoto encephalopathy during his childhood and his epilepsy may have been a sequel to this hypothesized encephalopathy.

  6. Cancer risk in patients hospitalised for Graves' disease: a population-based cohort study in Sweden

    OpenAIRE

    Shu, X; Ji, J.; Li, X; Sundquist, J.; Sundquist, K.; Hemminki, K

    2010-01-01

    Background: The possibility of an association of Graves' disease (GD) with subsequent cancers raised by certain studies. Methods: Using a database on 18 156 hospitalised GD patients, subsequent cancers were ascertained. Results: Increased risks of thyroid and parathyroid tumours were limited to the early follow-up period, which is probably a surveillance bias. Cancer sites with observed excess included the mouth and breast, in contrast to decreased risks of colon cancer, melanoma and non-Hodg...

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

    OpenAIRE

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

    2006-01-01

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

  8. Socioeconomic Disparities in the Presentation and Treatment of Graves' Disease and Thyroid Eye Disease.

    Science.gov (United States)

    Vargason, Caroline W; Chelnis, James G; Barahimi, Behin I; Mawn, Louise A

    2016-01-01

    Thyroid eye disease (TED) is an inflammatory, autoimmune orbitopathy with multifactorial etiology. Clinical presentation of TED spans a range from mild surface irritation to vision threatening compressive optic neuropathy. Potential vision loss underscores the importance of understanding genetic and environmental factors influencing the severity of TED presentation. This review will describe the classic risk factors for TED, outline treatments for Graves' disease (GD) and TED, and describe newer evidence of socioeconomic disparities in TED presentation.

  9. Cradle-to-Grave Nuclear Fuel Supply Assurance Workshop: Industry’s Potential Role

    Energy Technology Data Exchange (ETDEWEB)

    Bengelsdorf, Harold (Hal); Hund, Gretchen; Kessler, Carol E.; Mahy, Heidi A.; McGoldrick, Fred; Seward, Amy M.

    2007-09-30

    The Pacific Northwest Center for Global Security hosted a workshop on June 6, 2007 in Washington D.C. to discuss the feasibility, merits and implications of the United States offering cradle-to-grave nuclear fuel cycle services to other countries. The workshop consisted of a small group of senior individuals from the private sector, government and the national laboratories. The workshop is summarized and recommendations given.

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

    Directory of Open Access Journals (Sweden)

    Dandung Budi Yuwono

    2015-12-01

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

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

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    Fernando Márquez Ercia

    2012-02-01

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

  12. Avaliação e tratamento da hiperglicemia em pacientes graves

    Directory of Open Access Journals (Sweden)

    Marina Verçoza Viana

    2014-03-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1983-11-01

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

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

    International Nuclear Information System (INIS)

    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)

  15. Enfoque terapéutico de los traumatismos graves de los miembros

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    Roberto Joaquín del Gordo D´Amato

    2013-12-01

    Full Text Available Los traumatismos graves de miembros representan un porcentaje importante dentro de las patologías que consultan los servicios de urgencias de diversos centros hospitalarios. En la actualidad las estadísticas mundiales, nacionales y locales guardan unas proporciones similares en cuanto a frecuencia de presentación, sin embargo en países desarrollados la infraestructura en atención prehospitalaria con personal altamente calificado, permite obtener mejores resultados con respecto a atención y pronóstico de paciente politraumatizados, logrando en los últimos años una disminución significativa en cuanto a frecuencia de mortalidad. En todo traumatismo grave de miembros se requiere un manejo cuidadoso y ordenado a fin de disminuir complicaciones que en muchas ocasiones resultan verdaderamente catastróficas. Al considerar el tratamiento de traumatismos graves de miembros la amputación representa en algunas ocasiones una alternativa, sobre todo en aquellos pacientes con patologías asociadas que contribuyen a una evolución tórpida cuando se realiza reconstrucción.

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

    Directory of Open Access Journals (Sweden)

    Tomislav M. Pavlović

    2016-02-01

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

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

    International Nuclear Information System (INIS)

    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

  18. A study of the effect of seasonal climatic factors on the electrical resistivity response of three experimental graves

    Science.gov (United States)

    Jervis, John R.; Pringle, Jamie K.

    2014-09-01

    Electrical resistivity surveys have proven useful for locating clandestine graves in a number of forensic searches. However, some aspects of grave detection with resistivity surveys remain imperfectly understood. One such aspect is the effect of seasonal changes in climate on the resistivity response of graves. In this study, resistivity survey data collected over three years over three simulated graves were analysed in order to assess how the graves' resistivity anomalies varied seasonally and when they could most easily be detected. Thresholds were used to identify anomalies, and the ‘residual volume' of grave-related anomalies was calculated as the area bounded by the relevant thresholds multiplied by the anomaly's average value above the threshold. The residual volume of a resistivity anomaly associated with a buried pig cadaver showed evidence of repeating annual patterns and was moderately correlated with the soil moisture budget. This anomaly was easiest to detect between January and April each year, after prolonged periods of high net gain in soil moisture. The resistivity response of a wrapped cadaver was more complex, although it also showed evidence of seasonal variation during the third year after burial. We suggest that the observed variation in the graves' resistivity anomalies was caused by seasonal change in survey data noise levels, which was in turn influenced by the soil moisture budget. It is possible that similar variations occur elsewhere for sites with seasonal climate variations and this could affect successful detection of other subsurface features. Further research to investigate how different climates and soil types affect seasonal variation in grave-related resistivity anomalies would be useful.

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

    Directory of Open Access Journals (Sweden)

    Maria da Consolação Magalhães

    2012-06-01

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

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

    OpenAIRE

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

    2005-01-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Mohammad Pajhouhi

    1993-06-01

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

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

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    Chaitra

    2016-02-01

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

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

    International Nuclear Information System (INIS)

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

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

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    Márcia Lait Morse

    2011-06-01

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

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

    OpenAIRE

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

    2001-01-01

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

  7. Victims’ language: (noisy silences and (grave parodies to talk (unknowingly about individuals’ forced disappearance

    Directory of Open Access Journals (Sweden)

    Gabriel Gatti

    2011-07-01

    Full Text Available Based on the results of research carried out between 2005 and 2008 about social universes constructed in Argentina and Uruguay around the figure of the disappeared detainee, this piece aims to systematize several answer to one the more complex problems this repression figure bears: that of representation of facts and their consequences. This work focuses no on all possible answers, but on several of the more innovative and creative: those betting on talking about the impossibility to talk (the noisy silences, and those betting on forcing language up to its limit (grave parodies.

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

    OpenAIRE

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

    2014-01-01

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

  9. Walter Miles, Pop Warner, B. C. Graves, and the psychology of football.

    Science.gov (United States)

    Baugh, Frank G; Benjamin, Ludy T

    2006-01-01

    In 1926-1927, a graduate student, B. C. Graves, working with Stanford University psychologist Walter Miles and legendary football coach Pop Warner, conducted an investigation of variations in signal calling as they affected the charging times of football players. The study was one of two that involved Miles and the ingenious multiple chronograph that he had invented to time the reactions of seven players simultaneously. These studies represented a brief digression in the career of Miles, who certainly was no sport psychologist. They tell of an interesting collaboration between scientist and coaches that produced one of the richest studies in sport psychology in the first half of the twentieth century.

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

    OpenAIRE

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

    2013-01-01

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

  11. Systemic adverse events following rituximab therapy in patients with Graves' disease

    DEFF Research Database (Denmark)

    El Fassi, D; Nielsen, Claus Henrik; Junker, Michael Peter;

    2011-01-01

    Background and aim: Rituximab (RTX) therapy has shown promising results in Graves´ disease (GD), with or without ophthalmopathy. We examined the occurrence of adverse events in GD patients treated with RTX. Subjects and methods: Ten patients received RTX and methimazole, while ten patients received...... had the third highest increase in immunoglobulin deposition on monocytes by day 14. The arthralgias persisted in two of the patients, despite glucocorticoid rescue therapy. Conclusions: We report articular adverse events in three and gastrointestinal symptoms in two out of ten GD patients who received...

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

    OpenAIRE

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

    2014-01-01

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

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

    OpenAIRE

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

    1988-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Paulo E. Marchiori

    1988-09-01

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

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

    DEFF Research Database (Denmark)

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

    2014-01-01

    BACKGROUND: Thyroid hormones are crucial for metabolism in all tissues in humans, including the nervous system and muscles, and could thus affect handwriting, which is the synthesis of complex and fine movements. Hyperthyroidism, characterized by symptoms such as tremor and weakness, could affect...... handwriting, although this has not been studied yet. The aim of this study was to evaluate handwriting characteristics before and after therapy for hyperthyroid Graves' disease (GD). METHODS: Twenty-two patients (15 women, 7 men) with untreated GD (median age: 44 years; range: 20-70 years) were asked to write...

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

    Directory of Open Access Journals (Sweden)

    Marc PORÉE

    2005-10-01

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

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

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

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

  18. Progressive bilateral ophthalmoparesis--a case of simultaneous autoimmunity: balancing Graves' ophthalmoparesis and ocular myasthenia.

    Science.gov (United States)

    Canepa, Carlo; Venu, Maya

    2016-01-04

    A 44-year-old woman with no medical history presented with a 1-year history of horizontal diplopia, bilateral exophthalmos and progressive asymmetrical ophthalmoparesis, with no pupillary dysfunction or ptosis. Within 3 months of her initial presentation, she noticed paresis of right eye abduction, followed after 1 month with paresis of left eye abduction. Initial investigations revealed positive antiperoxidase antibodies for Graves' disease and positive AChR for myasthenia gravis. MRI of the brain showed increased intensity in bilateral inferior rectus muscles and CT of the chest showed thymic hyperplasia. Treatment with carbimazole and pyridostigmine was started, with complete resolution after 1 month.

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

    DEFF Research Database (Denmark)

    Rasmussen, Åse Krogh; Sundberg, Karin; Brocks, Vibeke;

    2011-01-01

    Treatment of Graves' disease during pregnancy with antithyroid drugs (ATDs) poses a risk of inducing hypothyroidism and, thus, development of a goiter to the fetus. PATIENT FINDINGS: We report two patients referred to our department after discovery of a fetal goiter by ultrasound examination...... in the second trimester of pregnancy. The women receiving 400¿mg/day propylthiouracil and 10¿mg/day thiamizole, respectively, had thyrotropin and total thyroxine values within the normal reference range but a lowered free thyroxine level. Fetal blood sampling by cordocentesis revealed severe fetal...

  20. Factores pronósticos en el traumatismo craneoencefálico grave

    OpenAIRE

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

    2011-01-01

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

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

    OpenAIRE

    Orrego Álvarez, José Manuel

    2014-01-01

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

  2. Graves' Disease

    Science.gov (United States)

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

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

    Science.gov (United States)

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

    1990-07-01

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

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

    Institute of Scientific and Technical Information of China (English)

    闫文博; 秦贵军

    2016-01-01

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

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

    OpenAIRE

    Aranguren Méndez, José Atilio

    2002-01-01

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

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

    OpenAIRE

    Jose Luis Villaseñor; J. Ismael Calzada; Patricia Dávila

    2011-01-01

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

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

    DEFF Research Database (Denmark)

    Sandvik, Kjetil; Christensen, Dorthe Refslund

    as they materialize on children’s graves, it is the accommodation and decoration of the graves themselves that function as media with their variety of physical objects as ritual and relational tools for communication. Based on observation studies and qualitative content analyses of both children’s graves and online...... for moving on. In the logic of this new paradigm, grief is an integration and re-integration process the aim of which is to establish and develop lasting bonds to the dead that makes it possible for the bereaved to gradually re-integrate themselves into society. This perspective implies that grieving...... here is not just to observe said practices in order to understand how parents establish and maintain relation (with the dead, with each other, with the outside world) through ways of communicating about loss, pain, bereavement and so on, but to develop, theorize and operationalize the methodology...

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

    International Nuclear Information System (INIS)

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

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

    Science.gov (United States)

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

    1995-04-01

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

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

    Science.gov (United States)

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

    2015-03-01

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

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

    International Nuclear Information System (INIS)

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

  12. Hay que poner de su parte para afrontar una enfermedad grave

    Directory of Open Access Journals (Sweden)

    Óscar Alberto Beltrán-Salazar

    2010-01-01

    Full Text Available Objetivo: describir el significado de la experiencia de estar gravemente enfermo y hospitalizado en una Unidad de Cuidado Intensivo. Metodología: investigación cualitativa basada en la teoría fundada, realizada en Medellín, Colombia, de abril a octubre de 2006; incluyó a nueve personas adultas entre 24 y 80 años que estuvieron críticamente enfermas y hospitalizadas en UCI. La entrevista en profundidad se utilizó para la recolección de información. Los datos se analizaron según el esquema propuesto por Cohen, Kahan y Steeves. Resultados: poner de su parte es necesario para afrontar una enfermedad y hace referencia a los medios personales y externos que los participantes utilizaron para aceptar y adaptarse a la enfermedad y atenuar su condición amenazante. Discusión: vivir la experiencia de padecer una enfermedad grave significó que los participantes se valieran de recursos personales internos disponibles y de algunas formas de apoyo social como la familia, la religión, los enfermeros, los amigos y conocidos e incluso de personas desconocidas. Conclusión: los recursos personales y sociales ayudan a los pacientes a afrontar las emociones que despierta una situación que no pueden resolver por sí mismos como es el padecimiento de una enfermedad grave.

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

    Directory of Open Access Journals (Sweden)

    Rocha Maria Sheila Guimarães

    2001-01-01

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

  14. The gravimeter "B-grave" for the in-situ surface gravity measurements of an asteroid

    Science.gov (United States)

    van Ruymbeke, Michel; karatekin, ozgur; rasson, jean; wielant, françois; dumont, Phillipe; Ritter, Birgit; zhu, Ping

    2016-04-01

    In the context of the preliminary study phase for the CubeSats supporting ESA's Asteroid Impact Mission (AIM) to the Didymos, we investigate a miniaturized gravimeter as part of the geophysical instrument package for the Asteroid Geophysical Explorer (AGEX). AGEX intends to land a CubeSat on the secondary object in the Didymos system, Didymoon in order to characterize the asteroid surface and internal structure A 3D compact gravimeter is developed at the Royal Observatory of Belgium. Its design allows to meter a weak 50 μm/sec² gravity field corresponding to 5 ppm of Earth gravity in a harsh environment. A system with three components mounted in an orthogonal geometry allows obtaining the gravity field in amplitude and in angular position without any requirement of levelling. B-GRAVES will use a in-situ calibration and multi-parameter approach for validation of the measurements. A laboratory simulation is induced with centrifugal forces applied to the pendulum set-up in a vertical position to reject the Earth gravity field. Signal treatment and uncertainties are discussed keeping in mind questions of thermal and vibration influence. The B-GRAVES can serve as a novel and robust instrument for future lander and rover missions .

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

    International Nuclear Information System (INIS)

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

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

    International Nuclear Information System (INIS)

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

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

    Science.gov (United States)

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

    1991-12-01

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

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

    International Nuclear Information System (INIS)

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

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

    Directory of Open Access Journals (Sweden)

    Haroldo Falcão Ramos da Cunha

    2013-03-01

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

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

    Directory of Open Access Journals (Sweden)

    Lineu Cesar Werneck

    1982-03-01

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

  1. Autoimmune thyroid diseases and Helicobacter pylori: The correlation is present only in Graves's disease

    Institute of Scientific and Technical Information of China (English)

    Vincenzo Bassi; Gennaro Marino; Alba Iengo; Olimpia Fattoruso; Crescenzo Santinelli

    2012-01-01

    AIM:To investigate the correlation between autoimmune thyroid diseases (ATDs) and the prevalence of Cag-A positive strains of Helicobacter pylori (H.pylon)in stool samples.METHODS:Authors investigated 112 consecutive Caucasian patients (48 females and 4 males with Graves' disease and 54 females and 6 males with Hashimoto's thyroiditis HT),at their first diagnosis of ATDs.Authors tested for H.pylori in stool samples using an amplified enzyme immunoassay and Cag-A in serum samples using an enzyme-linked immunoassay method (ELISA).The results were analyzed using the two-sided Fisher's exact test and the respective odds ratio (OR) was calculated.RESULTS:A marked correlation was found between the presence of H.pylori (P ≤ 0.0001,OR 6.3) and,in particular,Cag-A positive strains (P ≤ 0.005,OR 5.3)in Graves' disease,but not in Hashimoto's thyroiditis,where authors found only a correlation with Cag-A strains (P ≤ 0.005,OR 8.73) but not when H.pylori was present.CONCLUSION:The marked correlation between H.pylori and Cag-A,found in ATDs,could be dependent on the different expression of adhesion molecules in the gastric mucosa.

  2. The relationship between serum adipocytokines and Graves' ophthalmopathy: A hospital-based study.

    Science.gov (United States)

    Kim, Bo-Yeon; Mok, Ji-Oh; Kang, Sung-Koo; Jang, Sun-Young; Jung, Chan-Hee; Kim, Chul-Hee

    2016-05-31

    Adipocytokines are thought to be associated with inflammatory disorders and autoimmune diseases. However, limited information is available on the relationship between serum adipocytokine levels, Graves' disease (GD), and Graves' ophthalmopathy (GO). The present study examined the relationship between serum adipocytokine levels and GD and GO. A total of 80 patients with GD participated in this study. The medical records of patients were reviewed retrospectively. GO activity was assessed using the clinical activity score (CAS). GO severity was assessed by the modified NOSPECS classification and included soft tissue involvement, proptosis, and extraocular muscle involvement. Serum adiponectin, leptin, resistin, and retinol-binding protein 4 (RBP-4) levels were measured using commercially available enzyme-linked immunosorbent assays. The prevalence of GO was 36.3%. Serum adiponectin, leptin, and resistin levels were significantly higher in patients with GO than in those without GO. The CAS was positively correlated with serum adiponectin and leptin levels. The total eye score was positively correlated with serum adiponectin, leptin, resistin, and RBP-4 levels. A multivariate analysis revealed that serum leptin and resistin levels were associated with the presence of GO after adjusting for clinical factors. Free thyroxine was negatively correlated with serum leptin level. These results suggest that adipocytokines, such as leptin and resistin, may play a role in inflammatory and autoimmune processes of GD and GO. Future studies with larger numbers of patients are required to establish relationships between serum adipocytokines levels and GO and ascertain the role of adipocytokines in GD and GO.

  3. Thyroid peroxidase antibody positivity and triiodothyronine levels are associated with pediatric Graves' ophthalmopathy

    Institute of Scientific and Technical Information of China (English)

    Jung Hyun Lee; So Hyun Park; Dae Gyun Koh; Byung Kyu Suh

    2014-01-01

    Background: Graves' ophthalmopathy (GO) occurs commonly in children with Graves' disease (GD). However, there are limited studies on the clinical manifestations and thyroid autoantibodies in pediatric GO. The aim of this study was to investigate the prevalence and risk factors of GO in childhood GD. Methods: Clinical and biochemical data from children and adolescents with GD were retrospectively reviewed. Eighty patients under 19 years of age were included in the present study. We compared the clinical and biochemical differences between patients with and without GO. Results: Thirty-nine percent of the patients had GO, and 81% of the GO patients were females. Of these, two patients showed unilateral GO. Triiodothyronine (T3) levels were higher in GO patients than in those without GO. Anti-thyroglobulin antibody and thyroid stimulating hormone receptor antibody titers were not significantly different between the two groups. Anti-thyroid peroxidase antibody (TPO Ab) positivity was 68% in the patients with GO and only 47% in the patients without GO. In multivariate regression analysis, high T3 levels and TPO Ab positivity were related to the presence of GO. Conclusion: In children and adolescents with GD, TPO Ab positivity and high T3 levels could act as predictive factors for the presence of GO.

  4. Imaging studies for diagnosing Graves' orbitopathy and dysthyroid optic neuropathy

    Directory of Open Access Journals (Sweden)

    Allan C. Pieroni Gonçalves

    2012-11-01

    Full Text Available Although the diagnosis of Graves' orbitopathy is primarily made clinically based on laboratory tests indicative of thyroid dysfunction and autoimmunity, imaging studies, such as computed tomography, magnetic resonance imaging, ultrasound and color Doppler imaging, play an important role both in the diagnosis and follow-up after clinical or surgical treatment of the disease. Imaging studies can be used to evaluate morphological abnormalities of the orbital structures during the diagnostic workup when a differential diagnosis versus other orbital diseases is needed. Imaging may also be useful to distinguish the inflammatory early stage from the inactive stage of the disease. Finally, imaging studies can be of great help in identifying patients prone to develop dysthyroid optic neuropathy and therefore enabling the timely diagnosis and treatment of the condition, avoiding permanent visual loss. In this paper, we review the imaging modalities that aid in the diagnosis and management of Graves' orbitopathy, with special emphasis on the diagnosis of optic nerve dysfunction in this condition.

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

    Directory of Open Access Journals (Sweden)

    José Lamartine de Assis

    1976-09-01

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

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

    Directory of Open Access Journals (Sweden)

    Mario Moreno Ernesto

    1947-06-01

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

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

    Institute of Scientific and Technical Information of China (English)

    魏枫; 杜婧; 苏秀兰; 乌兰; 王津京; 霍晓静

    2008-01-01

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

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

    OpenAIRE

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

    2012-01-01

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

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

    OpenAIRE

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

    2013-01-01

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

  10. Efeito da hipertermia na pancreatite aguda grave experimental Effects of hyperthermia on experimental severe acute pancreatitis

    Directory of Open Access Journals (Sweden)

    Maurício Gustavo Ieri Yamanari

    2007-02-01

    Full Text Available OBJETIVO: O objetivo deste estudo é avaliar os efeitos da hipertermia na pancreatite aguda (PA grave experimental induzida por ácido taurocólico. MÉTODO: A PA grave foi induzida pela injeção retrógrada de ácido taurocólico a 2,5% ou 5% no ducto pancreático principal. Após a indução, os animais foram colocados numa gaiola contendo duas lâmpadas de 100 W. A temperatura corporal foi aumentada para 39,5ºC e mantida neste nível por 45 minutos. Foram estudados taxa de mortalidade em 72 horas, permeabilidade vascular no pâncreas, porcentagem de água no tecido pancreático, amilase sérica, histologia (edema, necrose acinar e infiltrado inflamatório e níveis séricos de IL-6 e IL-10. RESULTADOS: Não houve alteração em nenhum dos parâmetros avaliados. CONCLUSÃO: Não há benefício da hipertermia na PA grave experimental induzida por ácido taurocólico.OBJECTIVE: The aim of this study is to evaluate the effects of hyperthermia post-treatment on taurocholate-induced severe acute pancreatitis (AP in rats. METHOD: Severe AP was induced by retrograde injection of 2,5% or 5% taurocholate solution into the main pancreatic duct. After the AP induction, animals were heated in a cage with two 100 W lamps. Body temperature was increased to 39ºC and maintained at that level for 45 minutes. 72-hours mortality rate, amylase serum levels, histology (edema, acinar necrosis and inflammatory infiltrate, vascular permeability, pancreatic water content and serum levels of IL-6 and IL-1 were determinated. RESULTS: Hyperthermia post-treatment on severe AP showed no evidence of alteration in all evaluated parameters. CONCLUSION: The findings suggest no beneficial effect of the thermal stress on inflammatoy edema and mortality rate in taurocholate AP model.

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

    Directory of Open Access Journals (Sweden)

    Luiz Augusto Casulari

    2001-07-01

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

  12. Graves' ophthalmopathy and {sup 1}31{sup I} therapy

    Energy Technology Data Exchange (ETDEWEB)

    Marcocci, C.; Bartalena, L.; Tanda, M.L.; Manetti, L.; Dell' Unto, E.; Mazzi, B.; Rocchi, R.; Barbesino, G.; Pinchera, A. [Pisa Univ. of Pisa, Pisa (Italy). Dept. of Endocrinology and Metabolism

    1999-12-01

    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; (ii) 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

  13. Deformação miocárdica pelo speckle tracking na cardiomiopatia dilatada grave

    Directory of Open Access Journals (Sweden)

    Maria Cristina Donadio Abduch

    2012-09-01

    Full Text Available FUNDAMENTO: A alta e crescente prevalência de Cardiomiopatia Dilatada (CMD representa sério problema de saúde pública. Novas tecnologias vêm sendo utilizadas objetivando diagnósticos mais sofisticados, que melhorem a abordagem terapêutica. Nesse cenário, o Speckle Tracking (STE utiliza marcadores miocárdicos naturais para analisar a deformação sistólica do Ventrículo Esquerdo (VE. OBJETIVO: Mensurar o strain transmural longitudinal global (SG do VE através do STE em pacientes com CMD grave, comparando os resultados com indivíduos normais e com parâmetros ecocardiográficos consagrados para análise da função sistólica do VE, validando o método nessa população. MÉTODOS: Foram estudados 71 pacientes com CMD grave, (53 ± 12a, 72% homens e 20 controles (30 ± 8a, 45% homens. Foram obtidos os volumes e a FEVE pela ecocardiografia bi e tridimensional, parâmetros do Doppler, Doppler tecidual e o SG pelo STE. RESULTADOS: Comparados ao grupo controle, os volumes do VE foram maiores no grupo CMD; entretanto, a FEVE e velocidade de pico da onda E foram menores neste último. O índice de performance miocárdica foi maior entre os pacientes. As velocidades do miocárdio pelo Doppler tecidual (S', e', a' foram consideravelmente menores e a relação E/e' foi maior no grupo CMD. O SG apresentou-se diminuído no grupo CMD (-5,5% ± 2,3%, em relação aos controles (-14,0% ± 1,8%. CONCLUSÃO: No presente estudo, o SG foi significativamente menor nos pacientes com CMD grave, abrindo novas perspectivas para abordagens terapêuticas nessa população específica.

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

    International Nuclear Information System (INIS)

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

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

    OpenAIRE

    Paola Toth; Roberto Bernd

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Paola Toth

    2014-04-01

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

  17. Nye behandlinger af Graves' sygdom med fokus på det B-lymfocyt-depleterende antistof rituximab

    DEFF Research Database (Denmark)

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

    2008-01-01

    Graves' disease (GD) is caused by autoantibodies to the thyrotropin receptor (TRAb). In a controlled study using the B-lymphocyte depleting agent rituximab (RTX), an RTX-specific effect was found on long-term remission following methimazole (MMI) therapy. However, benefits were limited to patients...

  18. Migratory polyarthritis as an adverse effect of thiamazole use in a 13-year-old girl with Graves' disease

    NARCIS (Netherlands)

    Janson, J.A.; Laat, P. de; Draaisma, J.M.T.

    2015-01-01

    Graves' disease is the most prevalent cause of hyperthyroidism in children. The treatment commonly involves antithyroid therapy using a thionamide. We present a case of a 13-year-old girl with the antithyroid arthritis syndrome, presenting as a migratory polyarthritis, after the initiation of thiona

  19. In Graves' disease, increased muscle tension and reduced elasticity of affected muscles is primarily caused by active muscle contraction

    NARCIS (Netherlands)

    H.J. Simonsz (Huib); G. Kommerell (Guntram)

    1989-01-01

    textabstractIn three patients with Graves' disease of recent onset, length-tension diagrams were made during surgery for squint under eyedrop anesthesia, while the other eye looked ahead, into the field of action, or out of the field of action of the muscle that was measured. The affected muscles we

  20. Tratamento não operatório do trauma de baço grave

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    Bernardino C. Branco

    2013-06-01

    Full Text Available A reunião de revista "Telemedicina baseada em evidências - Cirurgia do Trauma e Emergência" (TBE-CiTE realizou uma revisão crítica da literatura e selecionou três artigos atuais sobre o tratamento do trauma de baço. O foco foi em lesão de baço grave, definida pela American Association for the Surgery of Trauma (AAST como graus III a V. O primeiro artigo foi uma atualização do protocolo de 2003 da Eastern Association for the Surgery of Trauma (EAST para o tratamento não operatório de trauma do baço. O segundo artigo foi apresentado na plenária de 2012 da AAST avaliando o papel do extravasamento de contraste na tomografia computadorizada em pacientes com lesão grave de baço (AAST IV-V. O último artigo é europeu e investigou o efeito da angioembolização da artéria esplênica na função do baço após lesão esplênica grave (AAST III-V. A reunião de revista TBE-CiTE elaborou conclusões e recomendações para o tratamento de lesão grave do baço.

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

    Directory of Open Access Journals (Sweden)

    V V Lazanovich

    2008-09-01

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

  2. Miastenia grave: aspectos históricos Myasthenia gravis: historical aspects

    Directory of Open Access Journals (Sweden)

    FRANCISCO MARCOS B. CUNHA

    1999-06-01

    Full Text Available Foram pesquisados aspectos históricos da miastenia grave desde as primeiras descrições da doença em 1672, pelo clínico inglês Thomas Willis. São descritas as dificuldades encontradas no manuseio dos primeiros pacientes diagnosticados. Pesquisaram-se fatos históricos ligados à investigação da doença, o tratamento, bem como curiosidades pouco citadas na literatura.We studied historical aspects of myasthenia gravis starting from its first description by the English physician, Sir Thomas Willis, in 1672. We also describe the difficulties in managing triating the first diagnosed patient. Historical facts related to the investigation and the initial treatment of this disorder as well as curiosities seldom mentioned in the literature are part of this paper.

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

    International Nuclear Information System (INIS)

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1990-05-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2003-12-01

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

  6. Grave's病患者外周血T细胞亚群变化意义

    Institute of Scientific and Technical Information of China (English)

    施毕; 成兴波; 金皆怡

    2001-01-01

    目的了解T细胞亚群在Grave's病(GD)患者治疗前后外周血中的分布情况.方法采用碱性磷酸酶-抗碱性磷酸酶桥联酶联免疫法.结果 GD治疗前、治疗6月后的CD3+T细胞、CD4+T细胞、CD4+T细胞与CD8+T细胞的比值均较正常对照组低,而C8+T细胞比正常组明显增高,差异均有显著性.结论细胞免疫在GD的发生、发展中起着重要的作用.

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

    Science.gov (United States)

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

    2012-06-01

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

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

    International Nuclear Information System (INIS)

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

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

    International Nuclear Information System (INIS)

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

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

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

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

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

    Science.gov (United States)

    Skinner, Neal G.; Maida, John L.

    2014-06-01

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

  12. Treatment of Graves' disease with rituximab specifically reduces the production of thyroid stimulating autoantibodies

    DEFF Research Database (Denmark)

    El Fassi, Daniel; Banga, J Paul; Gilbert, Jacqueline A;

    2008-01-01

    Treatment of Graves' disease (GD) with the B-lymphocyte depleting agent rituximab in addition to standard methimazole-therapy prolongs remission. Paradoxically, it does not mediate a reduction in thyrotropin receptor antibody (TRAb) levels over that of methimazole monotherapy. Using a bioassay...... involving Chinese hamster ovary cells transfected with the human thyrotropin receptor, we found that the stimulatory capacity of TRAbs was reduced markedly, by 66+/-22%, upon treatment with rituximab and methimazole for 21 days (p... methimazole alone (p=0.04 between groups). The overall levels of TRAbs decreased by around 15% in both groups. Within one year of follow-up, rituximab therapy mediated specific decreases in thyroid-peroxidase antibody- and IgM levels, whereas IgG levels were unaffected. The data indicate that rituximab...

  13. Injuria renal aguda en la sepsis grave Acute kidney injury in severe sepsis

    Directory of Open Access Journals (Sweden)

    Hernán Trimarchi

    2009-06-01

    Full Text Available La sepsis afecta al 40% de los pacientes críticos, siendo su mortalidad de aproximadamente un 30% en el caso de la sepsis grave, y de 75% con injuria renal aguda, la cual sucede en el 20-51% de los casos. Se realizó un estudio prospectivo, observacional, longitudinal, en 80 pacientes sépticos graves en el lapso de 1 año para determinar el desarrollo de injuria renal aguda y su relación con la mortalidad; correlacionar antecedentes clínicos y variaciones del laboratorio con la mortalidad; determinar la tasa de mortalidad de la sepsis grave; relacionar óbito y foco séptico primario; evaluar la predictibilidad de mortalidad según niveles de creatinina de ingreso y sus variaciones finales. Se definieron dos grupos: Obito (n = 25 y No-óbito (n = 55. Analizados según la creatinina de ingreso, 39 tenían valores normales de creatinina (10 óbitos y 41 la presentaban elevada (15 óbitos; según la creatinina de egreso, 48 presentaron creatinina normal y fallecieron 7, mientras que 32 tenían daño renal agudo, de los cuales 18 fallecieron. De los 25 pacientes fallecidos, el 72% presentaron daño renal. De éstos, 7 pacientes vivos y 2 fallecidos requirieron hemodiálisis. El foco primario más frecuente fue el respiratorio (26.4%. El desarrollo de daño renal es un alto predictor de mortalidad en la sepsis, independientemente de los valores iniciales de creatinina. Edad más avanzada, hipertensión arterial, score APACHE más elevado, anemia más grave, hipoalbuminemia, hiperfosfatemia e hiperkalemia se asociaron a mayor mortalidad. La mortalidad global fue 31.3%. La imposibilidad de identificar el foco séptico primario se asoció a mayor mortalidad. El foco respiratorio se relacionó a mayor riesgo de requerir hemodiálisis.Sepsis affects 40% of critically ill patients, with a reported mortality of approximately 30% in severe sepsis, raising to 75% when acute kidney injury ensues, which occurs in about 20-51% of cases. The present study

  14. Methylprednisolone Pulse Treatment of Graves´Ophthalmopathy is not associated with secondary Adrenocortical insufficiency

    DEFF Research Database (Denmark)

    Nygaard, Birte; Kristensen, Lars Østergaard

    2015-01-01

    Objective: Graves' ophthalmopathy (GO) is an inflammatory disease in the orbital region. The first-line medical treatment is glucocorticoids. An important potential side effect of glucocorticoid treatment is suppression of the hypothalamic-pituitary-adrenal (HPA) axis with impairment of endogenous...... cortisol production, implicating symptoms of adrenocortical insufficiency, especially in the period after cessation of therapy with possible risks in cases of intercurrent illness. The aim of this study was to evaluate HPA axis function before and after methylprednisolone pulse treatment of GO. Study...... Design: HPA axis function was evaluated by measurements of plasma ACTH and an ACTH stimulation test with plasma cortisol measurements at 0 and 30 min after an intravenous bolus of synthetic ACTH (Synacthen® 250 µg). This was done in 12 patients with GO before and at cessation of methylprednisolone pulse...

  15. Clinical evaluation of Graves ophthalmopathy in north-east Islamic Republic of Iran.

    Science.gov (United States)

    Razavi, M E; Abotoraby, R B; Kakhki, R D; Ghanavati, S Z; Layegh, P; Taghavi, M; Rajabian, M T

    2008-01-01

    This study evaluated the prevalence and severity of ophthalmic manifestations in all Graves disease patients (n = 68) presenting to endocrine clinics at Mashad University of Medical Sciences between December 2002 and September 2005. The mean age of patients was 38.0 (SD 14.0) years, range 15 to 71 years. The most common complaints were foreign body sensation (54.0%) and puffy eyelids (48.4%). The most common apparent abnormality was lid retraction in 64.2% of patients (bilateral in 95.3% of cases). The patients had a mean modified Werner's NO SPECS classification score of 3.00 (SD 1.46). The score was significantly higher in males than females [3.58 (SD 1.44) versus 2.63 (SD 1.35)] and was positively correlated with age.

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

    Directory of Open Access Journals (Sweden)

    Rivkees ScottA

    2010-08-01

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

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

    Directory of Open Access Journals (Sweden)

    Carla Amaral de Almeida

    2005-05-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2004-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Gustavo Arruda Viani

    2012-10-01

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

  20. Non-invasive management of fetal goiter during maternal treatment of hyperthyroidism in Grave's disease.

    Science.gov (United States)

    Lembet, Arda; Eroglu, Derya; Kinik, Sibel Tulgar; Gurakan, Berkan; Kuscu, Esra

    2005-01-01

    There is an increased risk of fetal goiter in patients who have a history of Grave's disease and undergo propylthiouracil (PTU) treatment during pregnancy. In this report, we describe a case of a fetal goiter detected by antenatal ultrasound at the 26th week of gestation in a mother treated with PTU for Grave's disease. A 32 x 38 x 20 mm fetal goiter was detected, each lobe measured 30 x 18 x 18 mm and estimated volume was 10 cm3. Subsequently, fetal thyroid function was assessed by umbilical fetal blood sampling. Cord blood showed elevated serum TSH (40.2 mU/l) and normal concentrations of free T4 (9.5 pmol/l) and free T3 (2.6 pmol/l). There were no other ultrasonographic signs of fetal hypothyroidism. Based on the above findings, the mother's PTU dosage was reduced to 50 mg daily from a total of 150 mg and weekly ultrasonographic examinations were performed. Six weeks after the initial ultrasound, a complete regression of the fetal goiter was noted. At the 34th week of gestation, the patient was delivered due to intrauterine growth restriction and oligohydramnios and gave birth to a male, weighing 1,920 g. The newborn thyroid was not palpable and thyroid ultrasonography was normal. Cord blood TSH was normal (8.4 mU/l) and free T4 was within lower normal limit (9.03 pmol/l). Ten days later, newborn thyroid function was normal and the baby did well afterwards. In conclusion, after the evaluation of fetal thyroid status, selected cases with fetal goiter can be initially managed without intrauterine treatment. PMID:15980635

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

    Directory of Open Access Journals (Sweden)

    Alessandra Alves

    2007-06-01

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

  2. 核素显像在活动性Graves'眼病中的临床研究进展

    Institute of Scientific and Technical Information of China (English)

    李剑明; 史蓉芳

    2011-01-01

    @@ Graves'眼病(Graves ophthalmopathy, GO)也称为甲状腺相关性眼病(thyroid associated ophthalmopathy,TAO)、甲状腺眼病(thyroid eye-disease)、内分泌突眼,近年来倾向于称之为Graves'眶病.GO最常见于Graves'病(Graves' disease, GD),一般可见于50%左右的GD患者,其发生时间与GD可不同步,且该病因及发病机制尚未彻底阐明,它以眶部炎症、水肿、继发性纤维化为特征,其早期组织病理学变化为大量淋巴细胞浸润(主要为T淋巴细胞)、氨基葡聚糖(glycosaminoglycans, GAGs)沉积和组织水肿,晚期则表现为眼球后组织纤维化[1].GO的自然进程通常经历初始阶段、进展恶化阶段(活动期)、部分缓解阶段和稳定阶段.判断GO 是否处于炎性活动期对指导治疗方案、疗效评估都十分重要,本文就核素显像在活动性GO诊断及治疗评价方面的临床研究进展做一综述.

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

    Directory of Open Access Journals (Sweden)

    Esther J. Naranjo

    2014-06-01

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

  4. Identificación de peligros químicos-tóxicos para la salud animal en comunidades de San José de las Lajas en territorio Habanero (Identification of chemical hazards to animal health in communities of San José de las Lajas in Havana territory

    Directory of Open Access Journals (Sweden)

    Suárez-Fernández Yolanda E.

    2009-04-01

    Full Text Available ResumenA partir del inventario de fuentes y presuntas fuentes de peligro químico – tóxico a la salud y producción animal, con la aplicación de la metodología de análisis de riesgos químicos – tóxicos para la sanidad animal de Suárez (1999 y Suárez et al., (2007 y como contribución a la gestión y reducción territorial de riesgos de desastres, se identificaron 20 fuentes de peligro de este tipo y sus elementos en riesgo en San José de Las Lajas, perteneciente a la provincia de La Habana. Estas fuentes se distribuyen fundamentalmenteen cinco comunidades e involucran a sectores como Industria, Agricultura, Investigación y Servicios. El 30% de estas fuentes poseen antecedentes de episodios químico - tóxicos o se reconocen como causa de contaminación ambiental. Fueron detectadas 167 situaciones críticas y 155 factores de riesgo. Se detectó además 47 elementos en riesgo, así como una población de 59173 animales amenazados por dichas fuentes de peligro. Se concluye acerca de la necesidad de elaboración e implementación de planes para la reducción de desastres tecnológicos que puedan afectar a la salud animal.SummaryThe methodology to analyze chemical risks to animal health designed bySuárez (1999 and Suárez et al., (2007 was applied in communities of San José de Las Lajas from Havana in order to contribute in the territorial reduction and management of disasters risks that affected animal production and health. Before that, some researchers were out the inventory of sources and presumptive sources of chemical hazards in these communities. 20 sources of chemical hazards to animal health were identified because chemicals. The chemical hazards belong to 5 communities and involve industry, agriculture, research and services. 30% of the chemical hazards are recognized as a cause of environmental contamination or had reports about former cases of chemical accidents. We detect 167 critical issues and155 risks factors that

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2009-03-15

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

  6. Estimated glomerular filtration rate by serum creatinine or standardized cystatin C in Japanese patients with Graves׳ disease.

    Science.gov (United States)

    Suzuki, Yoshitake; Matsushita, Kazuyuki; Seimiya, Masanori; Yoshida, Toshihiko; Sawabe, Yuji; Ogawa, Makoto; Nomura, Fumio

    2015-12-01

    Glomerular filtration rate (eGFR) by serum creatinine (eGFRCr) or standardized cystatin C (eGFRCysC) were estimated in Japanese patients with Graves׳ disease (GD) of different sex. Clinical samples were collected from patients with GD with normal renal function to accurately validate eGFRCr and eGFRCysC levels and evaluate how hyperthyroidism affects renal function. Levels of eGFRCr and eGFRCysC showed clinical usefulness in successfully treated euthyroid patients with GD regardless of sex. The article includes detailed experimental methods and data used in our analysis. The data relates to the "Paradoxical effect of thyroid function on the estimated glomerular filtration rate by serum creatinine or standardized cystatin C in Japanese Graves' disease patients" (Suzuki et al., 2015) [1].

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

    International Nuclear Information System (INIS)

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

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

    Data.gov (United States)

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

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

    OpenAIRE

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

    2015-01-01

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

  10. Comprehensive analysis of the related factors of early hypothyroidism occurring in patients with Graves' disease after 131I treatment

    International Nuclear Information System (INIS)

    Objective: To make a comprehensive analysis of the related factors of early hypothyroidism occurring in patients with Graves' disease after 131I treatment. Methods: The information of 131I treated Graves' disease was collected including general data, clinical observation, laboratory data, thyroid function test, etc. Then a retrospective statistical analysis was carried out, using cluster analysis, factor analysis, discriminant analysis, multivariate regression analysis, etc. Results: 1) Cluster analysis and factor analysis showed that among clinical observation such as clinical course, treatment course, patients' state and disease occurrance, the first three factors correlated highly; among laboratory data such as thyrotrophin receptor antibody (TRAb), thyroid-stimulating immunoglobulins (TSI), thyroglobulin antibody (TgAb) and thyroid microsomal antibody (TMAb), both the first two and the last two correlated highly, each two factors had the similar effect. 2) Fsher discriminant analysis showed that among the thyroid weight, the effective half life, the maximum 131I uptake percentage, total dose of 131I and the average dose of 131I per gram of thyroid, the last one had the most predicting value for incidence of early hypothyroidism. 3) Logistic regression analysis showed that among all the related factors of early hypothyroidism occurred after 131I treated Graves' disease, thyroid weight, average dose of 131I per gram of thyroid, the maximum 131I uptake percentage and the level of TSI were effective factors. Conclusions: The occurrence of early hypothyroidism for 131I-treated Graves' disease is probably affected by many factors. If more factors are taken into consideration before therapy and the theraputic dose is well adjusted accordingly, it can reduce the incidence of early hypothroidism to a certain extent. (authors)

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

    OpenAIRE

    Park, Suyeon; Kim, Tae Yong; Sim, Soyoung; Lim, Seonhee; Kim, Mijin; Kwon, Hyemi; Jeon, Min Ji; Kim, Won Gu; Shong, Young Kee; Kim, Won Bae

    2016-01-01

    Background Thyrotoxic periodic paralysis (TPP) is a rare complication of thyrotoxicosis characterized by acute attacks of muscle weakness and hypokalemia. Recently, variation in several genes was suggested to be associated with TPP. This study evaluated the genetic predisposition to TPP in terms of the β2-adrenergic receptor (ADRB2), androgen receptor (AR), and γ-aminobutyric acid receptor α3 subunit (GABRA3) genes. Methods This study enrolled 48 men with Graves disease (GD) and TPP, and 48 G...

  12. Impact Analysis of Changes in Human Resource Capital on Economic Development - from Gravely Underdeveloped to Highly Developed Societies

    OpenAIRE

    Zeljko Pozega; Boris Crnkovic

    2009-01-01

    This research encompasses 177 countries around the world with the data on human resource variables for the year 2005. The countries have been put into four groups: gravely underdeveloped, developing, developed, and highly developed. The research has looked into the variables Human Development Index, population, population over 65 years of age, primary education enrolment, investment into secondary education, investment into tertiary education, investment into research and development, Gender–...

  13. Graves病患者泪膜功能研究%The study of tear film function in Graves disease

    Institute of Scientific and Technical Information of China (English)

    谢怀林; 林育华; 王善洁; 蒋艳华; 曾少杰; 李慧娟

    2008-01-01

    目的 探讨Graves病患者的泪膜功能.方法 前瞻性研究78例Graves病患者(病例组),对照组为40例健康体检者.分别进行泪膜破裂时间测定(TBUT)、基础泪液分泌试验(SIT)、角膜荧光素染色和眼部干涩、不适症状询问.结果病例组TBUT和SIT与对照组比较,差异均有统计学意义(P<0.05). TBUT<10s和自觉有眼干涩症状以及角膜荧光素染色阳性的比率,病例组与对照组比较,差异均有统计学意义.结论 Graves病患者发生泪膜功能异常的比率高于健康体检者,是发生干眼症的易患人群.%Objective To investigate the tear fdm function with Graves disease.Methods Seven-ty-eight patients with Graves disease were studied respectiveIy,40 cases healthy person as contr01.Tear film function Was evaluated by tear break-up time(TBUT),Schirmer I test(SIT),corneal fluorescein staining,dry eye and unwell symptoms.Results The difference of TBUT and SIT resultsbetweenpatients and con-trois were significant(P<0.05).The rate ofTBUT,corneal fluorescein staining and symptom ofdry eye in patients were significantly higher than those in controls.Conclusions Graves disease patients have higher rate of abnormal tear film function in comparison with controls.Graves disease are correlated with xerophthalmia.

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

    Science.gov (United States)

    Booth, Adam D.; Pringle, Jamie K.

    2016-02-01

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

  15. Expression of IL-10, TNF-α mRNA in TEC in Graves' disease

    International Nuclear Information System (INIS)

    To study the transcription profiles of interleukin-10 (IL-10) and tumor necrosis factor-α (TNF-α) gene in human thyroid epithelial cells (TEC) from patients with Graves disease (GD), thyrocyte was isolated from thyroid tissues and cultured with RPMI-1640, then the expression of IL-10, TNF-α mRNA in the TEC was detected by means of RT-PCR. IL-10 mRNA expression in TEC was detected only in one case of GD group, and TNF-α mRNA was transcribed in all GD TEC. Neither IL-10 nor TNF-α mRNA was found in normal TEC. Thyroid as well as TEC can produce some kinds of cytokines. The transcription profiles of certain cytokines in the thyroid of patients with autoimmune thyroid disease (AITD) are different from those of normal thyroid tissues taken from MNG, which means that they are important features for the pathogenesis of AITD and abnormal thyroid function

  16. SÍNDROMES HIPERTENSIVAS GRAVES – ESTUDO DESCRITIVO COM ADOLESCENTES ATENDIDAS EM MATERNIDADE ESCOLA

    Directory of Open Access Journals (Sweden)

    Andreia Gregório Lima

    2012-01-01

    Full Text Available Estudio exploratorio y descriptivo, con objetivo de analizar los datos clínicos y obstétricos relacionados a síndromes hipertensivos graves en adolescentes asistidas en maternidad escuela de Recife-PE, Brasil. La población fue de 186 adolescentes embarazadas con preeclampsia severa y/o eclampsia entre 2003 y 2008. La edad varió entre 15 y 19 años, eran negras, solteras y con baja escolaridad. La mayoría era primíparas, pero la recurrencia del embarazo fue de 16% de los casos. Realizaran seis o más consultas de prenatal, el embarazo avanzó a término y el tipo de parto más frecuente fue la cesárea. Las comorbidades identificadas fueron alteraciones de volumen del líquido amniótico, cuadros hemorrágicos e infecciosos. Fueron identificados también casos de retraso del crecimiento intrauterino, prematuridad, ictericia, hipoxia y bajo peso al nacer. El embarazo en la adolescencia asociado con los síndromes hipertensivos severos posee relación con complicaciones maternas, fetales y neonatales.

  17. Early Medieval Muslim Graves in France: First Archaeological, Anthropological and Palaeogenomic Evidence.

    Science.gov (United States)

    Gleize, Yves; Mendisco, Fanny; Pemonge, Marie-Hélène; Hubert, Christophe; Groppi, Alexis; Houix, Bertrand; Deguilloux, Marie-France; Breuil, Jean-Yves

    2016-01-01

    The rapid Arab-Islamic conquest during the early Middle Ages led to major political and cultural changes in the Mediterranean world. Although the early medieval Muslim presence in the Iberian Peninsula is now well documented, based in the evaluation of archeological and historical sources, the Muslim expansion in the area north of the Pyrenees has only been documented so far through textual sources or rare archaeological data. Our study provides the first archaeo-anthropological testimony of the Muslim establishment in South of France through the multidisciplinary analysis of three graves excavated at Nimes. First, we argue in favor of burials that followed Islamic rites and then note the presence of a community practicing Muslim traditions in Nimes. Second, the radiometric dates obtained from all three human skeletons (between the 7th and the 9th centuries AD) echo historical sources documenting an early Muslim presence in southern Gaul (i.e., the first half of 8th century AD). Finally, palaeogenomic analyses conducted on the human remains provide arguments in favor of a North African ancestry of the three individuals, at least considering the paternal lineages. Given all of these data, we propose that the skeletons from the Nimes burials belonged to Berbers integrated into the Umayyad army during the Arab expansion in North Africa. Our discovery not only discusses the first anthropological and genetic data concerning the Muslim occupation of the Visigothic territory of Septimania but also highlights the complexity of the relationship between the two communities during this period. PMID:26910855

  18. Síndrome hemofagocítico secundario a infecciones graves en un quemado

    Directory of Open Access Journals (Sweden)

    Carolina V. Mahuad

    2013-06-01

    Full Text Available El síndrome hemofagocítico constituye una entidad infrecuente, heterogénea, subdiagnosticada, y muchas veces fatal. En los casos secundarios, los desencadenantes pueden ser numerosos, tales como infecciones, fármacos, enfermedades autoinmunes y neoplasias. El mecanismo fisiopatogénico se explica por la presencia de una función disminuida o defectuosa de células NK y linfocitos T citotóxicos, que resulta en una activación inmune inefectiva y descontrolada, conduciendo al daño celular, falla multiorgánica y proliferación macrofágica con hemofagocitosis. Existen diferentes opciones terapéuticas, mayormente combinaciones de citostáticos y esteroides, cuyo objetivo es la supresión de la respuesta inmune descontrolada. Ocasionalmente, la condición clínica de algunos pacientes con síndrome hemofagocítico impide la utilización de esquemas terapéuticos intensivos. Comunicamos el caso de un paciente quemado grave, que reúne los criterios diagnósticos de síndrome hemofagocítico, quien presentó una evolución favorable con el tratamiento combinado de esteroides e inmunoglobulinas endovenosas.

  19. Th1/Th2 cytokine production and reception features in Graves' disease

    Directory of Open Access Journals (Sweden)

    T V Saprina

    2012-06-01

    Full Text Available Cytokines and their receptors belong to a significant role in the initiation and the subsequent course and outcome of autoimmune thyroid disease. Interleukin-2 (IL-2, interleukin-4 (IL-4 and tumor necrosis factor-alpha (TNF-α-cytokines, which have a multifaceted impact on the various stages of the immune response: the development of inflammatory response, cell proliferation, antibody and acute phase proteins synthesis. Pre-existing pattern of development of autoimmune thyroiditis (Hashimoto's thyroiditis and Graves' disease (GD as a state with two opposite positions of the predominant profile of Th1/Th2-lymphocyte activation. The study evaluated the cytokine production by Th1- and Th2-lymphocytes in patients with GD, assessment of lymphocyte receptor system and identified lymphocytes subpopulation in patients with BG, and the impact on the functional state of thyroid gland. It was shown that the immunoregulatory cytokines as Th1(IL2- and Th2(IL-4-helper lymphocytes are involved in the immune mechanism of BG. The level of IL-2, IL4, and TNF-α, and the number complementary lymphocyte receptors were not significantly changed in euthyroid or hyperthyroid GD patient. Nevertheless, there are strong correla! tions between production of immunoregulatory cytokines (IL-2, IL-4 with the functional state of the thyroid gland and increase of its volume in GD patient, what confirms the “functional synergies” of these cytokines in autoimmune inflammation in the GD.

  20. Early Medieval Muslim Graves in France: First Archaeological, Anthropological and Palaeogenomic Evidence.

    Directory of Open Access Journals (Sweden)

    Yves Gleize

    Full Text Available The rapid Arab-Islamic conquest during the early Middle Ages led to major political and cultural changes in the Mediterranean world. Although the early medieval Muslim presence in the Iberian Peninsula is now well documented, based in the evaluation of archeological and historical sources, the Muslim expansion in the area north of the Pyrenees has only been documented so far through textual sources or rare archaeological data. Our study provides the first archaeo-anthropological testimony of the Muslim establishment in South of France through the multidisciplinary analysis of three graves excavated at Nimes. First, we argue in favor of burials that followed Islamic rites and then note the presence of a community practicing Muslim traditions in Nimes. Second, the radiometric dates obtained from all three human skeletons (between the 7th and the 9th centuries AD echo historical sources documenting an early Muslim presence in southern Gaul (i.e., the first half of 8th century AD. Finally, palaeogenomic analyses conducted on the human remains provide arguments in favor of a North African ancestry of the three individuals, at least considering the paternal lineages. Given all of these data, we propose that the skeletons from the Nimes burials belonged to Berbers integrated into the Umayyad army during the Arab expansion in North Africa. Our discovery not only discusses the first anthropological and genetic data concerning the Muslim occupation of the Visigothic territory of Septimania but also highlights the complexity of the relationship between the two communities during this period.

  1. Disease activity in Graves' ophthalmopathy: diagnosis with orbital MR imaging and correlation with clinical score.

    Science.gov (United States)

    Tortora, Fabio; Cirillo, Mario; Ferrara, Marco; Belfiore, Maria Paola; Carella, Carlo; Caranci, Ferdinando; Cirillo, Sossio

    2013-10-01

    In Graves' ophthalmopathy (GO) it is important to distinguish acute inflammation at an early stage, responsive to immunosuppressive treatment, from inactive fibrotic end stage disease, unresponsive to the same treatment. The purpose of this study was to identify the most relevant signal intensities on orbital MR imaging with contrast administration both to classify patients according to their clinical activity score (defined by a cut-off value of 3) and to make a prediction of patient's CAS. Such threshold was considered as widely used in literature. Sixteen consecutive patients with a diagnosis of GO in different phases of thyroid disease based on clinical and orbital MR imaging signs, and six normal volunteers were examined. Orbital MR imaging was performed on a 1.5 Tesla MR Unit. MR scans were assessed by an experienced neuroradiologist, blinded to the clinical examinations. We found a statistical correlation between CAS and both STIR and contrast enhanced T1-weighted sequences. There was also a statistically significant correlation between STIR and contrast-enhanced T1 images disclosing the possibility of avoiding the injection of contrast medium. Our study proved that signal intensity values on STIR sequence increase in the inflammatory oedematous phase of disease. We confirmed the correlation between signal intensities on this sequence and CAS, showing an increase in signal intensity proportional to the CAS value. So we validated MRI use to establish the activity phase of disease more sensitively than CAS alone.

  2. [A study on observation of bone metabolism in middle-aged and senile female Graves' disease].

    Science.gov (United States)

    Zhu, L Q; Liu, Y H; Zhou, Y B

    1996-08-01

    Sixty-nine cases of middle aged and senile female Graves' desease (GD) patients suffered from abnormal bone metabolism have been studied. They were divided randomly into group A and B, treated separately with antithyroid drugs (Tapazol and inderal, etc.) in group A, and added with Chinese herbal medicine for tonifying Kidney and promoting blood circulation in group B. Before treatment, patients of both groups showed obvious higher blood calcium (Ca) 24-hour urinary Ca, phosphorus (P) and serum clcitonin (CT) levels than that in normal subjects. These patients' serum Ca, moreover, had a parallel relationship with serum T3 levels (r = 0.6142, P < 0.01) and the serum Ca also a paralleled with serum CT levels (r = 0.5714, P < 0.05). After six months of treatment, the serum Ca, 24-hour urinary Ca, P and blood CT values were all reduced in various degree. The decrease of these bone metabolic parameters were more significant in group B than that in group A. PMID:9387746

  3. The outcome of adjusted accumulation dose of treatment of Graves` disease

    Energy Technology Data Exchange (ETDEWEB)

    Gomi, Yukari; Inoue, Takeshi; Suzuki, Seiji [Showa Univ., Yokohama (Japan). Fujigaoka Hospital; Hamada, Noboru; Yoshimura, Hiroshi; Ishikawa, Naofumi; Momotani, Naoko; Ito, Kunihiko

    1997-12-01

    We evaluated the outcome of {sup 131}I treatment of Graves` disease in two different protocols (old and new protocol) of adjusted accumulation dose from 1988 to 1995. Adjusted accumulation doses of patients with above 50 g thyroid weights were increased by 5-20 Gy/g tissue in new protocol compared to those in old one. In 166 patients treated with single and plural doses of {sup 131}I treatment in 1990 (Group In), the therapeutic doses were calculated according to new protocol and in 130 patients in 1988 (Group Io), according to old one, modification of Quimby`s formula. The patients treated with plural doses were classified as hyperthyroidism because the efficacies of the first treatments with {sup 131}I were insufficient. At the 5-yr follow up, the incidence of hypothyroid in Group In was 9%, subclinical hypothyroid 17%, euthyroid 30%, subclinical hyperthyroid 7%, hyperthyroid 37%. In Group Io, 11% of the patients were hypothyroid, 6% subclinical hypothyroid, 29% euthyroid, 3% subclinical hyperthyroid, 51% hyperthyroid. The incidence of hyperthyroid in Group In was lower than that in Group Io (p<0.05). There were no significant differences in hypothyroid and euthyroid. In conclusion, we suggest that an adjusted dose of {sup 131}I in relation to the patients` thyroid weight shows some room for improvement. (author)

  4. Hipoxia após traumatismos crânio-encefálicos graves

    Directory of Open Access Journals (Sweden)

    R. A. Frowein

    1964-09-01

    Full Text Available Após traumatismos crânio-encefálicos graves ocorre hipoxia cerebral, não apenas nas primeiras horas mas também durante vários dias da fase aguda. A saturação arterial de O2 é muitas vêzes normal, mas, com mais freqüência do que se supõe, existe anemia; como conseqüência do aumento da pressão intracraniana, da hipotensão arterial ou da alcalose respiratória, diminui o afluxo sangüíneo ao encéfalo, baixando a tensão do O2 celular, o que é demonstrado pela diminuição da tensão de O2 no sangue venoso provindo do encéfalo. Por isso, no tratamento da fase aguda pós-traumática deve-se, ao lado da normalização da pressão intracraniana, manter a pressão arterial, evitar a hiperventilação pulmonar mediante a administração de neuroplégicos e impedir a anemia mediante transfusões de sangue.

  5. Early Medieval Muslim Graves in France: First Archaeological, Anthropological and Palaeogenomic Evidence

    Science.gov (United States)

    Pemonge, Marie-Hélène; Hubert, Christophe; Groppi, Alexis; Houix, Bertrand; Deguilloux, Marie-France; Breuil, Jean-Yves

    2016-01-01

    The rapid Arab-Islamic conquest during the early Middle Ages led to major political and cultural changes in the Mediterranean world. Although the early medieval Muslim presence in the Iberian Peninsula is now well documented, based in the evaluation of archeological and historical sources, the Muslim expansion in the area north of the Pyrenees has only been documented so far through textual sources or rare archaeological data. Our study provides the first archaeo-anthropological testimony of the Muslim establishment in South of France through the multidisciplinary analysis of three graves excavated at Nimes. First, we argue in favor of burials that followed Islamic rites and then note the presence of a community practicing Muslim traditions in Nimes. Second, the radiometric dates obtained from all three human skeletons (between the 7th and the 9th centuries AD) echo historical sources documenting an early Muslim presence in southern Gaul (i.e., the first half of 8th century AD). Finally, palaeogenomic analyses conducted on the human remains provide arguments in favor of a North African ancestry of the three individuals, at least considering the paternal lineages. Given all of these data, we propose that the skeletons from the Nimes burials belonged to Berbers integrated into the Umayyad army during the Arab expansion in North Africa. Our discovery not only discusses the first anthropological and genetic data concerning the Muslim occupation of the Visigothic territory of Septimania but also highlights the complexity of the relationship between the two communities during this period. PMID:26910855

  6. Choroidal changes observed with enhanced depth imaging optical coherence tomography in patients with mild Graves orbitopathy.

    Science.gov (United States)

    Özkan, B; Koçer, Ç A; Altintaş, Ö; Karabaş, L; Acar, A Z; Yüksel, N

    2016-07-01

    PurposeTo evaluate the choroidal thickness in patients with Graves orbitopathy (GO) using enhanced depth imaging-optical coherence tomography (EDI-OCT).MethodsThirty-one patients with GO were evaluated prospectively. All subjects underwent ophthalmologic examination including best-corrected visual acuity, intraocular pressure measurement, biomicroscopic, and fundus examination. Choroidal thickness was measured at the central fovea. In addition, visual evoked potential measurement and visual field evaluation were performed.ResultsThe mean choroidal thickness was 377.8±7.4 μ in the GO group, and 334±13.7 μ in the control group. (P=0.004). There was a strong correlation between the choridal thickness and the clinical activity scores (CAS) of the patients (r=0.281, P=0.027). Additionally, there was a correlation between the choroidal thickness and the visual-evoked potential (VEP) P100 latency measurements of the patients (r=0.439, P=0.001).ConclusionsThe results of this study demonstrate that choroid is thicker in patients with GO. The choroidal thickness is also correlated with the CAS and VEP P100 latency measurements in these patients. PMID:27315349

  7. Compensated low-dose /sup 131/I therapy of Graves' disease

    Energy Technology Data Exchange (ETDEWEB)

    Roudebush, C.P.; Hoye, K.E.; DeGroot, L.J.

    1977-10-01

    To minimize the high rate of residual thyrotoxicosis encountered in low-dose /sup 131/I therapy of Graves' disease, we have treated 62 patients with a low-dose /sup 131/I protocol that includes a compensation for thyroid size. Dose varied between 40 ..mu..Ci retained/g for glands of normal size to 100 ..mu..Ci/g for glands of 100 g or greater. Mean dose was 51.9 ..mu..Ci/g. At 1 year after therapy, 66.1 percent of subjects were euthyroid, 9.7 percent hypothyroid, and 24.2 percent hyperthyroid, a significant improvement (P less than 0.01) over our previous experience using 50 ..mu..Ci/g independent of gland size. Several factors, other than /sup 131/I dose, which might influence the outcome of therapy, were investigated. Initial free thyroxine index observed before therapy was found to have prognostic significance. Hypothyroidism developed only in patients having an initial free thyroxine index of 22.5 or less (about 2.5 times the upper limit of normal in our laboratory).

  8. Factores pronósticos en el traumatismo craneoencefálico grave

    Directory of Open Access Journals (Sweden)

    José Purón-Barrera

    2011-01-01

    Full Text Available Se señalaron los factores relacionados con la mortalidad del trauma craneoencefálico grave y que pueden influir sobre su pronóstico. La presencia de puntuación en la Escala de Glasgow ¿ 8, hiperglicemia, shock, necesidad de ventilación mecánica, alteraciones pupilares y múltiples lesiones en la tomografía axial computarizada (TAC entre las cuales siempre estuvo asociado el hematoma subdural concuerda con lo referido por otros estudios. El hallazgo de hipernatremia tuvo alta significación estadística, siendo un factor no relacionado con la mortalidad en otros trabajos similares aunque si se justifica su aparición y su relación con mal pronóstico en la bibliografía revisada. El uso de Solución Salina Hipertónica, Manitol, supresión de la vía oral y ventilación.

  9. Ultrasonography compared to magnetic resonance imaging in thyroid-associated Graves' ophthalmopathy

    Energy Technology Data Exchange (ETDEWEB)

    Vlainich, Ana R.; Romaldini, Joao H.; Pedro, Ana B.; Farah, Chady S.; Sinisgalli Junior, Cicero A., E-mail: anavlainich@uol.com.b [Hospital do Servidor Publico Estadual de Sao Paulo (IAMSPE), SP (Brazil)

    2011-04-15

    Objective: to compare ultrasonography (US) to magnetic resonance imaging (MRI) and the clinical activity score (CAS) in Graves' ophthalmopathy. Subjects and methods: Nineteen patients underwent extraocular muscle thickness measurements by US and MRI, reflectivity by US and signal-intensity ratio by MRI. There were also twelve US control subjects. Results: US median thicknesses were greater than in controls. Correlation was found between US and MRI in the median thickness of the left eye rectus medial muscle as well as between signal-intensity ratio (SIR) and thickness by US. An inverse correlation was found between reflectivity and SIR in the inferior and lateral rectus. On associating the tests for detecting activity the best results were obtained with CAS plus MRI (sensitivity 75%), and US and MRI (positive predictive value 77% and specificity 80%). Conclusion: CAS and US results showed poor correlation with MRI results suggesting that they cannot replace each other but when combined these methods can improve the evaluation of thyroid-associated ophthalmopathy. (author)

  10. Formas graves de retinopatia predizem aterosclerose subclínica em indivíduos com diabetes tipo 1

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    Fernando K. Almeida

    2011-10-01

    Full Text Available FUNDAMENTO: Em pacientes com diabetes tipo 2, a presença de retinopatia está associada a doença cardiovascular aumentada, independentemente dos fatores de risco conhecidos para a doença vascular. OBJETIVO: Investigar a associação da retinopatia diabética (RD e seus graus com a presença de aterosclerose coronariana subclínica em pacientes com diabetes tipo 1. MÉTODOS: Um estudo transversal foi conduzido com 150 pacientes com diabetes tipo 1, assintomáticos para doença arterial coronariana. Foram submetidos à avaliação clínica para verificar complicações microvasculares e avaliação para a presença de calcificação arterial coronariana (CAC. RESULTADOS: Formas graves de RD (RD grave não proliferativa - RDNP - e RD proliferativa - RDP foram associadas à CAC (RC: 3,98; IC de 95%; 1,13-13,9, p = 0,03, de maneira independente dos fatores de risco conhecidos para a doença cardiovascular (idade, A1C, hipertensão, dislipidemia e sexo masculino. CONCLUSÃO: Os pacientes com formas graves de RD estão em risco de presença de doença arterial coronariana, de maneira independente dos tradicionais fatores de risco cardiovascular.

  11. Preliminary results of sequential monitoring of simulated clandestine graves in Colombia, South America, using ground penetrating radar and botany.

    Science.gov (United States)

    Molina, Carlos Martin; Pringle, Jamie K; Saumett, Miguel; Hernández, Orlando

    2015-03-01

    In most Latin American countries there are significant numbers of missing people and forced disappearances, 68,000 alone currently in Colombia. Successful detection of shallow buried human remains by forensic search teams is difficult in varying terrain and climates. This research has created three simulated clandestine burial styles at two different depths commonly encountered in Latin America to gain knowledge of optimum forensic geophysics detection techniques. Repeated monitoring of the graves post-burial was undertaken by ground penetrating radar. Radar survey 2D profile results show reasonable detection of ½ clothed pig cadavers up to 19 weeks of burial, with decreasing confidence after this time. Simulated burials using skeletonized human remains were not able to be imaged after 19 weeks of burial, with beheaded and burnt human remains not being able to be detected throughout the survey period. Horizontal radar time slices showed good early results up to 19 weeks of burial as more area was covered and bi-directional surveys were collected, but these decreased in amplitude over time. Deeper burials were all harder to image than shallower ones. Analysis of excavated soil found soil moisture content almost double compared to those reported from temperate climate studies. Vegetation variations over the simulated graves were also noted which would provide promising indicators for grave detection. PMID:25596556

  12. Prediction of post-treatment hypothyroidism using changes in thyroid volume after radioactive iodine therapy in adolescent patients with Graves' disease

    OpenAIRE

    Fukata Shuji; Nakatake Nobuhiro; Tajiri Junichi

    2011-01-01

    Abstract Background The goal of iodine-131 therapy for pediatric Graves' disease is to induce hypothyroidism. However, changes in post-treatment thyroid volume have not been investigated in pediatric and/or adolescent patients. Objective The aim of this retrospective study was to examine whether changes in thyroid volume predict post-treatment hypothyroidism in adolescent Graves' disease patients. Patients and Methods We used ultrasonography to examine changes in thyroid volume, and also asse...

  13. Mass graves gone missing: Producing knowledge in a world of absence

    Directory of Open Access Journals (Sweden)

    Douglas, Lee

    2014-12-01

    Full Text Available On May 1st, 2014 members of the historical memory team from the Aranzadi Sciences Society arrived in Oropesa de Toledo. The objective: to locate two mass graves containing the remains of Republicans killed in the weeks after Franco’s troops entered the town in 1936. Despite evidence regarding the mass graves’ existence, they were never found. Drawing on empirical, ethnographic data collected in the town of Oropesa in the months following this “unsuccessful” exhumation, this paper narrates the curious story of two graves that have “gone missing.” It considers the intellectual labor exerted to produce historical knowledge in a context where municipal archives remain inaccessible and family histories are marked by silence and dis-information. The author suggests that the absence of information –the dearth of historical, narrative evidence– regarding the lives of the defeated makes the production of historical and forensic knowledge a complicated affair. It tracks how kin-based knowledge and scarce archival documents are gathered and animated in order to make exhumations possible. Considering the forms of knowledge that are needed in order to engage techno-scientific expertise in meaningful ways, the paper attends to the important role that kin-based knowledge and seemingly “unimportant” documents play in processes of historical enunciation.El 1 de mayo de 2014, los miembros del equipo forense de la Sociedad de Ciencias Aranzadi llegaron a Oropesa de Toledo. El objetivo: localizar dos fosas comunes que contenían los restos de republicanos asesinados en las semanas posteriores a la llegada de las tropas de Franco en 1936. A pesar de la evidencia que apuntaba a la existencia de las dos fosas comunes, nunca se encontraron. Utilizando los datos empíricos y etnográficos recogidos en Oropesa en los meses posteriores a esta exhumación “fallida”, este trabajo narra la curiosa historia de dos tumbas que han “desaparecido”. El

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

    Directory of Open Access Journals (Sweden)

    Lucas Lima Ferreira

    2013-12-01

    Full Text Available Objetivo: Analisar os desfechos aumento/diminuição da pressão intracraniana e/ou queda da pressão de perfusão cerebral, proporcionados pela fisioterapia respiratória em pacientes graves assistidos em unidade de terapia intensiva. Métodos: Por meio de uma revisão sistemática da literatura, foram selecionados ensaios clínicos publicados entre 2002 e 2012. A busca envolveu as bases de dados LILACS, SciELO, MedLine e PEDro, usando os descritores "physical therapy", "physiotherapy", "respiratory therapy" e "randomized controlled trials" em cruzamento com o descritor "intracranial pressure". Resultados: Foram incluídos 5 estudos, que somaram 164 pacientes, com média de idade entre 25 e 65 anos, e que indicaram que as manobras de fisioterapia respiratória aumentaram significativamente a pressão intracraniana, sem alterar a pressão de perfusão cerebral. Os artigos abordaram as técnicas de vibração, vibrocompressão, tapotagem, drenagem postural, além da manobra de aspiração intratraqueal. Todos os pacientes estavam sob ventilação mecânica invasiva. Conclusão: A fisioterapia respiratória promove aumento da pressão intracraniana. Os estudos sugerem que não há repercussões hemodinâmicas e respiratórias a curto prazo ou alteração da pressão de perfusão cerebral. Entretanto, não há estudos que avaliem desfechos clínicos e que assegurem a segurança das manobras.

  15. Indium-111 octreotide in graves` disease and in evaluation of active exophthalmos

    Energy Technology Data Exchange (ETDEWEB)

    Mansi, L.; Rambaldi, P.F.; Del Vecchio, E.; Bizzarro, A.; Di Martino, S.; De Bellis, A.; Panza, A.

    1995-06-01

    Thyroid Associated Ophthalmopathy (TAO) is an autoimmune disorder associated with Graves` disease (GD). This study evaluated the uptake of indium-111 Octreotide ({sup 111}In-OCT), a somatostatin (SS) analogue able to bind specific SS receptors, at the level of the thyroid and orbits in patients with TAO. Seven patients with exophthalmos were investigated: six had GD while one was affected with a non small cell lung cancer (NSCLC). One patient with GD had undergone total thyroidectomy (TT) for a thyroid cancer. At the time of the study two patients were hyperthyroid, four were euthyroid and one was hypothyroid. 111 MBq of {sup 111}In-OCT were i.v. injected and two 30 minute scans were performed at 4 and 24 hours; 5 minute planar images were also obtained at 25, 60 and 120 minutes. A 180 SPECT was carried out 5 hours after the injection in one patient. A qualitative analysis was performed, comparing these images with those obtained in 7 control patients without thyroid illness or exophthalmos. Moreover, in the TAO patients thyroid, orbit and brain counts were evaluated in comparison with background (BK) and blood activity (BA), measured at the level of the venous longitudinal sinus. In GD intense thyroid uptake was demonstrated independently of the functional state, with highest ratio compared to BK seen at 24 hours. Low uptake in the patient with NSCLC, no activity in the patient with GD that underwent TT, and slight or absent thyroid uptake in the controls were observed. Intense uptake was seen in the orbits of the patient who clinically had the most severe ophthalmopathy. SPECT identified the intra orbital location of this accumulation. Moderate uptake was seen in two GD patients and slight uptake in two others. No accumulation was found in one patient with GD, or in the patient with NSCLC, despite his exophthalmos. Lastly, when cerebral uptake was compared to BA, no significant blood brain barrier permeability to {sup 111}In-OCT was demonstrated.

  16. Turf wars: authority and responsibility for the investigation of mass graves.

    Science.gov (United States)

    Skinner, Mark; Sterenberg, Jon

    2005-07-16

    Mass graves are complex products of large-scale crimes. Such scenes pose four conceptual challenges to investigators and forensic experts: the individual victim, the crime, the setting, and the statistical. Exhumation and post-mortem examination of mortal remains with associated personal and forensic evidence require integrated management of core forensic personnel including investigators, archaeologists, anthropologists, odontologists and pathologists, among whom there is overlapping expertise. The key to avoiding competition and ill-will among experts is to recognize that all such experts should be enabled to make known how their expertise matches with the temporal and spatial boundaries of victim, crime and setting. In turn, they should be apprised of where they fit into the overall judicial process and their limits within the investigation. Consequently, each expert requires access to the factual background of the case, to the site and its contents throughout the investigation. Each forensic team member has a responsibility to influence the investigation--throughout its course when possible--to make findings within their areas of expertise, and to make these available to the rest of the team so as to contribute most meaningfully to the aims of the investigation, both forensic and humanitarian. The on-site crime scene manager has an overarching role to enable integrated access to the complete scene and its contents by each forensic expert team member. In other words, the forensic scientist is given access and the ability to influence the investigation while control of evidence from the site as to identity and criminal activity are maintained by the crime scene manager. This contribution is directed at both the crime scene manager and each forensic expert; it describes the essential spatial and temporal parameters of an expert's opinion so as to encourage cooperation, and discourage conflict, within the forensic team. PMID:15939156

  17. Gene Map of the HLA Region, Graves' Disease and Hashimoto Thyroiditis, and Hematopoietic Stem Cell Transplantation.

    Science.gov (United States)

    Sasazuki, Takehiko; Inoko, Hidetoshi; Morishima, Satoko; Morishima, Yasuo

    2016-01-01

    The human leukocyte antigen (HLA) genomic region spanning about 4 Mb is the most gene dense and the polymorphic stretches in the human genome. A total of the 269 loci were identified, including 145 protein coding genes mostly important for immunity and 50 noncoding RNAs (ncRNAs). Biological function of these ncRNAs remains unknown, becoming hot spot in the studies of HLA-associated diseases. The genomic diversity analysis in the HLA region facilitated by next-generation sequencing will pave the way to molecular understanding of linkage disequilibrium structure, population diversity, histocompatibility in transplantation, and associations with autoimmune diseases. The 4-digit DNA genotyping of HLA for six HLA loci, HLA-A through DP, in the patients with Graves' disease (GD) and Hashimoto thyroiditis (HT) identified six susceptible and three resistant HLA alleles. Their epistatic interactions in controlling the development of these diseases are shown. Four susceptible and one resistant HLA alleles are shared by GD and HT. Two HLA alleles associated with GD or HT control the titers of autoantibodies to thyroid antigens. All these observations led us to propose a new model for the development of GD and HT. Hematopoietic stem cell transplantation from unrelated donor (UR-HSCT) provides a natural experiment to elucidate the role of allogenic HLA molecules in immune response. Large cohort studies using HLA allele and clinical outcome data have elucidated that (1) HLA locus, allele, and haplotype mismatches between donor and patient, (2) specific amino acid substitution at specific positions of HLA molecules, and (3) ethnic background are all responsible for the immunological events related to UR-HSCT including acute graft-versus-host disease (GVHD), chronic GVHD, graft-versus-leukemia (GvL) effect, and graft failure.

  18. Clinical observation of associated treatment for Graves' disease with traditional chinese medicine and 131I

    International Nuclear Information System (INIS)

    To investigate the method and curative effect of associated treatment for Graves Disease (GD) with traditional Chinese medicine and 131I. 100 patients with GD were randomly divided into two groups, the patients in group A was only given 131I treatment and the patients in group B was given traditional Chinese medicine (Shimaiqing Fluid, 3 times of 20 mL per day for 40 days) after 7 days of 131I treatment. The serum FT3, FT4 and TSH were measured before and 30 and 90 days after treatment. 8 cardinal symptoms were selected and Kupperman 4-grade grading method was used to assess the remission of the disease. The Results showed that the symptoms of patients in group B were improved ahead of time, and pass through the FT3 and FT4 rebound elevation period safely after one month of 131I treatment. The symptoms of patients in group A after 30 days treatment were more serious than that of before treatment, the levels of serum FT3 and FT4 were both higher than those of before treatment. The symptoms of patients in group B after 90 days treatment were improved significantly, and the levels of serum FT3, FT4 and TSH were in normal value. The clinical symptoms of patients in group A were improved, but the levels of serum FT3 and FT4 were lower and TSH was higher than normal value. The curative effect in group B was better than that in group A, the patients passed through the high risk period safely after 30 days treatment, and the hypothyroidism rate was decreased after 90 days treatment. The Shimaiqing Fluid is a nontoxic and safe medicine, and it may be widely used in clinical treatment for patients with GD. (authors)

  19. Susceptibility genes of Graves' disease%Graves病易感基因研究进展

    Institute of Scientific and Technical Information of China (English)

    吴岚; 韩刚; 葛家璞

    2008-01-01

    Graves'disease(GD)is an organ-specific autoimmune disorder,which is commonly speculated as the result of interaction between heredity and environment.In the last years,significant progress has been made in understanding of the genetic contribution to the etiology of GD,including the human leukocyte antigen(HLA)gene,cytotoxic T lymphocyte antigen-4(CTLA-4)gene and thyroid-stimulating hormone receptor(TSHR)gene.This review focuses on immune-regulatory genes(HLA gene,CTLA-4 gene,CD40 gene,interleukin genes,vitamin D receptor gene,TAP2 gene,CBLB gene)and thyroid-specific genes(TSHR gene and thyroglobulin gene),as well as the recent advances of them.%Graves病(GD)是一种器官特异性自身免疫性疾病,目前一般认为是遗传和环境因素相互作用的结果.多年来在GD易感基因的研究上已经取得了很多进展,如人白细胞抗原(HLA)基因、细胞毒性T淋巴细胞抗原-4(CTLA-4)基因以及促甲状腺激素受体(TSHR)基因等.本文对免疫调节基因(如HLA基因、CTLA-4基因、CD40基因、白细胞介素基因、维生素D受体基因、抗原肽运载体基因、CBLB基因等)和甲状腺特异性基因(TSHR基因和甲状腺球蛋白基因)的研究现状进行综述.

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

    Directory of Open Access Journals (Sweden)

    Fatemeh Esfahanian

    2013-06-01

    Full Text Available About 25-50% of Graves' disease (GD patients develop thyroid eye diseases, which is associated with inflammatory process and abnormalities in the levels of several cytokines in orbital tissues in GD.  The aim of this study was to determine the Th1 and Th2 serum cytokines in patients with GD with or without ophthalmopathy.Serum  levels of  cytokines  and  autoantibodies  including Interferon-gamma  (IFN-γ,Interleukin-2 (IL-2, Interleukin-4 (IL-4, Interleukin-10 (IL-10, TSH receptor autoantibody (TRAb, thyroid  peroxidase antibody (TPOAb  and  thyroglobulin antibody(TgAb were measured by enzyme linked immunosorbent assay(ELISA in 34 patients with GD and in 33 normal controls. Patients were also divided in two subgroups: 18 cases with ophthalmopathy and 16 cases without ophthalmopathy. Cytokine and antibody responses were analyzed in both groups.Compared with control subjects, patients with GD  showed elevated levels of IL-2 and IL-10. IFN-γ  levels were lower in patients in comparison to the controls. No significant differences were found  between patients and controls regarding the IL-4. There was no statistically significant  difference  in  cytokine  levels  between  those   with  or   without ophthalmopathy.Quantitative-cytokine  analysis  demonstrated  that  a  combination  of  Th1  and  Th2 cytokines may contribute to the pathogenesis of GD. These results also indicate that IL-10, but not IL-4, is related to the moderate and severe forms of thyroid associated ophthalmophathy.

  1. Cardiovascular complications secondary to Graves' disease: a prospective study from Ukraine.

    Directory of Open Access Journals (Sweden)

    Iryna Tsymbaliuk

    Full Text Available Graves' disease (GD is a common cause of hyperthyroidism resulting in development of thyrotoxic heart disease (THD.to assess cardiovascular disorders and health related quality of life (HRQoL in patients with THD secondary to GD.All patients diagnosed with THD secondary to GD between January 2011 and December 2013 were eligible for this study. Clinical assessment was performed at baseline and at the follow-up visit after the restoring of euthyroid state. HRQoL was studied with a questionnaire EQ-5D-5L.Follow-up data were available for 61 patients, but only 30 patients with THD secondary to GD were consented to participate in investigation of their HRQoL. The frequency of cardiovascular complications was significantly reduced as compared before and after the antithyroid therapy as follows: resting heart rate (122 vs. 74 bpm, blood pressure: systolic (155 vs. 123 mm Hg, diastolic (83 vs. 66 mm Hg, supraventricular premature contractions (71% vs. 7%, atrial fibrillation (72% vs. 25%, congestive heart failure (69% vs. 20%, thyrotoxic cardiomyopathy (77% vs. 26%, all p<0.01. Anti-TSH receptor antibodies were determined as independent predictor of left ventricular geometry changes, (b-coefficient = 0.04, 95%CI 0.01-0.07, p = 0.02. HRQoL was improved in all domains and self-rated health increased from 43 to 75 units by visual analogue score (p<0.001.Restoring of euthyroid state in patients with GD is associated with significant elimination of cardiovascular disorders and improvement of HRQoL. To our knowledge this is the first study evaluating Ukrainian patients with THD secondary to GD with focus on HRQoL.

  2. Fenótipos clínicos de asma grave Clinical phenotypes of severe asthma

    Directory of Open Access Journals (Sweden)

    Roseliane de Souza Araújo Alves

    2008-09-01

    Full Text Available OBJETIVO: Estabelecer os fenótipos clínicos em portadores de asma grave. MÉTODOS: Foram estudados, retrospectivamente, 111 pacientes em um ambulatório especializado. Os pacientes foram avaliados e acompanhados de maneira sistemática, estabelecendo-se ao final do acompanhamento a adesão e o controle ou não da doença por dados clínicos e funcionais. A resistência ao tratamento foi definida como o não preenchimento, ao final do acompanhamento, por pelo menos seis meses, dos critérios de controle de asma, apesar do uso correto e adesão à medicação. Os fenótipos foram determinados por análise fatorial e comparados por testes diversos. RESULTADOS: Ao final, 88 pacientes foram considerados aderentes e 23 não aderentes. Por análise fatorial do grupo aderente, quatro fenótipos foram determinados: o fenótipo 1 (28 pacientes, formado pelos pacientes resistentes ao tratamento, com maior freqüência de sintomas noturnos, maior número de exacerbações e uso mais freqüente de broncodilatador de resgate; o fenótipo 2 (48 pacientes, formado pelos pacientes com obstrução persistente, com menores valores de relação volume expiratório forçado no primeiro segundo/capacidade vital forçada na avaliação inicial, idade mais avançada e maior tempo de doença; o fenótipo 3 (42 pacientes, representa os pacientes com rinossinusite alérgica, sendo constituído de não fumantes com obstrução predominantemente reversível; e o fenótipo 4 (15 pacientes, formado por casos com história de intolerância à aspirina associado à asma quase fatal. CONCLUSÕES: Um número significativo de portadores de ama grave não adere ao tratamento. Muitos pacientes com asma grave têm obstrução irreversível, mas o fenótipo clínico mais relevante é constituído pelos pacientes resistentes ao tratamento habitual.OBJECTIVE: To characterize clinical phenotypes of severe asthma. METHODS: A total of 111 patients were retrospectively evaluated at a

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

    Directory of Open Access Journals (Sweden)

    Maribel Rodríguez Matos

    2013-09-01

    Full Text Available La hidropesía fetal es un grave proceso de elevada mortalidad perinatal, de etiología multifactorial, caracterizado por un síndrome edematoso generalizado, con o sin acumulación de líquido en las cavidades serosas del organismo fetal. Se presenta un caso de hidropesía fetal no inmunológica en una paciente de sexo femenino, de color de piel blanca y de 20 años de edad con enfermedad hipertensiva grave, diagnosticada mediante ultrasonido, como estudio de bienestar fetal a las 35,1 semanas de gestación, cuando fue remitida desde su área de salud por presentar cifras de tensión arterial de 160/100 mmHg. A su llegada al cuerpo de guardia de ginecobstetricia del hospital Héroes del Baire de la Isla de la Juventud se constataron cifras de 140/90 mmHg, se presentaba asintomática, por lo que se ingresó para estudio y tratamiento. Teniendo en cuenta el examen físico y el resultado del ultrasonido obstétrico, se decidió la interrupción de embarazo por cesárea de urgencia. Se recibió un recién nacido pretérmino de aspecto malformado. Se decide la presentación del caso por lo poco común de esta patología asociada a una enfermedad hipertensiva grave lo que incrementa el riesgo perinatal.

  4. Induction of Graves' disease in patients with non-autoimmune hyperthyroidism or nontoxic goiter after radioiodine treatment

    International Nuclear Information System (INIS)

    Thyrotropin receptors antibodies may occur and induce Graves' disease (GD) several months after radioiodine therapy in a small number of patients with non-autoimmune hyperthyroidism or nontoxic goiter. The prevalence of radiation-induced GD is between 0.05% and 5%. The hypothesis of this disease includes induction by autoimmune reaction and others. Detection of the thyroid autoantibodise or of 99mTc pertechnetate scan can forecast the appearance of GD. Antithyroid drugs, again radioiodine therapy and surgery are the treatments. (authors)

  5. Thyroid stimulating immunoglobulins in Graves' disease with goitre growth, low thyroxine and increasing triiodothyronine during PTU treatment

    DEFF Research Database (Denmark)

    Hegedüs, Laszlo; Hansen, J M; Bech, K;

    1984-01-01

    In 50 consecutive patients with Graves' disease treated with PTU, 7 (group 1) developed increasing goitre in spite of unmeasurable TSH. Thyroid variables were compared with those from 10 controls with an ordinary response to PTU (group 2). Serum T4 decreased in group 1 from 246 +/- 47 nmol/l (mean...... above the normal range in group 1 after that time. In spite of unmeasurable TSH during the 6 months of treatment in group 1, thyroid volume, determined ultrasonically, increased significantly from 60 +/- 29 to 93 +/- 68 ml (P less than 0.05), but was unaltered in group 2 about 25 ml. Thyroid stimulating...

  6. Cuadriceplastia de Judet : una alternativa quirúrgica para las rigideces graves en extensión de la rodilla

    OpenAIRE

    Pérez Ortiz, S.; Gómez Barbero, Patricia; Borrás Cebrián, Juan Carlos; Ripoll Vidal, F.

    2016-01-01

    Introducción. La contractura en extensión de la rodilla es una complicación de las fracturas femorales con importante afectación de partes blandas. La cuadriceplastia de Judet es una alternativa quirúrgica para aumentar la movilidad. Material y métodos. Presentamos el caso de un paciente con rigidez grave de rodilla en extensión tras una fractura abierta bifocal de fémur estabilizada mediante osteosíntesis que se complicó con una infección y retardo de consolidación que requirió v...

  7. Fênomeno de Raynaud grave associado a terapia com interferon-beta para esclerose múltipla: relato de caso

    OpenAIRE

    CRUZ BORIS AFONSO; QUEIROZ EUSTÁQUIO DE; SIMONE VILELA NUNESi; CRUZ FILHO ACHILES; CAMPOS GILBERTO BELISARIO; MONTEIRO ERNESTO LENTZ DE CARVALHO; CRIVELLARI HUMBERTO

    2000-01-01

    Interferon-B (IFN-beta) é usado no tratamento de esclerose múltipla (EM). Descrevemos o caso de uma mulher com EM que apresentou fenômeno de Raynaud grave, livedo reticular e necrose digital duas semanas após tratamento com IFN-beta. Os sintomas melhoraram após suspensão do IFN-beta e início de anticoagulação associada a ciclofosfamida e corticóide. Fenômeno de Raynaud é um efeito colateral provável da terapia com IFN-beta para EM.

  8. Tratamento da miastenia grave mediante imunossupressão medicamentosa não esteróide

    OpenAIRE

    José Lamartine de Assis; Paulo Eurípedes Marchiori; Milberto Scaff; Antonio Alberto Zambon

    1986-01-01

    São estudados 14 pacientes (doze dos quais eram mulheres) com miastenia grave severa e resistente aos procedimentos terapêuticos habituais. Em um paciente a prednisona foi substituída pela imunossupressão com citotóxicos e em outro o emprego destes permitiu redução da dose do esferóide, que passou a ser bem tolerado. Nos dois casos o emprego dos citostáticos foi decorrência de complicações da prednisona. São empregadas azatioprina e ciclosfosfamida em programas em que estão associadas, na mai...

  9. La inclusión educativa de alumnos con discapacidades graves y permanentes en la Unión Europea

    OpenAIRE

    López Torrijo, Manuel

    2009-01-01

    Este artículo presenta un estudio comparado de la atención realizada a los alumnos con discapacidades graves y permanentes en los seis países de la UE que presentan mayores índices de inclusión educativa (Italia, Grecia, Portugal, Noruega, Chipre e Islandia). Dicho estudio está realizado teniendo en cuenta los siguientes indicadores: concepción de las necesidades educativas especiales, identificación de los déficit, alumnado escolarizado en Centros Específicos de Educación Especial, marco leg...

  10. Estudio clínico del proceso conductual de la emergencia del coma grave por accidente cerebrovascular

    OpenAIRE

    Romero López, Modesto Jesús

    2007-01-01

    Objetivos: Estudiar el proceso de la emergencia del coma en pacientes en coma grave por accidente cerebrovascular (ACV). Método: Se han evaluado a 32 pacientes ingresados en una unidad de cuidados intensivos por un coma de origen cerebrovascular. Se ha realizado un seguimiento diario por neuropsicólogos e intensivistas y monitorizado el despertar del coma mediante 8 escalas de evalua ... ción clínica de los niveles de coma. Se han analizado las variables: edad, género, residencia, índice prem...

  11. Increase of thyroid stimulating activity in Graves' immunoglobulin-G by high polyethylene glycol concentrations using porcine thyroid cell assay.

    Science.gov (United States)

    Inui, T; Kouki, T; Yamashiro, K; Hachiya, T; Ochi, Y; Kajita, Y; Sato, Y; Nagata, A

    1998-04-01

    Cyclic adenosine monophosphate (cAMP) production during a 5-hour incubation using porcine thyroid cells (PTC) was stimulated significantly more by polyethylene glycol (PEG) 22.5% precipitated fractions (ppt frs) than by PEG 12.5% ppt frs from almost all Graves' sera. However, the thyrotropin (TSH) binding inhibition (TBI) activities of the PEG 12.5% and 22.5% ppt frs using porcine thyroid membranes were similar, and did not change in the 5-hour incubation. When the PEG 12.5% ppt fr from Graves' serum and the PEG 22.5% ppt fr from normal human serum (NHS) were coincubated, cAMP production was also stimulated as much as by the PEG 22.5% ppt fr from Graves' serum. When purified thyroid stimulating antibody (TSAb)-immunoglobulin G (IgG) and the PEG 22.5% ppt fr from NHS were coincubated, increased cAMP production was also observed, whereas bovine thyrotropin (bTSH) did not produce this effect. When purified TSAb-IgG and PEG solutions were coincubated, maximum increases in cAMP production (approximately 10-fold) with 5% PEG were found, whereas no increase was observed using bTSH. The stimulatory effect of high PEG concentrations on thyroid stimulating activity was observed by TSAb-IgG in salt-free or salt-containing medium (<0.15 mol/L NaCl concentration) but not by either TSAb-IgG conjugated to protein A-sepharose 4B or the inactivated TSAb-IgG by the treatment of 70 degrees C for 10 minutes. No stimulatory action by PEG was found with the thyroid stimulating substances such as GTPgammaS, forskolin, or pituitary adenylate-cyclase activating polypeptide (PACAP). The increased thyroid stimulating activity of Graves (IgG) at high PEG concentrations suggests the existence of some factors influencing the ability of TSAb to stimulate thyroid cells, although the exact mechanism remains to be clarified. PMID:9588497

  12. La falsificación: un delito grave que pasa desapercibido/Counterfeiting: a serious crime that goes unnoticed

    OpenAIRE

    Sandro Calvani (Italia); Mtro. Marco Musumeci (Italia)

    2015-01-01

    La asociación a la delincuencia organizada es en sí misma un “factor de riesgo” para la seguridad de los ciudadanos y para el orden público. La falsificación es una actividad delictiva peligrosa porque, al copiar productos, los falsificadores causan enormes daños al mercado y ponen en grave riesgo a los consumidores. Una de las consecuencias negativas de las economías son el resultado de la pérdida de ventas que sufren los legítimos productores cmoo0 resultado de la pérdida de ventas. Otras...

  13. Fatores de risco para lesão renal aguda em pacientes com trauma grave e seus efeitos na mortalidade

    Directory of Open Access Journals (Sweden)

    André Luciano Baitello

    2013-06-01

    Full Text Available Os estudos que relacionaram lesão renal aguda (LRA e trauma surgiram durante a Segunda Guerra Mundial e, desde então, tem havido progressiva evolução dos cuidados para a prevenção da LRA. Entretanto, a determinação dos fatores de risco para o desenvolvimento de LRA pós-trauma permanece crucial e pode ajudar a reduzir esta complicação. OBJETIVO: Este estudo tem como objetivo identificar os fatores de risco para o desenvolvimento de LRA em pacientes com trauma grave e sua influência na mortalidade. Trata-se de um estudo retrospectivo com 75 pacientes incluídos por apresentarem trauma grave; seis foram excluídos por terem chegado ao hospital sem condições de ressuscitação. MÉTODO: As variáveis estudadas foram: idade, sexo, gravidade do trauma de acordo com Injury Severity Score (ISS e Escala de Coma de Glasgow (ECG, mecanismo de trauma, pressão arterial média na admissão, reposição volêmica nas primeiras 24h, níveis séricos de creatinina, uso de antibióticos nefrotóxicos, tempo de internação, necessidade de internação em UTI e mortalidade. RESULTADOS: A prevalência de LRA em traumatizados graves foi de 17,3%, sendo que os fatores associados à IRA nessa amostra foram TCE, ECG < 10. A mortalidade, o tempo de internação e a necessidade de UTI foram significativamente maiores nos pacientes que desenvolveram LRA. CONCLUSÕES: A identificação desses fatores de risco é de suma importância para a formulação de estratégias de atendimento aos pacientes vítimas de trauma grave, visando à prevenção da lesão renal aguda e da elevada mortalidade.

  14. Reclassificando o espectro de pacientes septicos com o uso do lactato: sepse grave, choque criptico, choque vasoplegico e choque disoxico

    Directory of Open Access Journals (Sweden)

    Otavio Tavares Ranzani

    2013-12-01

    Full Text Available Objetivo: A definição atual de sepse grave e choque séptico inclui um perfil heterogêneo de pacientes. Embora o valor prognóstico de hiperlactatemia seja bem estabelecido, ela está presente em pacientes com ou sem choque. Nosso objetivo foi comparar o prognóstico de pacientes sépticos estratificando-os segundo dois fatores: hiperlactatemia e hipotensão persistente. Métodos: Este estudo é uma análise secundária de um estudo observacional conduzido em dez hospitais no Brasil (Rede Amil - SP. Pacientes sépticos com valor inicial de lactato das primeiras 6 horas do diagnóstico foram incluídos e divididos em 4 grupos segundo hiperlactatemia (lactato >4mmol/L e hipotensão persistente: (1 sepse grave (sem ambos os critérios; (2 choque críptico (hiperlactatemia sem hipotensão persistente; (3 choque vasoplégico (hipotensão persistente sem hiperlactatemia; e (4 choque disóxico (ambos os critérios. Resultados: Foram analisados 1.948 pacientes, e o grupo sepse grave constituiu 52% dos pacientes, seguido por 28% com choque vasoplégico, 12% choque disóxico e 8% com choque críptico. A sobrevida em 28 dias foi diferente entre os grupos (p<0,001, sendo maior para o grupo sepse grave (69%; p<0,001 versus outros, semelhante entre choque críptico e vasoplégico (53%; p=0,39 e menor para choque disóxico (38%; p<0,001 versus outros. Em análise ajustada, a sobrevida em 28 dias permaneceu diferente entre os grupos (p<0,001, sendo a maior razão de risco para o grupo choque disóxico (HR=2,99; IC95% 2,21-4,05. Conclusão: A definição de pacientes com sepse inclui quatro diferentes perfis, se considerarmos a presença de hiperlactatemia. Novos estudos são necessários para melhor caracterizar pacientes sépticos e gerar conhecimento epidemiológico, além de possível adequação de tratamentos dirigidos.

  15. Indium-111 octreotide in graves' disease and in evaluation of active exophthalmos

    International Nuclear Information System (INIS)

    Thyroid Associated Ophthalmopathy (TAO) is an autoimmune disorder generally associated with Graves' disease (GD). The aim of this study was to evaluate the uptake of indium-111 Octreotide (111In-OCT), a somatostatin (SS) analogue able to bind specific SS receptors, at the level of the thyroid and orbits in patients with TAO. Seven patients with exophthalmos were investigated: six had GD while one was affected with a non small cell lung cancer (NSCLC). One patient with GD had undergone total thyroidectomy (TT) for a thyroid cancer. At the time of the study two patients were hyperthyroid, four were euthyroid and one was hypothyroid. 111 MBq of 111In-OCT were i.v. injected and two 30 minute scans were performed at 4 and 24 hours; 5 minute planar images were also obtained at 25, 60 and 120 minutes. A 180 SPECT was carried out 5 hours after the injection in one patient. A qualitative analysis was performed, comparing these images with those obtained in 7 control patients without thyroid illness or exophthalmos. Moreover, in the TAO patients thyroid, orbit and brain counts were evaluated in comparison with background (BK) and blood activity (BA), measured at the level of the venous longitudinal sinus. In GD intense thyroid uptake was demonstrated independently of the functional state, with highest ratio compared to BK seen at 24 hours. Low uptake in the patient with NSCLC, no activity in the patient with GD that underwent TT, and slight or absent thyroid uptake in the controls were observed. Intense uptake was seen in the orbits of the patient who clinically had the most severe ophthalmopathy. SPECT clearly identified the intra orbital location of this accumulation. Moderate uptake was seen in two GD patients and slight uptake in two others. No accumulation was found in one patient with GD, or in the patient with NSCLC, despite his exophthalmos. No orbital activity was seen in the controls. Lastly, when cerebral uptake was compared to BA, no significant blood brain

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

    Directory of Open Access Journals (Sweden)

    Diego R.G. Tudela

    2012-06-01

    Full Text Available This paper presents the results of TL and OSL dating of soil and fragments of bricks from a grave, which was occupied by two mummified nuns, found at "Luz" Monastery, located in the state of São Paulo, Brazil. The TL and OSL ages were compared to C-14 dating ones obtained from bone collagens of the mummies. The majority of the ages is related to the eighteenth century. The gamma-ray spectroscopy was used to evaluate natural radioisotope concentrations in the samples, and by using these concentrations the annual dose rates, from 3.0 to 5.3 Gy/kyr, were obtained. Neutron activation analysis was performed and the radioisotope contents results are in agreement with those obtained by gamma-ray spectroscopy. The contents of U, Th and Ce elements were higher than those found in usual sediments.Este artigo apresenta os resultados de datação por TL e OSL de solos, e fragmentos de tijolos de um túmulo, que foi ocupado por duas freiras mumificadas encontradas no Mosteiro da "Luz", localizado no Estado de São Paulo, Brasil. As idades encontradas por TL e OSL foram comparadas às obtidas a partir de C-14 dos colágenos contidos em amostras de osso das múmias. A maioria das idades obtidas são do século XVIII. A espectroscopia de radiação-gama foi utilizada para avaliar concentrações de radioisótopos naturais nas amostras e para calcular as taxas de dose anual que resultaram em 3,0 a 5,3 Gy/kano. As concentrações radioativas são próximas daquelas obtidas através de Análise por Ativação de Nêutrons. Os conteúdos de elementos U, Th e Ce são superiores aos encontrados na maioria dos sedimentos.

  17. Thyroid storm associated with Graves' disease covered by diabetic ketoacidosis: A case report

    Science.gov (United States)

    2011-01-01

    Background Thyroid storm is a condition in which multiple organ dysfunction results from failure of the compensatory mechanisms of the body owing to excessive thyroid hormone activity induced by some factors in patients with thyrotoxicosis. While diabetic ketoacidosis (DKA) is an important trigger for thyroid storm, simultaneous development of DKA and thyroid storm is rare. Case presentation A 59-year-old woman with no history of either diabetes mellitus or thyroid disease presented to our hospital because of developing nausea, vomiting and diarrhea for 2 days. Physical examination showed mild disturbance of consciousness, fever, and tachycardia. There were no other signs of thyrotoxicosis. Laboratory studies revealed elevation of random blood glucose and glycosylated hemoglobin, strongly positive of urine acetone, and metabolic acidosis. Since DKA was diagnosed, we initiated the patient on treatment with administration of insulin and adequate fluid replacement. Although the hyperglycemia and acidosis were immediately relieved, the disturbance of consciousness and tachycardia remained persistent. Levels of FT3 and FT4 were extremely high and TSH was below the detectable limit. TRAb was positive. The thyroid storm score of Burch & Wartofsky was 75/140, and the thyroid storm diagnostic criteria of the Japan Thyroid Association were satisfied. Oral administration of thiamazole, potassium iodide and propranolol resulted in immediate relief of the tachycardia. Discussion We encountered a case of thyroid storm associated with Graves' disease covered by DKA. Thyroid storm and DKA are both potentially fatal, and the prognosis varies depending on whether or not these conditions are detected and treated sufficiently early. The thyroid storm diagnostic criteria prepared in 2008 by the Japan Thyroid Association are very simple as compared to the Burch & Wartofsky scoring system for thyroid storm. The Japanese criteria may be useful in the diagnosis of this condition since they

  18. Thyroid storm associated with Graves' disease covered by diabetic ketoacidosis: A case report

    Directory of Open Access Journals (Sweden)

    Osada Erika

    2011-04-01

    Full Text Available Abstract Background Thyroid storm is a condition in which multiple organ dysfunction results from failure of the compensatory mechanisms of the body owing to excessive thyroid hormone activity induced by some factors in patients with thyrotoxicosis. While diabetic ketoacidosis (DKA is an important trigger for thyroid storm, simultaneous development of DKA and thyroid storm is rare. Case presentation A 59-year-old woman with no history of either diabetes mellitus or thyroid disease presented to our hospital because of developing nausea, vomiting and diarrhea for 2 days. Physical examination showed mild disturbance of consciousness, fever, and tachycardia. There were no other signs of thyrotoxicosis. Laboratory studies revealed elevation of random blood glucose and glycosylated hemoglobin, strongly positive of urine acetone, and metabolic acidosis. Since DKA was diagnosed, we initiated the patient on treatment with administration of insulin and adequate fluid replacement. Although the hyperglycemia and acidosis were immediately relieved, the disturbance of consciousness and tachycardia remained persistent. Levels of FT3 and FT4 were extremely high and TSH was below the detectable limit. TRAb was positive. The thyroid storm score of Burch & Wartofsky was 75/140, and the thyroid storm diagnostic criteria of the Japan Thyroid Association were satisfied. Oral administration of thiamazole, potassium iodide and propranolol resulted in immediate relief of the tachycardia. Discussion We encountered a case of thyroid storm associated with Graves' disease covered by DKA. Thyroid storm and DKA are both potentially fatal, and the prognosis varies depending on whether or not these conditions are detected and treated sufficiently early. The thyroid storm diagnostic criteria prepared in 2008 by the Japan Thyroid Association are very simple as compared to the Burch & Wartofsky scoring system for thyroid storm. The Japanese criteria may be useful in the diagnosis

  19. The Efficacy of Radiation Therapy in the Treatment of Graves' Orbitopathy

    Energy Technology Data Exchange (ETDEWEB)

    Matthiesen, Chance, E-mail: chance-matthiesen@ouhsc.edu [Department of Radiation Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK (United States); Thompson, J. Spencer [Department of Radiation Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK (United States); Thompson, David [Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK (United States); Farris, Bradley; Wilkes, Byron [Dean A. McGee Eye Institute, Oklahoma City, OK (United States); Ahmad, Salahuddin; Herman, Terence; Bogardus, Carl [Department of Radiation Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK (United States)

    2012-01-01

    Purpose: To review our institutional outcomes of patients treated with radiation therapy (RT) for Graves' orbitopathy (GO), assess the role of orbital reirradiation, and identify prognostic factors of complete response (CR). Methods and Materials: This is a retrospective review of 211 patients who presented with a diagnosis of GO and received RT between January 2000-2010. RT dose was 20 Gy in 10 fractions. Patient median age was 51 years (range, 15-84 years), median follow-up was 11 months (range, 1-88 months). Patient symptoms included any combination of proptosis (90.9%), extraocular muscle dysfunction (78.9%), soft tissue signs (68.4%), and diplopia (58.4%). Corticosteroids were used as first-line therapy in 20.6% of patients. Among those who achieved either CR or partial response (PR), prognostic factors were evaluated. Results: Stabilization of disease without recurrence was clinically achieved overall in 202 patients (96.7%). At the completion of RT, 176 patients (84.2%) reported a symptomatic improvement of pretreatment symptoms. CR of GO symptoms was achieved using multiple treatment modalities, including RT by 93 patients (44.5%), of which 32 patients received RT only. Corticosteroids were discontinued in 97.8% of patients who received them as initial therapy. Surgical intervention following radiotherapy was required for 144 (68.9%) of all patients. Fourteen patients received orbital reirradiation for persistent or recurrent symptoms. Five of these achieved a CR, and the other nine achieved disease stabilization but retained persistent ocular symptoms. Long-term side effects of RT included dry eyes (12%). Of the prognostic factors we investigated, only gender predicted CR, which was less common in men (33.9%) than in women (49.7%) p = 0.0471. Conclusions: Orbital radiation for GO is an established treatment modality for patients. Orbital reirradiation is beneficial for patients who do not respond to initial RT or experience symptom recurrence without

  20. Comprehensive genotyping in two homogeneous Graves' disease samples reveals major and novel HLA association alleles.

    Directory of Open Access Journals (Sweden)

    Pei-Lung Chen

    Full Text Available BACKGROUND: Graves' disease (GD is the leading cause of hyperthyroidism and thyroid eye disease inherited as a complex trait. Although geoepidemiology studies showed relatively higher prevalence of GD in Asians than in Caucasians, previous genetic studies were contradictory concerning whether and/or which human leukocyte antigen (HLA alleles are associated with GD in Asians. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a case-control association study (499 unrelated GD cases and 504 controls and a replication in an independent family sample (419 GD individuals and their 282 relatives in 165 families. To minimize genetic and phenotypic heterogeneity, we included only ethnic Chinese Han population in Taiwan and excluded subjects with hypothyroidism. We performed direct and comprehensive genotyping of six classical HLA loci (HLA-A, -B, -C, -DPB1, -DQB1 and -DRB1 to 4-digit resolution. Combining the data of two sample populations, we found that B*46:01 (odds ratio under dominant model [OR]  = 1.33, Bonferroni corrected combined P [P(Bc]  = 1.17 x 10⁻², DPB1*05:01 (OR  = 2.34, P(Bc = 2.58 x 10⁻¹⁰, DQB1*03:02 (OR  = 0.62, P(Bc  = 1.97 x 10⁻², DRB1*15:01 (OR  = 1.68, P(Bc = 1.22 x 10⁻² and DRB1*16:02 (OR  = 2.63, P(Bc  = 1.46 x 10⁻⁵ were associated with GD. HLA-DPB1*05:01 is the major gene of GD in our population and singly accounts for 48.4% of population-attributable risk. CONCLUSIONS/SIGNIFICANCE: These GD-associated alleles we identified in ethnic Chinese Hans, and those identified in other Asian studies, are totally distinct from the known associated alleles in Caucasians. Identification of population-specific association alleles is the critical first step for individualized medicine. Furthermore, comparison between different susceptibility/protective alleles across populations could facilitate generation of novel hypothesis about GD pathophysiology and indicate a new direction for future

  1. Un nuevo modelo para abordar el protocolo familiar

    OpenAIRE

    Rodríguez Zapatero, M.; Rodríguez Jiménez, Magdalena; Rodríguez Alcaide, J.J.

    2014-01-01

    Entender y gestionar la singularidad de la empresa familiar es determinante para mejorar las posibilidades de transmisión de la misma a generaciones futuras. Las estadísticas, año tras año, vienen a confirmar bajos índices de supervivencia en el traspaso generacional de la empresa familiar; Es por ello que desarrollar herramientas, que permitan y faciliten la comprensión y gestión de dicha singularidad, generará sin duda un fuerte valor añadido y ventaja competitiva para la familia empresaria...

  2. Experimental model of severe acute pancreatitis in rabbits Modelo experimental de pancreatite aguda grave em coelhos

    Directory of Open Access Journals (Sweden)

    Alberto Goldenberg

    2007-10-01

    Full Text Available PURPOSE: To develop an experimental model of severe acute pancreatitis in rabbits through a pancreatic ductal injection of sodium taurocholate. METHODS: Twenty-four albino rabbits of the New Zealand lineage were distributed into four groups of six animals (A, B, C and S. The rabbits of three experimental groups (A, B and C were submitted to a laparatomy and received a pancreatic ductal injection of 1ml/kg sodium taurocholate 5%. Also, they were submitted to further laparatomies after 4h, 8h and 12h, respectively. The control group (S was subdivided into two groups of three animals: in subgroup S1 only the pancreatic duct catheterization was performed whereas in subgroup S2 the pancreatic duct catheterization as well as an injection of 1ml/kg physiologic solution 0.9% were carried out. After 12 hours, the rabbits were evaluated. In the re-intervention, blood was collected to determine the amylasemia and a pancreatectomy was carried out to investigate interstitial infiltration, steatonecrosis and necrosis of the organ, using an optical microscope. RESULTS: There was an elevation of amylase in all groups thus proving the existence of acute pancreatitis. The size of the interlobular septum increased progressively with a greater variation between group S1 (0.13 and group C (0. 53 (p=0.035. While all the animals in group A exhibited focal cellular necrosis, it was more intense in the rabbits of group B and culminated with a high proportion of severe pancreatic necrosis in group C animals. The difference in the intensity of cellular necrosis showed statistic significance (p=0.001. CONCLUSION: The proposed experimental model demonstrated its reproducibility and effectiveness in producing severe acute pancreatitis in rabbits.OBJETIVO: Desenvolver modelo experimental de pancreatite aguda grave em coelhos por meio da injeção de taurocolato de sódio no ducto pancreático. MÉTODOS: Vinte e quatro coelhos albinos da linhagem Nova Zelândia foram distribu

  3. Nutrición y anemias en pacientes graves Nutrition and anaemias in critical illness

    Directory of Open Access Journals (Sweden)

    F. Gallardo

    2010-02-01

    Full Text Available Introducción: Realizamos un estudio clínico original sobre nutrición en pacientes graves, que incluye a un grupo heterogéneo típico de pacientes críticos, con/sin anemias, que nos han ingresado en la Unidad de Cuidados Intensivos, UCI. Es difícil individualizar y generalizar la relativa importancia de todos los factores que pueden contribuir a estas anemias en la admisión en la Unidad, incluyendo las deficiencias nutricionales, las alteraciones inflamatorias, la respuesta a las agresiones, las modificaciones inmunitarias y las complejas relaciones existente entre estos procesos clínicos. Objetivo: Valoración indirecta de la situación nutricional y anemias, en un grupo heterogéneo típico de pacientes críticos. Método/Resultados: Se estudian 202 pacientes ingresados en la UCI, de variada y heterogénea procedencia, y clasificándolos en 3 grupos: control, postoperados y sépticos, realizándose la valoración indirecta de la situación nutricional en base a: la Valoración Global Subjetiva, (VGS, y las determinaciones analíticas nutricionales pronosticas de linfocitos totales, albúmina, y transferrina. También se realizo hemograma y determinaciones de sideremia y ferritinemia a todos ellos. En un 57% de los pacientes, se observo cifras de hemoglobina inferior a 12.5 gr/dl, básicamente en el grupo de postoperados, (68 pacientes y sépticos, (10 pacientes. Y con cifras inferiores a 10 g/dl de hemoglobina, en 25 pacientes mas, (12,3%. Hubo 87 pacientes, 23 de ellos en el grupo control, 58 en los postoperados y 5 sépticos, cuya cifra de hemoglobina era superior a 12,5 g/dl. En cuanto a los indicadores pronósticos nutricionales, (VGS + perfil nutricional, en el grupo control no presentaban anemia ni desnutrición clínico analítica, en los postoperados, anemia y desnutrición leve y en los sépticos, anemia y desnutrición ligera-moderada. Había diferencias significativas entre los pacientes del grupo control y los grupos

  4. Cirurgia de estrabismo ajustável no peroperatório com anestesia tópica em pacientes com orbitopatia de Graves Intraoperative adjustable strabismus surgery under drop anesthesia in patients with Graves' orbitopathy

    Directory of Open Access Journals (Sweden)

    Patrícia Grativol Costa

    2008-06-01

    Full Text Available OBJETIVO: Descrever as características clínicas pré-operatórias dos pacientes com estrabismo secundário à orbitopatia de Graves e os resultados da cirurgia com anestesia tópica e sutura ajustável. MÉTODOS: Estudo retrospectivo realizado no Hospital das Clínicas da Universidade de São Paulo. Foram pesquisados os prontuários de todos os pacientes atendidos no ambulatório de estrabismo no período de março de 1994 a maio de 2004. Destes, foram separados aqueles com estrabismo associado à orbitopatia de Graves submetidos à cirurgia ajustável com anestesia tópica. As características clínicas pré-operatórias e os resultados cirúrgicos foram levantados a partir desta análise. RESULTADOS: Foram incluídos 13 pacientes. O tipo de desvio mais freqüentemente encontrado foi esotropia com hipotropia. Em 9 pacientes modificou-se o retrocesso programado no pré-operatório. Três casos necessitaram de uma segunda cirurgia. Após 6 meses de seguimento, 8 dos 13 pacientes estavam ortotrópicos ou com foria pequena e com algum grau de estereopsia. CONCLUSÃO: Neste estudo observou-se que 62% (8/13 dos pacientes apresentavam hipotropia com esotropia, provavelmente por causa do comprometimento associado do reto inferior e reto medial. Nove dos 13 pacientes necessitaram de ajuste no peroperatório e apenas 3 foram reoperados, indicando a importância da técnica ajustável para melhor alinhamento ocular no pós-operatório, possibilitando obter resultados mais satisfatórios.PURPOSE: To report the clinical features of strabismus associated with Graves' orbitopathy, and the results of surgery with adjustable suture under drop anesthesia. METHODS: The charts of 13 patients who had surgical treatment for strabismus related to Graves' orbitopathy at Hospital das Clínicas of University of São Paulo were retrospectively reviewed. Ocular motility, sensorial examination and the follow-up after strabismus correction were studied. RESULTS

  5. Morbidade materna extremamente grave: uso do Sistema de Informação Hospitalar Morbilidad materna extremadamente grave: uso del sistema de información hospitalaria Severe acute maternal morbidity: use of the Brazilian Hospital Information System

    Directory of Open Access Journals (Sweden)

    Maria da Consolação Magalhães

    2012-06-01

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

  6. Percepción del peligro por intensa sequía en provincia de Camagüey, punto de partida para la educación ambiental.Perceptions of intensive drought hazard in Camaguey province, start point for environmental education.

    Directory of Open Access Journals (Sweden)

    Oscar Leopoldo Parrado Alvarez

    2013-08-01

    Full Text Available Resumen.Se presentan los resultados del estudio de la percepción del peligro, por inundaciones, intensas lluvias, penetraciones del mar y afectaciones por fuertes vientos, según la metodología propuesta por el Grupo Nacional de Evaluación de Riesgos que coordina la Agencia de Medio Ambiente (AMA del CITMA. Las unidades de análisis fueron: los municipios. En el procesamiento estadístico de los datos fueron utilizados los software: Excel, SPSS y Data Entry. La muestra de 1509 personas representa el 0,20 % de la población de la provincia. Los resultados de la encuesta realizada determina que el nivel de percepción del peligro por parte de la población es predominantemente medio (una percepción cercana a la realidad en la mayoría de los encuestados (85% independientemente de las vulnerabilidades estructurales, funcionales, económicas y ecológicas, existiendo comportamientos particulares a nivel de los Consejos Populares de cada municipio. Se discuten las diferencias observadas de acuerdo a las variables sociodemográficas estudiadas y se plantean las recomendaciones para el empleo de esta información en los procesos de educación ambiental. Abstract.The results of the study of the perception of the intensive drought hazard are presented, according to the methodology proposed by the National Group of Evaluation of Risks that coordinates by the Environment Agency (AMA of the CITMA. The analysis units were: the municipalities. For the statistical analysis of data they were used the software: Excel, SPSS and Data Entry. The sample of 1 509 people, represents 0,20% of the province population. The results of survey determines that the level of perception of the hazard on the part of the population is mainly medium (a near perception to the reality in most of those interviewed (85 % independently of the structural, functional, economic and ecological vulnerabilities, existing peculiar manners to level of the Popular Council of each

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

    DEFF Research Database (Denmark)

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

    2014-01-01

    manifestations of Graves' disease: severeness of hyperthyroidism, presence of enlarged thyroid, and presence of orbitopathy, as well as between the different types of manifestations. Only around half of patients had enlarged thyroid gland at the time of diagnosis of hyperthyroidism, whereas 25-30% had...... orbitopathy. Conclusions. A positive but rather weak correlation was found between TSH-receptor antibodies in serum and the major clinical manifestation of Graves' disease. Only half of the patients had an enlarged thyroid gland at the time of diagnosis....... and Sustenance in Graves' Disease (RISG)." Patients were systematically tested for degree of biochemical hyperthyroidism, enlarged thyroid volume by ultrasonography, and the presence of orbitopathy. Results. Positive correlations were found between the levels of TSH-receptor autoantibodies in serum and the three...

  8. 131I治疗对Graves眼病转归的影响%Effect of 131I therapy on outcomes of Graves' ophthalmopathy

    Institute of Scientific and Technical Information of China (English)

    王任飞; 谭建; 张桂芝; 尹亮

    2011-01-01

    目的 分析131I治疗后Graves甲状腺功能亢进症(甲亢)疗效与Graves眼病转归的相关关系,探讨131I治疗对Graves眼病转归的影响.方法 652例Graves甲亢合并Graves眼病的患者,均按照常规程序一次性给予治疗量的131I.服用131I前测量患者眼球突出度,并详细记录眼部症状和特征.治疗结束后定期随访,评价疗效.结果 患者服用131I后Graves甲亢治疗的总有效率约为94.3%,Graves眼病的总好转率约为73.3%,而Graves甲亢及Graves眼病治疗均有效者约占总病例数的71.2%.131I治疗后Graves眼病的转归与Graves甲亢是否得到有效缓解具有明显的相关性(r=0.302,P<0.05).131I治疗后Graves甲亢治愈组与甲状腺功能减退症(甲减)组比较,Graves眼病的疗效差异无统计学意义(x2=0.296,P>0.05).结论 通过131I治疗来缓解Graves甲亢是控制Graves眼病的根本措施.患者服用131I后加强随访,及时发现和纠正甲减可有效避免Graves眼病的加重.%Objective To analyze the correlation between the therapeutic effect of Graves'hyperthyroidism and the outcomes of Graves' ophthalmopathy after 131I therapy,and to explore the effect of 131I treatment on turnout of Graves' ophthalmopathy.Methods Six hundreds and fifty-two patients of Graves' disease accompanied with Graves' ophthalmopathy,received one-time 131I treatment according to routine procedure.We recorded exophthalmometer readings,the signs and symptoms of eyes before therapy.Regular follow-up and appraisal of curative effect were carried out.Results At least six months after 131Itherapy,the effective rate of Graves' hyperthyroidism and Graves' ophthalmopathy were 94.3% and 73.3%respectively.The total effective rate of hyperthyroidism with ophthalmophy was 71.2%.There was a significant correlation between the prognosis of Graves' ophthalmopathy and therapeutic efficacy of hyperthyroidism (r=0.302,P<0.05).The outcomes of Graves' ophthalmopathy had no

  9. The Sonographic Features of the Thyroid Gland After Treatment with Radioiodine Therapy in Patients with Graves' Disease.

    Science.gov (United States)

    English, Collette; Casey, Ruth; Bell, Marcia; Bergin, Diane; Murphy, Joseph

    2016-01-01

    The aim of the study was to describe the typical sonographic features of the thyroid gland in patients with Graves' hyperthyroidism after radioiodine therapy (RIT). Thirty patients (21 female and 9 male) with a mean age of 53 y (standard deviation [SD] ± 11.3) and with previous Graves' disease who had been successfully treated with RIT were enrolled in the study. All were hypothyroid or euthyroid after treatment. The thyroid ultrasound was carried out by a single experienced operator with an 8-MHz linear transducer. Volume, vascularity, echogenicity and echotexture of the glands were noted. The presence of nodules and lymph nodes was also documented. The mean volumes of the right lobe were 2.4 mL ± 2.9 SD (0.6-14) and the left lobe were 1.8 mL ± 1.9 SD (0.4-9.1), with a mean total volume of 4.2 mL ± 4.7 SD (1.3-19.1). Of those who had a pre-treatment ultrasound (23%), the percentage reduction in volume was 87% (p glands were hypovascular, with the remaining 7% showing normal vascularity. The glands were hyperechoic and of coarse echotexture. Overall, the sonographic features of the post-RIT gland included a significantly reduced mean total volume of 4.2 mL, hypovascularity, coarse echotexture and hyperechogenicity.

  10. Interleukin-2 receptor α and Graves' disease%白细胞介素2受体α与Graves病

    Institute of Scientific and Technical Information of China (English)

    徐雅萍; 孟凤苓

    2012-01-01

    白细胞介素2受体α (IL-2Rα)是白细胞介素2受体(IL-2R)的α链,属低亲和力IL-2R,它主要参与T淋巴细胞的活化与增殖,在多种自身免疫性疾病中发挥作用.通过对IL-2Rα与Graves病之间关系的研究,进一步探讨Graves病的发病机制,并为本病的诊断与治疗提供新思路.%Interleukin-2 receptor a (IL-2Rα) is a chain of the interleukin-2 receptor (IL-2R) which belongs to low-affinity IL-2R. IL-2Rα participates in the activation and reduplication of T lymphocyte and plays a role in many autoimmune diseases. To further explore the pathogenesis and provide the new idea with the diagnosis and treatment of Graves' disease, we study the relationship between the IL-2Rα and Graves' disease.

  11. EXPRESSION OF T CELL RECEPTOR Vα GENE FAMILIES IN INTRATHYROIDAL T CELLS OF CHINESE PATIENTS WITH GRAVES' DISEASE

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Objective. Patients with Graves' disease (GD) have marked lymphocytic infiltration in their thyroid glands. We examined the gene for the variable regions of the α-chain of the Chinese T-cell receptor( Vα gene) in intrathyroidal Tcells to determine the role of T cells in the pathogenesis of GD and offer potential for the development of immunothera-peutic remedies for GD. Methods. We used the reverse transcription and polymerase chain reaction(RT-PCR) to amplify complementary DNA(cDNA) for the 18 known families of the Vα gene in intrathyroidal T cells from 5 patients with Graves' disease.The findings were compared with the results of peripheral blood T cells in the same patients as well as those in normalsubjects. Results. We found that marked restriction in the expression of T cell receptor Vα genes by T cells from the thyroidtissue of Chinese patients with GD(P < 0.001). An average of only 4.6 ± 1.52 of the 18 Vα genes were expressed insuch samples, as compared with 10.4 ± 2.30Vα genes expressed in peripheral blood T cells from the same patients.The pattem of expressed Vα genes differed from patient to patient with no clear predominance. Condusions. Expression of intrathyroidal T cell receptor Vα genes in GD is highly restricted suggesting the prima-cy of T cells in causing the disorders.

  12. Introducción a las complicaciones graves de la quimioterapia que debe enfrentar un cardiólogo

    Directory of Open Access Journals (Sweden)

    Patricia Avellana

    2007-01-01

    Full Text Available La aplicación de diferentes esquemas farmacológicos para el tratamiento oncológico ha tenido en los últimos años un gran crecimiento, en muchos casos con efectos curativos o claramejoría de la sobrevida y la calidad de vida. Algunos esquemas incluyen drogas que pueden provocar efectos cardiotóxicos graves, lo que motiva la consulta a los cardiólogos que en la mayor parte de los casos no hemos tenido entrenamiento en esta complicación. En estarevisión se resumen mecanismos de acción y efectos adversos de diferentes drogas de uso frecuente en patología oncológica y se exponen casos clínicos con reacciones adversas graves, con dificultades en la toma de decisiones. Finalmente, se discuten los aspectos para tener en cuenta para la prevención, el control y el tratamiento de la cardiotoxicidad por agentes quimioterapéuticos.

  13. Diagnostic accuracy of short-time inversion recovery sequence in Graves' ophthalmopathy before and after prednisone treatment

    Energy Technology Data Exchange (ETDEWEB)

    Tortora, Fabio; Belfiore, Maria Paola; Romano, Francesco; Cappabianca, Salvatore; Cirillo, Sossio [' ' F. Magrassi-A. Lanzara' ' Second University, Naples (Italy). Dept. of Clinical and Experimental Medicine and Surgery; Prudente, Mariaevelina [Second University, Naples (Italy). Medicine Dept.; Vita Salute San Raffaele Univ., Milan (Italy). Dept. of Neuroradiology; Cirillo, Mario [Second University, Naples (Italy). Neuroradiological Services; Elefante, Andrea [Federic II Univ., Naples (Italy). Neuroradilogical Dept.; Carella, Carlo [Polidiagnostic Center Check-Up, Salerno (Italy)

    2014-05-15

    In Graves' Ophthalmopathy, it is important to distinguish active inflammatory phase, responsive to immunosuppressive treatment, from fibrotic unresponsive inactive one. The purpose of this study is, first, to identify the relevant orbital magnetic resonance imaging signal intensities before treatment, so to classify patients according to their clinical activity score (CAS), discriminating inactive (CAS < 3) from active Graves' Ophthalmopathy (GO) (CAS > 3) subjects and, second, to follow post-steroid treatment disease. An observational study was executed on 32 GO consecutive patients in different phases of disease, based on clinical and orbital Magnetic Resonance Imaging parameters, compared to 32 healthy volunteers. Orbital Magnetic Resonance Imaging was performed on a 1.5 tesla Magnetic Resonance Unit by an experienced neuroradiologist blinded to the clinical examinations. In pre-therapy patients, compared to controls, a medial rectus muscle statistically significant signal intensity ratio (SIR) in short-time inversion recovery (STIR) (long TR/TE) sequence was found, as well as when comparing patients before and after treatment, both medial and inferior rectus muscle SIR resulted significantly statistically different in STIR. These increased outcomes explain the inflammation oedematous phase of disease, moreover after steroid administration, compared to controls; patients presented lack of that statistically significant difference, thus suggesting treatment effectiveness. In our study, we proved STIR signal intensities increase in inflammation oedematous phase, confirming STIR sequence to define active phase of disease with more sensibility and reproducibility than CAS alone and to evaluate post-therapy involvement. (orig.)

  14. From Stone Graves to Churchyards. Burial traditions in the Late Prehistoric and Early Medieval Island of Saaremaa

    Directory of Open Access Journals (Sweden)

    Marika Mägi

    2004-10-01

    Full Text Available Even though pre-historic burials have been the favourite topic of research of Estonian archaeologists at least for the past century, the focus has been on their appearance, chronology, ethnic context and objects discovered in them. Burial tradition, as it reflects in the archaeological remnants, has hardly been studied. Research in the field over the past few years, as well as osteological analysis of bone material, which was first carried out in the 1990s, has introduced new findings in the funeral customs of our ancestors. The article examines funeral customs on the island of Saaremaa, and the ideology behind it. The main focus is on the final centuries of the prehistoric period and the beginning of the Middle Ages – more specifically, on changes brought along by Christianity, although the study also provides an overview of earlier customs. A separate chapter discusses the partial distribution of bones and objects in graves, objects determining the boundaries of graves, and traces of funeral rituals. This evidently reflects a set of traditions, and thus also conceptions about the otherworld, composed of multiple layers and differing considerably from the modern funeral tradition. Christianisation of the population of Saaremaa in the 13th century changed these conceptions beyond recognition over a very short period of time.

  15. In vivo and in vitro studies into the immunological changes following iodine 131 therapy for Graves' disease

    Energy Technology Data Exchange (ETDEWEB)

    Wilson, R.; McKillop, J.H.; Jenkins, C.; Thomson, J.A. (Glasgow Univ. (UK). Dept. of Medicine)

    1991-04-01

    Radio-iodine therapy for Graves' disease is followed by immunological changes in addition to effects on thyroid hormone production. The present study examined these changes and the mechanisms responsible for them. Of the 15 patients enrolled in the study, 10 became hypothyroid in the first year after iodine 131 therapy. Patients who became hypothyroid had a tendency to show a rise in serum thyrotropin receptor antibody levels (30{plus minus}14 to 40{plus minus}9; NS) and a significant rise in immunoglobulin production (324{plus minus}153 to 740{plus minus}200 ng/ml; P<0.0005) from mitogen-stimulated peripheral blood lymphocytes (a measure of B-cell activity) 2 months after iodine 131 therapy. The increases were not seen in the patients who remained euthyroid at 1 year. In vitro studies suggested that the rise in B-cell activity is due to a fall in suppressor T cell numbers, a change shown to occur following iodine 131 therapy in previous studies. Our results indicate that immunological changes do arise after iodine 131 therapy for Graves' disease but appear to be confined to patients who subsequently became hypothyroid. It is not possible from this study to determine whether the immunological changes appear as a consequence of thyroidal destruction leading to hypothyroidism or whether they contribute directly to it. (orig.).

  16. BENTUK KERJASAMA PUBLIC-PRIVATE PEMBANGUNAN GRAVING DOCK DAN MANAJEMEN GALANGAN KAPAL DENGAN METODE ANALYTICAL HIERARCHI PROCESS (AHP

    Directory of Open Access Journals (Sweden)

    Hartono Hartono

    2012-08-01

    Full Text Available In paper Development of port infrastructure in Indonesia is now no longer the responsibility of centralgovernment, along with limited funds and the government's insistence seaport infrastructure needs. Toaccelerate economic growth, the government issued Government Regulation as a legal umbrella. The purpose ofthis study was to examine public-private partnership opportunities in the construction of graving dock andshipyard management. Targets do is review, the criteria are prioritized cooperation and cooperationpriorities.This study used qualitative and quantitative approach, a descriptive qualitative approach throughinterviews used to assess the normative aspect. The quantitative approach used to assess the priority criteriaforms of cooperation and public-private partnership in development graving dock and shipyard management byusing the Analytical Hierarchy Process (AHP. Based on the AHP analysis can be concluded that the expertsdisagree about the priority criteria of cooperation, where the majority of them choose the duration as the maincriterion. As for the analysis of priorities of the cooperation of all experts choose Built-Operate-Transfer (BOT,which is deemed suitable for long-term investment of up to 30 years. BOT puts private partners to more freely tofinance, construct, operate, anticipated rate of return on capital (rate of return and the risks of commercial andregulatory aspects

  17. Celiac disease, iron deficiency anaemia, grave's disease, osteopenia and short stature in single patient

    International Nuclear Information System (INIS)

    Celiac disease is an intestinal immune mediated disorder, triggered by ingestion of gluten-containing diet in genetically susceptible individuals. The genetic pre-disposition is related to human leukocyte antigen (HLA) class II genes, especially HLA-DQ2 positive patients. The prevalence of celiac disease in high worldwide and it has been estimated to be 1-26% in Western countries. Many auto-immune diseases can be associated with celiac disease including auto-immune thyroid disease; hashimoto thyroiditis and grave's disease. The opposite also appears to be true, celiac disease is found on persons with auto-immune thyroid disorders at high rates than the general population. Celiac disease is also associated with other extraintestinal diseases other the auto-immune diseases like anemia, short stature, metabolic bone disease and others. Screening for celiac disease should be considered in patients with auto-immune thyroid disease, anemia, short stature and metabolic bone disease. The life-long adherence to gluten-free diet is the only cure in celiac disease and can improve the quality of patients life and prevent future complications. This report describes a case of Grave's disease, Iron deficiency anemia, Short stature, Osteopenia, diagnosed to have Celiac disease. (author)

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

    Directory of Open Access Journals (Sweden)

    Noguchi Hitoshi

    2011-12-01

    Full Text Available Abstract We report two patients with anorexia nervosa and Graves' disease who received subtotal thyroidectomy for Graves' disease and concomitantly experienced remission from anorexia nervosa. Both were young women (aged 20 and 26 at the time of surgery. Both had well controlled thyroid function and eating behavior at the time of surgery. Both were followed for over five years without relapse of anorexia nervosa or hyperthyroidism. These cases suggest the existence of an endocrine factor originating from the thyroid gland that is involved in the pathogenesis of anorexia nervosa. Since patients of thyroidectomy can remain in good health with supplement of thyroxine alone, it can be hypothesized that this anorexigenic endocrine factor is an evolutionary relic not necessary for the normal function of humans and does not have physiological effects unless secreted beyond normal levels. Given that, it implies the existence of a creature in the animal kingdom for which such an anorexigenic hormone is essential for survival. Migrating birds eat beyond their caloric expenditure before migration and become anorexic for the duration of their flight. It is also known that their thyroid function is elevated during migration. The normal physiology of migration is a complex mechanism involving the hypothalamic, pituitary, thyroid, adrenal and reproductive hormones. The mechanism of disease, however, can be simpler. A review of the literature is presented that suggest a heretofore unreported thyroid hormone, which is involved in the regulation of migration behavior, may be the responsible factor behind anorexia nervosa.

  19. A USE-WEAR ANALYSIS OF THE KNAPPED LITHIC GRAVE GOODS FROM GRUTA DO MORGADO SUPERIOR (TOMAR, PORTUGAL

    Directory of Open Access Journals (Sweden)

    Ana Cruz

    2015-12-01

    Full Text Available The Morgado Superior cave is a karst cave located in the municipality of Tomar (Santarém, Portugal. As other caves of the same area, it has provided stratigraphic data and votive deposits falling within the Holocene, more precisely in a diachronic time range that extends from the Neolithic to the early Bronze Age. In the Morgado Superior cave there are multiple burials with a few votive objects like jars, bone artefacts and lithic tools (blades, arrowheads etc., beads, pendants, and other decorative items in association with more than 8,000 human bones: the number of the grave goods elements is low if compared with the number of individuals buried in the cave. Concerning the use-wear study, we analyzed the grave goods in order to understand both their meaning in this funerary context and their function in the economy of this prehistoric society. We focused on the most representative elements of the grave goods: arrowheads and knapped lithic artefacts. This study led us to understand that the majority of the grave goods were everyday objects but with a strong symbolic value. Since in the Morgado Superior Cave there are a lot of grave goods showing prior breaks, their symbolic value does not seem to be lost even if the objects were broken. Thus, the use-wear analysis of the grave goods from the Morgado Superior Cave allowed us to identify the strong symbolic value of these elements for that human community, but at the same time to hypothesize a funerary practice that did not provide a special respect for the body and the grave goods of those dead previously buried in the cave. For these reasons we hypothesize a progressive spoliation (probably ritual of the previous grave goods. Through the use-wear study of the knapped lithic assemblage of the Morgado Superior Cave it was possible to reconstruct part of the ritual activities that were carried out in the site: the 90% of the lithic artefacts are used objects, all of the artefacts have been

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

    Directory of Open Access Journals (Sweden)

    Neha Singhal

    2016-01-01

    Full Text Available Context: Most of the information on remission related factors in Grave's disease are derived from Western literature. It is likely that there may be additional prognostic factors and differences in the postdrug treatment course of Grave's disease in India. Aim: To study factors which predict remission/relapse in Grave's disease patients from South India. Also to establish if technetium (Tc uptake has a role in predicting remission. Subjects and Methods: Records of 174 patients with clinical, biochemical, and scintigraphic criteria consistent with Grave's disease, seen in our Institution between January 2006 and 2014 were analyzed. Patient factors, drug-related factors, Tc-99m uptake and other clinical factors were compared between the remission and nonremission groups. Statistical Analysis Used: Mann–Whitney U-test and Chi-square tests were used when appropriate to compare the groups. Results: Fifty-seven (32.7% patients attained remission after at least 1 year of thionamide therapy. Of these, 11 (19.2% patients relapsed within 1 year. Age, gender, goiter, and presence of extrathyroidal manifestations were not associated with remission. Higher values of Tc uptake were positively associated with remission (P- 0.02. Time to achievement of normal thyroid function and composite dose: Time scores were significantly associated with remission (P - 0.05 and P - 0.01, respectively. Patients with lower FT4 at presentation had a higher chance of remission (P - 0.01. The relapse rates were lower than previously reported in the literature. A higher Tc uptake was found to be significantly associated with relapse also (P - 0.009. Conclusion: The prognostic factors associated with remission in Graves's disease in this South Indian study are not the same as that reported in Western literature. Tc scintigraphy may have an additional role in identifying people who are likely to undergo remission and thus predict the outcome of Grave's disease.

  1. Increased microRNA-155 and decreased microRNA-146a may promote ocular inflammation and proliferation in Graves' ophthalmopathy.

    Science.gov (United States)

    Li, Kaijun; Du, Yi; Jiang, Ben-Li; He, Jian-Feng

    2014-01-01

    Graves' ophthalmopathy is an inflammatory autoimmune disease of the orbit, characterized by inflammation and proliferation of the orbital tissue caused by CD4+T cells and orbital fibroblasts. Despite recent substantial findings regarding its cellular and molecular foundations, the pathogenesis of Graves' ophthalmopathy remains unclear. Accumulating data suggest that microRNAs play important roles in the pathophysiology of autoimmunity and proliferation. Specifically, microRNA-155 (miR-155) can promote autoimmune inflammation by enhancing inflammatory T cell development. In contrast to miR-155, microRNA-146a (miR-146a) can inhibit the immune response by suppressing T cell activation. Furthermore, miR-155 and miR-146a are involved in cell proliferation, differentiation, and many other life processes. Thus, miR-155 and miR-146a, with opposite impacts on inflammatory responses carried out by T lymphocytes, appear to have multiple targets in the pathogenesis of Graves' ophthalmopathy. Our previous work showed that the expression of miR-146a was significantly decreased in peripheral blood mononuclear cells from Graves' ophthalmopathy patients compared with normal subjects. Accordingly, we proposed that the expression of miR-155 increased and the expression of miR-146a decreased in the target cells (CD4+T cells and orbital fibroblasts), thus promoting ocular inflammation and proliferation in Graves' ophthalmopathy. The proposed hypothesis warrants further investigation of the function of the differentially expressed microRNAs, which may shed new light on the pathogenesis of Graves' ophthalmopathy and lead to new strategies for its management. PMID:24743332

  2. Radiotherapy of Graves' ophthalmopathy. State of the art and review of the literature; Radiotherapie der endokrinen Orbitopathie. State of the Art und Literaturuebersicht

    Energy Technology Data Exchange (ETDEWEB)

    Eich, H.T. [Klinikum der Univ. Koeln (Germany). Klinik und Poliklinik fuer Strahlentherapie; Micke, O. [Franziskus-Hospital Bielefeld (Germany). Klinik fuer Radioonkologie und Strahlentherapie; Seegenschmiedt, M.H. [Alfried-Krupp Krankenhaus Essen (Germany). Klinik fuer Radioonkologie und Strahlentherapie

    2007-07-01

    Graves' ophthalmopathy (GO), the most frequent extrathyroidal manifestation of Graves' disease, is a disorder of autoimmune origin, the pathogenic mechanisms of which are still incompletely understood. Although GO is severe in only 3-5% of affected individuals, quality of life is severely impaired even in patients with mild GO. The role of radiotherapy in the management of GO is discussed controversially. However, recent randomized clinical trials have, with one exception, confirmed that orbital radiotherapy is an effective and safe therapeutic procedure for GO. This article describes the sequences, dosages and fractionation schemes as well as the risks and side effects of the radiotherapy. (orig.)

  3. Saint Sisoes above the grave of Alexander the Great. A monastic theme of post-Byzantine art and its examples from the 17th century Serbian painting

    OpenAIRE

    Živković Miloš

    2013-01-01

    The depiction of St. Sisoes above the grave of Alexander the Great was formulated at the end of the 15th century. The image in question is a visual interpretation of a short song («I see you, grave»), and it was often painted in the churches throughout the Balkans during the next two centuries. With references to the textual basis of this iconographic theme, as well as its meaning, the article is devoted to insufficiently studied Serbian examples of frescoe...

  4. Haptoglobin study in myasthenia gravis Estudo sobre a haptoglobina na miastenia grave

    Directory of Open Access Journals (Sweden)

    Leonardo H. Mendonça Oliveira

    2008-06-01

    Full Text Available OBJECTIVE: A cross-sectional study of haptoglobin (Hp in myasthenia gravis (MG was designed, with the objective to identify its values and correlate them with different disease status. METHOD: 46 patients were enrolled in the study, all having disease severity established according to the quantitative myasthenia gravis strength scores (QMGSS. Based on the functional scale determined by Myasthenia Gravis Foundation of America (MGFA recommendations, patients were classified as having: complete stable remission (CSR; n=10; minimal manifestations-0 (MM0; n=6, minimal manifestations-1 (MM1; n=4; pharmacological remission (PR; n=6. Two other groups participated: thymomatous patients (T; n=10 and patients without imunosuppression or thymectomy, until the assessment for Hp (WIT; n=10. Hp dosage was done by immunonephelometry, blindly to clinical data. Student's t-test, Anova test and linear regression were employed for statistical analyses. RESULTS: Statistically significant differences occurred between CSR+MM0xWIT groups (86.62x157.57, pOBJECTIVO: Desenhou-se estudo transversal sobre a haptoglobina (Hp na miastenia grave (MG com o objetivo de identificar seus valores e correlacioná-los a diferentes condições na doença. MÉTODO: 46 pacientes foram incluídos, todos tendo a gravidade da doença estabelecida segundo escores internacionais (QMGSS. Os pacientes tiveram seu estado funcional determinado de acordo com a Myasthenia Gravis Foundation of América (MGFA e classificados em: remissão completa estável (CSR; n=10; mínima manifestação-0 (MM0; n=6, mínima manifestação-1 (MM1; n=4; remissão farmacológica (PR; n=6. Dois outros grupos participaram: pacientes timomatosos (T; n=10 e pacientes sem imunossupressão ou timectomia, até o momento da inclusão no estudo (WIT; n=10. A dosagem de Hp foi realizada por imunonefelometria, de modo cego quanto à clínica. As análises estatísticas incluíram o teste de Student, Anova e regressão linear

  5. Avaliação nutricional em pacientes graves Nutritional assessment of the severely ill patient

    Directory of Open Access Journals (Sweden)

    Anahi Ottonelli Maicá

    2008-09-01

    Full Text Available Considerando a importância e as dificuldades inerentes à avaliação do estado nutricional, assim como da interpretação dos resultados, além da inexistência de diretrizes específicas e validadas quanto aos métodos aplicados ao paciente crítico, o objetivo deste estudo foi contribuir para a análise e recomendação de métodos eficazes, passíveis de utilização e fidedignos do ponto de vista da interpretação no contexto do paciente grave. A presença de edema e alterações inespecíficas nas concentrações plasmáticas de proteínas; variáveis antropométricas alteradas, refletindo muito mais o rearranjo da água corporal total do que modificações do estado nutricional; estudos pouco conclusivos com a bioimpedância elétrica; ausência de dados relativos à aplicação da avaliação subjetiva global; indicadores bioquímicos alterados como conseqüência das mudanças metabólicas, entre outros, indicam as várias limitações dos métodos a esses pacientes. Na ausência de estudos que os validem, existem recomendações baseadas em evidências clínicas, observação e fundamentação nas alterações fisiopatológicas. Independentemente dos métodos, a observação clínica pela equipe de saúde é imprescindível em todas as etapas. Há necessidade de maiores estudos que identifiquem claramente os métodos e sua especificidade para a detecção, avaliação de risco ou monitorização.Considering the importance and the difficulties inherent to nutritional state assessment, as well as the results interpretation and the inexistence of specific and validated guidelines related to applied methods to the severely ill patient, the present revision aims to contribute to the analysis and recommendation of efficient methods, which are suitable to use and reliable in terms of interpretation in the context of the severely ill patient. The presence of edema and unspecific alterations in the plasmatic concentrations of proteins

  6. Bases técnicas para la aplicación del sistema de análisis de peligro y puntos críticos de control (haccp desde la granja de ponedoras hasta la recepción y distribución de huevos para el consumo.

    Directory of Open Access Journals (Sweden)

    Yanetsy Pérez Pérez; Alcides Pérez Bello.-

    2006-10-01

    Full Text Available Pérez Pérez, Yanetsy; Suárez Fernández, Yolanda; CuraRESUMENPara garantizar alimentos de calidad, y sinriesgos para la salud pública, debenemplearse sistemas de producción dealimentos seguros, "desde el productorhasta el consumidor", lo que reduce loscostos de producción por concepto deinspección y decomiso de productoscontaminados o deteriorados, y elconsiguiente impacto económico, político ysocial. Es con este objetivo que se realizaun estudio de identificación y análisis deriesgos biológicos, químicos y físicos enuna granja avícola de ponedoras y elcentro de acopio y distribución de huevoscomerciales de la provincia Villa Clara; loque permitió la determinación de losriegos, los Puntos Críticos de Control(PCC, sus correspondientes LímitesCríticos (LC y las posibles desviaciones deestos últimos, los procedimientos devigilancia y monitoreo y la propuesta demedidas o acciones correctivas queconstituyen las bases técnicas para laimplementación del Sistema de Análisis dePeligro y Puntos Críticos de Control(HACCP, en la producción de huevoscomerciales; previa decisión de lasautoridades empresarialescorrespondientes.Palabras claves:

  7. Endangered languages: Heritage of humanity in dire need of protection Four approaches which support their preservation and maintenance Lenguas en peligro: una herencia de la humanidad en gran necesidad de protección Cuatro acercamientos para apoyar su preservación y mantenimiento

    Directory of Open Access Journals (Sweden)

    M.A Enrique Uribe-Jongbloed

    2007-12-01

    Full Text Available The purpose of this paper is to present and discuss four approaches which support actions in favor of endangered language preservation and maintenance. Preservation, on the one hand, refers to the process of documenting and storing information which can later on be accessed by the public; whereas maintenance, on the other, implies a support for the users of the language to prevent its disappearance by encouraging its use. Each of the approaches is assessed on its priority in one or the other form of language protection, drawing on their justifications and main goals. Finally, conclusions are brought forth regarding the potential uses of the different approaches.El propósito de este artículo es presentar y discutir cuatro aproximaciones que apoyan las acciones en favor de la preservación y mantenimiento de los idiomas en peligro de extinción. La preservación se entiende como el proceso de documentar y almacenar información que pueda ser posteriormente accesible por el público general, mientras que mantenimiento, por otro lado, implica el apoyo a los usuarios del idioma para prevenir la desaparición y promover la continuación de su uso. Cada una de las aproximaciones es evaluada con respecto a su prioridad como forma de proteger el idioma, obtenidas a partir de su justificación y objetivos. Por último, las conclusiones se presentan hacia su uso potencial de las distintas aproximaciones.

  8. Dosimetric comparison between fixed and individualized activity in Graves' disease treatment with 131{sub I}; Comparacion dosimetrica entre actividad fiija y actividad individualizada en el tratamiento de la enfermedad de Graves con 131{sub I}

    Energy Technology Data Exchange (ETDEWEB)

    Melgar Perez, J.; Orellana Salas, A.; Santaella Guardiola, Y.; Arrocha Acevedo, J. F.

    2013-07-01

    A patient-especific method has been used to calculate the therapeutic {sup 1}'3{sup 1} I activity to administer to patients with Graves disease in order to obtain the optimal thyroid dose. The aim of this study was to analyze the dose variation in contrast to the fixed a ctivity regimen. In 30 patients, biokinetic and morfological parameters were estimated from planar scintigraphic images obtained at 4, 24 and 96 hours after injection of {sup 123} I and {sup 131} I activities were calculated to deliver 120 Gy to the thyroid. Comparative dose calculations were carried out assuming that the individual patients had been treated according to 370 MBq activity administration. Activity (or dose) was reduced by an average factor of 2.4 and up to a factor 4.9 for an individual patient. The implemen ted method seeks a balance among the accuracy of the calculations, resource consumption and patient comfort. (Author)

  9. I-131 Treatment of Graves' Disease in an Unsuspected First Trimester Pregnancy; the Potential for Adverse Effects on the Fetus and a Review of the Current Guidelines for Pregnancy Screening

    Directory of Open Access Journals (Sweden)

    Barrett Mark

    2010-03-01

    Full Text Available Graves' disease is a thyroid-specific autoimmune disorder in which the body makes antibodies to the thyroid-stimulating hormone receptor leading to hyperthyroidism. Therapeutic options for the treatment of Graves' disease include medication, radioactive iodine ablation, and surgery. Radioactive iodine is absolutely contraindicated in pregnancy as exposure to I-131 to the fetal thyroid can result in fetal hypothyroidism and cretinism. Here we describe a case of a female patient with recurrent Graves' disease, who inadvertently received I-131 therapy when she was estimated to be eight days pregnant. This was despite the obtaining of a negative history of pregnancy and a negative urine pregnancy test less than 24 hours prior to ablation. At birth, the infant was found to have neonatal Graves' disease. The neonatal Graves' disease resolved spontaneously. It was suspected that the fetal thyroid did not trap any I-131 as it does not concentrate iodine until 10 weeks of gestation.

  10. Quality of Life of Severe Sepsis Survivors After Hospital Discharge Calidad de vida de sobrevivientes de sepsis grave después del alta hospitalar Qualidade de vida de sobreviventes de sepse grave após alta hospitalar

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    Ligia Marcia Contrin

    2013-06-01

    Full Text Available AIMS: to evaluate the quality of life in severe sepsis survivors, using specific QoL questionnaires: the EuroQol-5 Dimensions and the Visual Analogue Scale (EQ-VAS. METHOD: This case-control study was performed in patients discharged from a teaching hospital after being admitted to the ICU with severe sepsis. Medical records from 349 patients were retrieved from the hospital sepsis registry. Each patient with sepsis was considered as a case. Patients who were admitted immediately after the sepsis episode were considered as controls, provided that they did not have sepsis and survived the ICU admission. This specific study population included 100 patients. RESULTS: The sepsis group showed higher mortality at 1 year compared with critically ill patients. However, the control group showed no sepsis. Older patients (>60 years in the sepsis group had a significantly higher prevalence of problems. There were no differences in EQ-VAS between respondents from both groups. CONCLUSIONS: After discharge from ICU, sepsis survivors of sepsis had a higher mortality rate than critically ill patients without sepsis. Older patients with sepsis had more moderate and severe problems in all five quality of life dimensions evaluated. OBJETIVO: Evaluación de la calidad de vida de los sobrevivientes de sepsis grave con los instrumentos EuroQol-5D y la Escala Analógica Visual (EQ-VAS. MÉTODO: Estudio caso-control anidado en pacientes que recibieron alta de la unidad de cuidados intensivos (UCI de un hospital de enseñanza después de la admisión con sepsis grave. La selección fue realizada a partir del registro de sepsis conteniendo 349 pacientes y cada paciente con sepsis fue considerado como un caso y el que fue hospitalizado inmediatamente después fue seleccionado como control, desde que no tuviera sepsis y hubiera sobrevivido a la hospitalización en la UCI y la sepsis, totalizando 100 sujetos. RESULTADOS: El grupo de sepsis mostró una mayor mortalidad a 1 a

  11. Graves病发病机制中T淋巴细胞的研究进展%Research Progress of T Lymphocytes in Pathogenesis of Graves' Disease

    Institute of Scientific and Technical Information of China (English)

    马学芹

    2013-01-01

    Graves病(GD)是甲状腺功能亢进症最常见的类型,占85% ~90%,其发病机制尚未完全明了.但作为一种自身免疫性甲状腺疾病,T淋巴细胞在其发病机制中起着举足轻重的作用,Th1、Th2、Treg及Th1/Th2细胞因子失衡与其发生关系密切.近年来发现Th17及其相关因子可能在GD发病机制中起重要作用.该文就Th1、Th2、Th17及Treg与GD关系的研究进展进行综述.%Graves disease is the most common type of hyperthyroidism,accounting for 85%-90% of the total, the pathogenesis of which is not entirely clear yet. But as an autoimmune thyroid disease, T lymphocytes plays an important role in the pathogenesis. Th1 , Th2, Treg and Th1/Th2 cytokines imbalance are closely associated with the pathogenesis of Graves disease. In recent years, Th17 and its related cytokines may play an essential role in the pathogenesis of Graves disease. Here is to make a review on the relationship between Th1 ,Th2 ,Th17,Treg and Graves disease.

  12. Clinical Observation on Sanhuang Yikang (三黄抑亢) CapsuleSupplemented with Small Dosage of Tapazole in Treating Graves Disease

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    The authors used Sanhuang Yikang (三黄抑亢, SHYK) capsule supplemented with small dosage of tapazole in treating 62 Graves disease patients from January 1992 to December 1997, and compared the results with that in treating 35 patients with routine dosage of tapazole, and now it is reported as follows.

  13. Divergent frequencies of IGF-I receptor-expressing blood lymphocytes in monozygotic twin pairs discordant for Graves' disease: evidence for a phenotypic signature ascribable to nongenetic factors

    DEFF Research Database (Denmark)

    Douglas, Raymond S; Brix, Thomas H; Hwang, Catherine J;

    2009-01-01

    CONTEXT: Graves' disease (GD) is an autoimmune process of the thyroid and orbital connective tissues. The fraction of T and B cells expressing IGF-I receptor (IGF-IR) is increased in GD. It is a potentially important autoantigen in GD. Susceptibility to GD arises from both genetic and acquired fa...

  14. Increased muscle tension and reduced elasticity of affected muscles in recent-onset Graves' disease caused primarily by active muscle contraction

    NARCIS (Netherlands)

    H.J. Simonsz (Huib); G. Kommerell (Guntram)

    1989-01-01

    textabstractIn 3 patients with Graves' disease of recent onset, length-tension diagrams were made during surgery for squint under eyedrop anesthesia. The affected muscles were found to be very stiff when the other eye looked straight ahead. It was expected that these stiff muscles would be able to s

  15. Subcapsular hepatic hematoma. Serious complication during pregnancy Hematoma subcapsular hepático. Grave complicación del embarazo

    Directory of Open Access Journals (Sweden)

    Viviana de la Caridad Sáez Cantero

    2010-12-01

    Full Text Available Subcapsular hepatic hematoma is a rare complication during pregnancy, but potentially lethal and usually related to severe pre-eclampsia or HELLP syndrome (hemolysis, elevated liver enzymes and diminished platelets. Maternal and perinatal mortality in these cases is high, hence the importance of early diagnosis and timely and multidisciplinary treatment. This paper is a review on the subject, held in Ebsco, Hinari and Sci databases.El hematoma subcapsular hepático es una complicación rara del embarazo, pero potencialmente letal, generalmente relacionada con pre-eclampsia grave o síndrome HELLP (hemólisis, enzimas hepáticas elevadas y plaquetas disminuidas. La mortalidad materna y perinatal en estos casos es elevada, de ahí la importancia del reconocimiento precoz y tratamiento oportuno y multidisciplinario. El presente trabajo constituye una revisión sobre el tema, realizada en las bases de dato Ebsco, Hinari y Scielo.

  16. A Prospective Investigation of Graves' Disease and Selenium: Thyroid Hormones, Auto-Antibodies and Self-Rated Symptoms

    DEFF Research Database (Denmark)

    Calissendorff, Jan; Mikulski, Emil; Larsen, Erik Huusfeldt;

    2015-01-01

    Background: In Graves' thyrotoxicosis tachycardia, weight loss and mental symptoms are common. Recovery takes time and varies between patients. Treatment with methimazole reduces thyroid hormone levels. According to previous research, this reduction has been faster if selenium (Se) is added....... Objective: The objective was to investigate whether supplementing the pharmacologic treatment with Se could change the immune mechanisms, hormone levels and/or depression and anxiety. Methods: We prospectively investigated 38 patients with initially untreated thyrotoxicosis by measuring the thyroid......-stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), thyroid receptor antibodies and thyroid peroxidase auto-antibodies before medication and at 6, 18 and 36 weeks after commencing treatment with methimazole and levo-thyroxine, with a randomized blinded oral administration of 200 µg Se...

  17. Comportement de chaussées expérimentales à assises en graves non traitées calcaires

    OpenAIRE

    EL ABD, A; HORNYCH, P; Breysse, D.; Denis, A.; DEBLEECKER, P

    2003-01-01

    Cet article présente les premiers résultats d'une expérimentation réalisée en charente Maritime, pour tester l'utilisation de graves non traitées issues de calcaires tendres (matériaux locaux à valoriser) dans les structures de chaussées. Une première étude en laboratoire a montré que ces matériaux calcaires, de faible résistance mécanique (coefficent Los Angeles et Micro-Deval élevés) présentaient de très bonnes caractéristiques mécaniques à l'essai triaxial (module élastique élevé, faibles ...

  18. Effect of thyroid auto-antibodies on hypothyroidism of adolescents with graves disease after 131I treatment

    International Nuclear Information System (INIS)

    To investigate the effect of TSH receptor antibody (TRAb) and thyroid peroxidase antibody (TPOAb) levels in adolescents with Graves disease (GD) before 131I treatment on the incidence of hypothyroidism after 131I therapy. The total 264 adolescent with GD were treated with 131I. All patients before the treatment were divided into A, B, C, D, E and F groups in accordance with the levels of TRAb and TPOAb in various combinations. The serum TSH, FT3, FT4, TRAb and TPOAb levels in all patients were measured after 131I treatment. The incidence of hypothyroidism within three years were observed in each group. The results showed that the incidence of hypothyroidism in TRAb negative group was higher than that of positive group (χ2=4.67, P2=4.10, 4.34, 5.66, P131I therapy. It could be cautious in treatment of GD adolescents of TRAb negative and TPOAb positive with 131I. (authors)

  19. Unusual presentation of Warthin variant of Papillary thyroid carcinoma with lymph nodal metastases in a patient of Graves' disease.

    Science.gov (United States)

    Padma, Subramanyam; Sundaram, Palaniswamy Shanmuga; Arun, B R

    2015-01-01

    Warthin-like Papillary thyroid carcinoma (WPTC) is a rare variant of papillary carcinoma of thyroid, PTC which derives its name by closely resembling Warthin's tumor of salivary gland. Hallmark histological feature of this variant is papillary folding lined by oncocytic neoplastic cells with clear nuclei and nuclear pseudoinclusions, accompanied by prominent lymphocytic infiltrate in the papillary stalks. It is thought to be one of those differentiated thyroid cancers with favorable prognosis. We report a case of Graves' disease with a cold nodule harboring WPTC with initial presentation of lymph nodal metastases. It is important to identify this peculiar variant of PTC as 5 to 10% of them undergo dedifferentiation and 30% have the lymph nodal metastases and extra thyroidal extension.

  20. Procalcitonina como biomarcador de prognóstico da sepse grave e choque séptico

    Directory of Open Access Journals (Sweden)

    José Raimundo Araujo de Azevedo

    2012-12-01

    Full Text Available OBJETIVO: Avaliar a tendência da concentração plasmática e do clearance de procalcitonina (PCT-c como biomarcadores de prognóstico de pacientes com sepse grave e choque séptico, comparado a um outro marcador precoce de prognóstico representado pelo número de critérios de SIRS no momento do diagnóstico da sepse. MÉTODOS: Estudo de coorte prospectivo observacional onde foram incluídos pacientes com sepse grave e choque séptico. A concentração sérica de procalcitonina foi determinada no momento do diagnóstico da sepse e após 24 e 48 horas. Foram coletados dados demográficos, escore APACHE IV, escore SOFA na chegada, número de critérios de SIRS no momento do diagnóstico, sitio da infecção e resultados microbiológicos. RESULTADOS: Vinte e oito pacientes foram incluídos, 19 clínicos e nove cirúrgicos. Em 13 (46,4% a fonte da sepse foi pulmonar, em sete abdominal (25,0%, em cinco urinária (17,9% e de partes moles em três casos (10,7%. Quinze pacientes tinham sepse grave e 13 choque séptico. A mortalidade global foi cinco pacientes (17,9%, três deles com choque séptico. Vinte e oito determinações de PCT foram realizadas no momento do diagnóstico da sepse, 27 após 24 horas e 26 após 48 horas. A concentração inicial não se mostrou expressivamente diferente entre os grupos sobreviventes e não sobreviventes, mas as diferenças entre os dois grupos após 24 e 48 horas alcançaram significância estatística expressiva. Não se observou diferença em relação ao número de critérios de SIRS. O clearance de procalcitonina de 24 horas mostrou-se expressivamente mais elevado no grupo de sobreviventes (-3,0 versus -300,0, p=0,028. Embora o clearance de procalcitonina de 48 horas tenha mostrado resultado mais elevado no grupo de sobreviventes comparado aos não sobreviventes, a diferença não alcançou significância estatística. CONCLUSÃO: Concentrações persistentemente elevadas de procalcitonina no plasma, assim

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

    Energy Technology Data Exchange (ETDEWEB)

    Tudela, Diego R.G.; Tatumi, Sonia H.; Yee, Marcio; Brito, Silvio L.M., E-mail: tatumi@fatecsp.br [Faculdades de Tecnologia de Sao Paulo (FATECs/CEETEPS/UNESP), Sao Paulo, SP (Brazil). Centro Estadual de Educacao Tecnologica Paula Souza; Morais, Jose L.; Morais, Daisy de; Piedade, Silvia C. [Universidade de Sao Paulo (USP), SP (Brazil). Museu de Arqueologia e Etnologia; Munita, Casimiro S.P.; Hazenfratz, Roberto [Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Sao Paulo, SP (Brazil)

    2012-06-15

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

  2. Tratamento da miastenia grave mediante imunossupressão medicamentosa não esteróide

    Directory of Open Access Journals (Sweden)

    José Lamartine de Assis

    1986-06-01

    Full Text Available São estudados 14 pacientes (doze dos quais eram mulheres com miastenia grave severa e resistente aos procedimentos terapêuticos habituais. Em um paciente a prednisona foi substituída pela imunossupressão com citotóxicos e em outro o emprego destes permitiu redução da dose do esferóide, que passou a ser bem tolerado. Nos dois casos o emprego dos citostáticos foi decorrência de complicações da prednisona. São empregadas azatioprina e ciclosfosfamida em programas em que estão associadas, na maioria dos casos, prednisona e plasmaférese. Todos os pacientes mantiveram o uso de anticolinesterásicos. A azatioprina é administrada pela via oral nas doses de 100-200mg/dia por período de 20 meses, enquanto a ciclofosfamida é empregada pela via oral nas doses de 100-200mg/dia por 6 meses ou lg pela via intravenosa a intervalos de 15-30 dias durante 6 meses. O período mais longo de observação até o momento é de 32 meses. Ocorreram melhoras importantes em 71,4% dos pacientes, sendo que em 8 (57% as melhoras começaram entre um e 6 meses após o início do tratamento. Efeitos colaterais foram infreqüentes e de pouca monta, não tendo ocorrido complicações graves dependentes diretamente das drogas até o momento.

  3. Study on T lymphocyte subsets and NK cells in patients with Graves' disease combined with type 2 diabetes

    Institute of Scientific and Technical Information of China (English)

    Wei Feng; Du Jing; Su Xiulan; Wu Lan; Wang Jinjing; Huo Xiaojing

    2008-01-01

    Objective To investigate changes in T lymphocyte subsets and NK cells in patients with simple Graves' disease (GD)and Graves' disease combined with type 2 diabetes mellitus (GD/T2DM). Methods Fifteen cases of GD/ T2DM were selected from our hospital from November 2001 to November 2004. Before and after therapy thyroid function, thyroglobulin antibody (TGA), thyroid microsomal antibody (TMA) and blood glucose level were measured, and T lymphocyte subsets (CD3, CD4, CD8, CD4/CD8) and NK cells (CD56) were measured by immunofluorescence double labeling monoclonal antibody and flow cytometry, respectively. At the same time, comparison was made with simple GD (15 cases), T2DM (15 cases) and healthy control (20 cases). Results Before therapy, CD4/CD8, CD4 and NK cells in GD/T2DM were less than normal, and there was no significant difference in comparison with simple GD (P<0.05). In T2DM group, only CD4/CD8 and CD4 were less than those of healthy controls (P<0.05). When thyroid function recovered after 1 to 3 months of methimazole treatment in both GD/T2DM and simple GD groups, various indexes recovered, which were more obvious in simple GD. Conclusion Immune hypofunction of GD may be the key to the immune abnormality of GD/T2DM, which is more significant than that of simple GD or T2DM. The recovery of thyroid function and immune abnormality is not consistent, and the recovery of GD is more significant than that of GD/T2DM.

  4. Eficácia do sulfato de aminosidine na leishmaniose visceral grave, resistente ao tratamento com antimonial pentavalente

    Directory of Open Access Journals (Sweden)

    Cleudson Castro

    1995-09-01

    Full Text Available Descreve-se um caso de calazar grave resistente a dez cursos de antimonial petitavalente (glucantime à base de 20mg de Sb5/kg/dia, que respondeu favoravelmente ao sulfato de aminosidine intramuscular na dose de 20mg/kg/dia por 20 dias, repetido após 20 dias. O parasitismo esplénico passou de 50 parasitos por campo a 3 parasitos em 10 campos logo após a primeira série de sulfato de aminosidine, tornando-se negativo depois de sete meses. A melhora clínica foi imediata, com redução gradual da hepatoesplenomegalia, e desaparecimento 26 meses após. Neste período aumentou 13 kg. Após o uso de aminosidine a reação de Monténégro tornou-se positiva e as células mononucleares responderam quando estimuladas com antígenos de leishmânia.A grave kala-azar infection in a 14 years old boy is described. The leishmanial infection failed to respond to ten interrupted courses of glucantime of variable duration (14-56 days at a dose of 20mg Sb5/kg/day. However a favorable response ocurred to intramuscular aminosidine sulphate (20mg/kg/day for 20 days. This same regimen was repeated 20 days later. After the first treatment splenic puncture parasite density fell from 50 amastigotes per oil immersion field to 3 amastigotes in 10 fields. A further splenic puncture 7 months after treatment was negative. The marked hepatoesplenomegaly gradually resolved over 26 months follow up and he gained 13 kilogramas in weight. After aminosidine sulphate therapy his Montenegro reaction become positive and his lymphocytes responded to leishmania antigens.

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

    Energy Technology Data Exchange (ETDEWEB)

    Viani, Gustavo Arruda; Stefano, Eduardo Jose [Escola de Medicina de Marilia, SP (Brazil). Radiation Oncology Department; Boin, Andre Campiolo [Escola de Medicina de Marilia, SP (Brazil); De Fendi, Ligia Issa; Fonseca, Ellen Carrara [Escola de Medicina de Marilia, SP (Brazil). Department of Ophthalmology; Paula, Jayter Silva de [Universidade de Sao Paulo (USP), Ribeirao Preto, SP (Brazil). Escola de Medicina. Department of Ophthalmology

    2012-07-01

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

  6. Abordaje quirúrgico de la elefantiasis escrotal a propósito de dos casos graves

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    C. Recalde-Losada

    2014-06-01

    Full Text Available El linfedema puede afectar a cualquier parte del cuerpo, incluido el escroto y el pene. Esta alteración en el drenaje linfático provoca en ocasiones grandes deformidades que conocemos como elefantiasis. El linfedema genital causa graves limitaciones funcionales y emocionales en los pacientes que lo padecen, pues a menudo sufren dolor debido a la irritación crónica, infecciones recurrentes, incapacidad para asearse, disfunción sexual, deformidad estética, llegando incluso a limitar la movilidad o la deambulación. No existe un tratamiento médico o quirúrgico ideal para el linfedema genital masculino. En la literatura se hace referencia a colgajos fasciocutáneos de la cara interna de los muslos tras grandes resecciones de tejido escrotal, pero este tipo de cirugía altera la termorregulación testicular y puede producir esterilidad. También está descrito el uso de injertos laminares de piel, que no aportan una cobertura estable. Otra opción es la reconstrucción con colgajos perineales posteriores, que preservan los linfáticos perirrectales para proveer un drenaje linfático adecuado a la zona. Presentamos 2 casos de linfedema escrotal grave, elefantiásico, no infeccioso, en los cuales realizamos linfangiectomía, resección de todo el tejido linfedematoso y reconstrucción con colgajos perineales locales. En ambos pacientes los resultados fueron satisfactorios, mejorando significativamente su calidad de vida sin evidenciar signos de recurrencia 1 año después del tratamiento.

  7. PPARg2 Ala¹² variant protects against Graves' orbitopathy and modulates the course of the disease.

    Science.gov (United States)

    Pawlak-Adamska, Edyta; Daroszewski, Jacek; Bolanowski, Marek; Oficjalska, Jolanta; Janusz, Przemyslaw; Szalinski, Marek; Frydecka, Irena

    2013-07-01

    Orbital fibroblast differentiation to adipocytes is a peroxisome proliferator-activated receptor g (PPARg)-dependent process essential for pathogenic tissue remodeling in Graves' orbitopathy (GO). PPARg2 Pro¹²Ala polymorphism modulates expression and/or function of the molecule encoded by this gene and is a promising locus of GO. Here, we analyzed associations of PPARg2 Pro¹²Ala with clinical manifestation of GO in 742 Polish Caucasians including 276 Graves' disease (GD) patients. In our study, the Ala¹² allele and Ala¹² variant (Ala¹²Ala and/or Pro¹²Ala genotype) decreased the risk of GO (p = 0.000012 and p = 0.00013). Moreover, Ala¹²Ala genotype was observed only in patients without GO (p = 0.002). GD patients with Ala¹² variant had less active and less severe eye symptoms. Female carriers of the Ala¹² allele rarely developed GO, but the marker was not related to symptoms of GO. The opposite finding was recorded in males, in whom the studied polymorphism was related to activity, but not to the development, of GO. In Ala¹² variant carriers without familial history of thyroid disease, risk of GO was lower than in persons with a familial background. The Ala¹² allele seemed to protect smokers from GO, but in nonsmokers, such a relation was not obvious. A multivariate analysis indicated the Pro¹²Ala marker as an independent risk factor of eye symptoms (p = 0.0001) and lack of Ala increases the risk of GO 3.24-fold. In conclusion, the gain-of-function Ala¹² variant protects against GO and modulates the course of the disease.

  8. Five different types of thyroid gammagraphics images in patients with Graves's illness dealt with 131I in Paraguay

    International Nuclear Information System (INIS)

    Thyroid disease is frequent in Paraguay, a country with a prevalence of goiter 48,6% in general population located in the center of South America. Grave's disease constitutes the most common thyroid hyper function observed whose treatment can be carried out with medication (propilthiouracil, metamizole, etc.), surgery or iodine 131(131I). We analyzed 70 patients this type of hyperthyroidism treated with the 131I, in its clinical aspect pre and post treatment, ultrasound and nuclear scan findings of the gland thyroid, the hormonal respond F4, T3, TSH, thyroid antibodies TPOab, TGab, TRab. Besides the diffuse classic image observed in the thyroid scan and by ultrasonography of the gland, in Grave's disease, 4 types of images were identified with nodules (multi nodular, hot nodule, cold nodule and miliar). The group with diffuse increase in size form was the most numerous (50%) continued by the variety multi nodular (30%), Marin-Lenhart's Sx (hot nodule) 14%, miliar 3%, and cold nodule 3%. Three months after the treatment with the radioiodine was observed the decrease of the size and thyroid volume in 68% of the patients, thyroid uptake with 131I diminished in 75%. All patients had an increase of weight of 20% and 87% of then were feminine. The signs and symptoms were normalized in 88,5% of the patients. The levels of FT4 were normalized in 73, 8%, T3 in 66%, TSH in 47,7%, TPOab in 83%, TGab in 90%, and TRab in 84%.A received a single dose of 131I was used it in 93% of the patient. The cost of the 131I in the Clinic Hospital was half of the cost of the surgery, and at private level the fourth part but cheap (au)

  9. 李洲坳东周墓玉觿的研究%Research on Xi(觿) jade from Lizhouao grave of Eastern Zhou Tomb

    Institute of Scientific and Technical Information of China (English)

    曹妙聪

    2011-01-01

    研究了玉觿的演变过程,分析了李洲坳墓葬出土玉觿及金箔的形制及纹饰特点,推断了李洲坳墓葬的大致年代及等级。李洲坳东周墓出土的玉觿具有器形体薄、扁平状,弯曲弧度大,素面的特点,其年代大致在春秋到战国,为贵族墓葬。金箔上"七"组龙纹的级别应该相当于诸侯王一级,说明拥有该金器的李洲坳东周墓主人可能是一方诸候。该推断与考古学者的结论相符。%This paper makes a research on the evolvement process of Xi(觿)jade,an analysis of the structure and emblazonry characteristics of Xi(觿)fade and gold foil unearthed in this grave,and a roughly deduction of the age and level of the Lizhouao grave.The Xi(觿)jade unearthed in the Lizhouao grave of Eastern Zhou Dynasty tomb has the characteristics of thin,tabular and free of decoration,belonging to the period from Spring and Autumn to Warring States.The grave is deduced to be nobility's.The dragon design on the gold foil signifies the level of vassal,which illustrates that Lizhouao,the host of this grave and possessing this jade was a vassal.This deduction corresponds with the conclusion of archeologists.

  10. Exceptional hyperthyroidism and a role for both major histocompatibility class I and class II genes in a murine model of Graves' disease.

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    Sandra M McLachlan

    Full Text Available Autoimmune hyperthyroidism, Graves' disease, can be induced by immunizing susceptible strains of mice with adenovirus encoding the human thyrotropin receptor (TSHR or its A-subunit. Studies in two small families of recombinant inbred strains showed that susceptibility to developing TSHR antibodies (measured by TSH binding inhibition, TBI was linked to the MHC region whereas genes on different chromosomes contributed to hyperthyroidism. We have now investigated TSHR antibody production and hyperthyroidism induced by TSHR A-subunit adenovirus immunization of a larger family of strains (26 of the AXB and BXA strains. Analysis of the combined AXB and BXA families provided unexpected insight into several aspects of Graves' disease. First, extreme thyroid hyperplasia and hyperthyroidism in one remarkable strain, BXA13, reflected an inability to generate non-functional TSHR antibodies measured by ELISA. Although neutral TSHR antibodies have been detected in Graves' sera, pathogenic, functional TSHR antibodies in Graves' patients are undetectable by ELISA. Therefore, this strain immunized with A-subunit-adenovirus that generates only functional TSHR antibodies may provide an improved model for studies of induced Graves' disease. Second, our combined analysis of linkage data from this and previous work strengthens the evidence that gene variants in the immunoglobulin heavy chain V region contribute to generating thyroid stimulating antibodies. Third, a broad region that encompasses the MHC region on mouse chromosome 17 is linked to the development of TSHR antibodies (measured by TBI. Most importantly, unlike other strains, TBI linkage in the AXB and BXA families to MHC class I and class II genes provides an explanation for the unresolved class I/class II difference in humans.

  11. Colchicine in the treatment of the inflammatory phase of Graves' ophthalmopathy: a prospective and randomized trial with prednisone Colchicina no tratamento da fase inflamatória da oftalmopatia de Graves: um estudo prospectivo e randomizado com prednisona

    Directory of Open Access Journals (Sweden)

    Francisco José da Cunha Stamato

    2006-12-01

    Full Text Available PURPOSE: To investigate if colchicine is valuable in the treatment of Graves' ophthalmopathy (GO, we compared its effect with prednisone in 22 patients during the inflammatory phase of GO. METHODS: All patients, similar in age, sex and smoking habits, were euthyroid for at least 3 months and randomly divided into two groups, one treated with colchicine (1.5 mg/day and the other treated with prednisone (0.75 mg/kg/day. They were monitored with ophthalmologic assessment (clinical activity score-CAS and magnetic resonance imaging, using a signal intensity ratio (SIR of the recti muscles in comparison to the cerebral substantia alba. RESULTS: Amelioration of CAS was seen in 68% of the orbits in both groups. SIR also had a significant reduction after treatment: the initial median of 1.14 in G1 and 1.27 in G2, evolved, after treatment, to 1.07 in G1 and 0.69 in G2. The variation between both groups after treatment was not significant (p=0.22. None of the patients treated with colchicine had side effects; on the other hand, side effects in G2 were weight gain, edema, gastric complaints, hirsutism, weakness, depression, and alterations in blood pressure. CONCLUSION: Colchicine had a beneficial effect on the inflammatory phase of GO without the side effects of prednisone.OBJETIVO: Investigar se a colchicina é eficaz no tratamento da oftalmopatia de Graves, nós comparamos o seu efeito com a prednisona em 22 pacientes tratados na fase inflamatória da doença. MÉTODOS: Todos os pacientes, similares quanto à idade, sexo e hábitos de tabagismo, estavam em eutiroidismo por pelo menos três meses e foram randomizados em dois grupos. O grupo 1 (G1 recebeu colchicina (1,5 mg/dia e o grupo 2 (G2 foi tratado com prednisona (0,75 mg/kg/dia. Os pacientes foram acompanhados com avaliação oftalmológica (escore de atividade clínica - CAS e de imagem por meio da ressonância magnética, usando a relação da intensidade de sinal (SIR dos músculos reto em

  12. Autoinmunidad tiroidea: Mecanismos patogénicos comunes y distintivos en tiroiditis de Hashimoto y enfermedad de Graves Thyroid Autoimmunity: Common and Distinctive Pathogenic Mechanisms in Hashimoto's Thyroiditis and Graves' Disease

    Directory of Open Access Journals (Sweden)

    G Astarita

    2012-09-01

    Full Text Available Las enfermedades tiroideas autoinmunes (ETA son los desórdenes más frecuentes que llevan a la disfunción de la glándula tiroidea. Incluyen varias formas clínicas como Tiroiditis de Hashimoto (TH y Enfermedad de Graves (EG. La relación entre TH y EG ha sido objeto de debate por décadas. Si bien, muy diferentes en su clínica, algunos las consideran los lados opuestos de una misma moneda. En su patogénesis tienen aspectos en común, como la predisposición genética demostrado por la ocurrencia en una misma familia y en un mismo individuo. Sin embargo, diferencias en el microambiente local determinan la diferente expresión fenotípica o el viraje de una a otra patología. El objetivo de esta monografía es investigar similitudes y diferencias entre TH y EG en las distintas etapas que llevan al desarrollo de autoinmunidad. Los autores declaran no poseer conflictos de interés.Autoimmune thyroid disease (ATD is the most common disorder that leads to thyroid gland dysfunction. ATD manifests in various clinical forms, such as Hashimoto's Thyroiditis (HT and Graves' Disease (GD. The relation between HT and GD has been discussed for decades. Even if they greatly differ in their clinical features and treatment, some people believe they are the opposite sides of the same coin. In their pathogenesis, they share some mechanisms, such as genetic susceptibility, shown by the fact that they tend to occur both in the same person and within the same family. However, differences in the local micro-environment can determine the distinct phenotypic expression or the switch from one disease to the other. The aim of this monograph was to investigate similarities and differences between HT and GD at the diverse stages leading to the development of autoimmunity. No financial conflicts of interest exist.

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

    Directory of Open Access Journals (Sweden)

    Jose Luis Villaseñor

    2011-09-01

    Full Text Available Melampodium sinuatum Brandegee, especie endémica del extremo sur del estado de Baja California Sur, México, constituye una especie poco conocida debido a su rareza y distribución restringida. No se conoce de más de 5 sitios; todos ellos amenazados por las actividades humanas. El escaso número de individuos por población, así como la estrecha superficie que abarca su área de distribución la colocan como una especie en inminente peligro de extinción, por lo que es imperativo realizar acciones encaminadas a protegerla, las que sin lugar a dudas redundarán en beneficio de otras especies también endémicas de la región donde prospera M. sinuatum e igualmente en riesgo, debido al fuerte impacto antropocéntrico, sobre todo por actividades turísticas, y para las que no existe resguardo alguno.Melampodium sinuatum Brandegee, a species endemic to the southernmost tip of the state of Baja California Sur, Mexico, is poorly known, mostly due to its rarity and narrow geographic distribution range. Historically the species has been collected at only 5 localities and all of these are currently threatened by human activities. The scarce number of individuals per population and its narrow geographic distribution contribute to this species being critically endangered, and it is urgent to carry out activities to help it escape extinction. Without a doubt, such activities will also benefit other endemic species that grow in the vicinity and similarly lack conservation strategies to protect them from the impact of touristic activities in the region.

  14. Clinical significance of a sensitive assay for thyroid-stimulating antibodies in Graves' disease using polyethylene glycol at high concentrations and porcine thyroid cells.

    Science.gov (United States)

    Kamijo, K; Nagata, A; Sato, Y

    1999-06-01

    The Inui and Ochi group recently reported that cAMP production by porcine thyroid cells (PTC) was augmented more by polyethylene glycol (PEG) 22.5% precipitated fractions from almost all Graves' sera than those of PEG 12.5%. In the present study, thyroid stimulating immunoglobulin (TSI) activity was determined with PTC and prepared crude Ig fractions precipitated by two different concentrations of PEG (final concentrations 13.5% and 22.5%) from sera obtained from 117 Graves' patients. The activity of TSI determined by the PEG 13.5% assay and activity determined by the PEG 22.5% assay were designated as thyroid-stimulating antibody (TSAb) and sTSAb, respectively. At first we studied 55 TSAb-positive patients with untreated hyperthyroid Graves' disease and classified them according to the TSAb activity-below 500% (group 1) and above 500% (group 2). The positive stimulatory effect, arbitrarily defined as the ratio of sTSAb to TSAb, being more than 1.2, was observed in 85% of patients, and group 1 had a significantly (P<0.025) greater stimulatory effect (34/35, 97.1%) than group 2 (13/20, 65%). Subsequently, in 29 TSAb-negative patients, sTSAb was measured and detected in 26 (89.7%). Finally, sTSAb, TSAb and TBII were compared between patients presenting with recurrent Graves' disease and those with silent thyroiditis after withdrawal of antithyroid drug treatment for Graves' disease. sTSAb was detected in all 14 relapsed patients, but none of the 9 patients with silent thyroiditis had detectable sTSAb. In contrast, TSAb and TBII activities were found in only 7 (50.0%) of the 14 relapsed cases. The present paper demonstrated that the assay with a higher PEG concentration was found to be sensitive, specific and useful for the diagnosis and follow-up of Graves' disease after drug withdrawal, although the underlying mechanism remains unclear. PMID:10503992

  15. Neumonía grave del adulto adquirida en la comunidad SEVERE COMMUNITY-ACQUIRED PNEUMONIA IN ADULTS

    Directory of Open Access Journals (Sweden)

    Francisco Arancibia H.

    2005-04-01

    Full Text Available El paciente con neumonía grave adquirida en la comunidad es aquel que necesita de la vigilancia y monitorización de una Unidad de Cuidados Intensivos (UCI donde, si es necesario, puede recibir apoyo especializado con conexión a un ventilador mecánico y/o soporte hemodinámico. Los pacientes que requieren tratamiento en la UCI representan entre 10 y 30% de los pacientes hospitalizados por neumonía. En esta categoría, la tasa de complicaciones, estadía en el hospital y mortalidad son elevadas. Los criterios para neumonía grave de la Sociedad Americana de Tórax (American Thoracic Society-ATS son: criterios mayores: necesidad de ventilación mecánica y presencia de shock séptico; criterios menores: presión sistólica 20 mg/dl y confusión mental. En todos los pacientes con neumonía adquirida en la comunidad se recomienda evaluar la gravedad de la infección en el momento de su admisión al hospital. Esta evaluación es preferible realizarla junto a un médico con experiencia, y si presenta criterios de mal pronóstico se sugiere trasladar precozmente a la UCI. Son útiles para esta evaluación los criterios de la ATS y los criterios de la BTS modificados (CURB. En los pacientes con neumonía grave adquirida en la comunidad se recomienda solicitar los siguientes exámenes microbiológicos: tinción de Gram y cultivo de expectoración, hemocultivos, tinción de Gram y cultivo de líquido pleural, antígeno urinario de Legionella pneumophila, antígenos de virus influenza A y B (período epidémico de otoño-invierno, y serología para microorganismos atípicos (Mycoplasma pneumoniae y Chlamydia pneumoniaePatients with severe community acquired pneumonia (CAP need continuous surveillance and monitoring at intensive care units (ICU, where they can receive specialized support as mechanical ventilation and/or hemodynamic support. Patients that require ICU admittance represent 10 to 30% of all patients interned because a pneumonia. In this

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

    Directory of Open Access Journals (Sweden)

    Seidl Christian

    2009-12-01

    Full Text Available Abstract Background Three genes have been confirmed as major joint susceptibility genes for endocrine autoimmune disease:human leukocyte antigen class II, cytotoxic T-lymphocyte antigen 4 and protein tyrosine phosphatase non-receptor type 22. Recent studies showed that a genetic variation within the interferon induced helicase domain 1 (IFIH1 locus (rs1990760 polymorphism is an additional risk factor in type 1 diabetes and Graves' disease (GD. Methods The aim of the present study was to investigate the role of the rs1990760 polymorphism within the IFIH1 gene in German patients with GD (n = 258, Hashimoto's thyroiditis (HT, n = 106, Addison's disease (AD, n = 195 and healthy controls (HC, n = 227 as well as in 55 GD families (165 individuals, German and 100 HT families (300 individuals, Italian. Furthermore, the interaction between rs1990760 polymorphism with human leukocyte antigen (HLA risk haplotype DQ2(DQA*0501-DQB*0201, the risk haplotypes DQ2/DQ8 (DQA*0301-DQB*0302 and the status of thyroglobulin antibody (TgAb, thyroid peroxidase antibody (TPOAb and TSH receptor antibody (TRAb in patients and families were analysed. Results No significant differences were found between the allele and genotype frequencies for rs1990760 IFIH1 polymorphism in patients with GD, HT, AD and HC. Also no differences were observed when stratifying the IFIH1 rs1990760 polymorphism for gender, presence or absence of thyroid antibodies (GD:TRAb and HT:TPOAb/TgAb and HLA risk haplotypes (DQ2:for GD and HT, DQ2/DQ8:for AD. Furthermore the transmission analysis in GD and HT families revealed no differences in alleles transmission for rs1990760 IFIH1 from parents with or without HLA risk haplotype DQ2 to the affected offspring. In contrast, by dividing the HT parents according to the presence or absence of thyroid Ab titers, mothers and fathers both positive for TPOAb/TgAb overtransmitted the allele A of IFIH1 rs1990760 to their HT affected offspring (61.8% vs 38.2%;p = 0

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

    Directory of Open Access Journals (Sweden)

    Denise Rossato Silva

    2012-06-01

    Full Text Available A tuberculose é uma doença curável que pode evoluir para formas graves com necessidade de tratamento dos pacientes em UTI, especialmente se essa não for diagnosticada em tempo ou se afetar pacientes idosos, aqueles em diálise e aqueles com infecção pelo HIV ou outros estados de imunossupressão, assim como nos casos de doença multirresistente. O conhecimento da apresentação radiológica dos casos pode auxiliar no diagnóstico dessas formas graves, assim como a introdução de novos testes, como a detecção rápida do agente por PCR e a TC de tórax, favorecendo o início precoce do tratamento. Além disso, o uso de esquemas sem isoniazida e rifampicina, a absorção entérica incerta e as baixas concentrações séricas das drogas antituberculose podem contribuir para a diminuição da eficácia do tratamento. O prognóstico desses pacientes geralmente é ruim, com elevadas taxas de mortalidade.Tuberculosis is a curable disease that can evolve to severe forms, requiring the treatment of the patients in an ICU, especially if there is a delay in the diagnosis or if it affects elderly patients, those on dialysis, or those with HIV infection or other states of immunosuppression, as well as in cases of multidrug resistant disease. Knowledge of the radiological presentation of the cases can help diagnose these severe forms, as can the introduction of new tests, such as the early detection of the etiological agent by PCR and chest CT, which favors the early initiation of treatment. In addition, the use of regimens without isoniazid and rifampin, as well as uncertain enteral absorption and low serum concentrations of antituberculosis drugs, can reduce the efficacy of treatment. For such patients, the prognosis is generally poor and mortality rates are high.

  18. REPOSIÇÃO VOLÊMICA EM CÃES PORTADORES DE SEPSE GRAVE: REVISÃO DE LITERATURA

    Directory of Open Access Journals (Sweden)

    Inajara Nakamura Hirota

    2013-06-01

    Full Text Available The water to be a vital component in all forms of life becomes an important tool in the therapy of various disorders. The use of volume replacement aims to restore losses and electrolyte homeostasis. When patients are under severe sepsis, a syndrome of emergency, there is the presence of hemodynamic instability leading to the picture of hypoperfusion and tissue hypoxia, which may progress to multiple organ dysfunction. However, a thorough physical examination associated with early diagnosis and the realization of fluid replacement therapy, may reduce the high mortality rate of these patients, which is a challenge for the veterinarian. Therefore, we attempted to perform an updated, highlighting key definitions, classifications, pathophysiology, clinical signs and causes of severe sepsis, emphasizing the need for therapy and fluid resuscitation protocols in this context, as well as the importance of monitoring patients' clinical.A água por ser um componente vital para todas as formas de vida torna-se uma ferramenta importante na terapia de várias afecções. A utilização da reposição volêmica visa restabelecer as perdas hidroeletrolíticas e a homeostase do organismo. Quando pacientes apresentam-se no quadro de sepse grave, uma síndrome complexa de caráter emergencial há a presença da instabilidade hemodinâmica levando ao quadro de hipoperfusão e hipóxia tecidual, podendo evoluir para a disfunção múltipla de órgãos. Contudo, um exame físico minucioso associado ao diagnóstico precoce e a realização da terapia de reposição volêmica, podem reduzir a alta taxa de mortalidade destes pacientes, sendo este um desafio para o médico veterinário. Com isso, buscou-se realizar uma atualização bibliográfica, destacando as principais definições, classificações, fisiopatogenia, sinais clínicos e causas de sepse grave, enfatizando a necessidade de terapia e protocolos de reposição volêmica neste contexto, bem como a import

  19. Efeito rebote dos fármacos modernos: evento adverso grave desconhecido pelos profissionais da saúde

    Directory of Open Access Journals (Sweden)

    Marcus Zulian Teixeira

    2013-12-01

    Full Text Available OBJETIVO: Apoiado no aforismo hipocrático primum non nocere, o princípio bioético da não maleficência roga que o ato médico cause o menor dano ou agravo à saúde do paciente, incumbindo ao médico avaliar os riscos de determinada terapêutica por meio do conhecimento dos possíveis eventos adversos das drogas. Dentre esses, o efeito rebote representa um efeito colateral comum a inúmeras classes de fármacos modernos, podendo causar transtornos graves e fatais nos pacientes. Esta revisão tem o objetivo de esclarecer os profissionais da saúde sobre os aspectos clínicos e epidemiológicos do fenômeno rebote. MÉTODOS: Uma revisão qualitativa, exploratória e bibliográfica foi realizada na base de dados PubMed utilizando os unitermos 'rebound', 'withdrawal', 'paradoxical', 'acetylsalicylic acid', 'anti-inflammatory', 'bronchodilator', 'antidepressant', 'statin', 'proton pump inhibitor' and 'bisphosphonate' RESULTADOS: O efeito rebote ocorre após a descontinuação de inúmeras classes de fármacos com ação contrária aos distúrbios da doença, exacerbando-os a níveis superiores aos anteriores do tratamento. Independente da doença,dadrogaedaduração do tratamento, o fenômeno se manifesta numa pequena proporção de indivíduos suscetíveis. No entanto, pode causar eventos adversos graves e fatais, devendo ser considerado um problema de saúde pública em vista do enorme consumo de fármacos pela população CONCLUSÃO: Reunindo um corpo de evidências crescente e inquestionável, o médico precisa ter conhecimento das consequências do efeito rebote e de como minimizá-lo, aumentando a segurança no manejo das drogas modernas. Por outro lado, este efeito rebote pode ser utilizado de forma curativa, ampliando o espectro da terapêutica moderna.

  20. Determination of the optimal minimum radioiodine dose in patients with Graves' disease: a clinical outcome study

    Energy Technology Data Exchange (ETDEWEB)

    Howarth, D.; Tan, P.; Booker, J. [Pacific Medical Imaging, Newcastle, NSW (Australia); Epstein, M. [Dept. of Endocrinology, John Hunter Hospital, Newcastle, NSW (Australia); Lan, L. [High-Dependency Unit, St. George Hospital, Sydney, NSW (Australia)

    2001-10-01

    The study was performed under the auspices of the International Atomic Energy Commission, Vienna, Austria, with the aim of determining the optimal minimum therapeutic dose of iodine-131 for Graves' disease. The study was designed as a single-blinded randomised prospective outcome trial. Fifty-eight patients were enrolled, consisting of 50 females and 8 males aged from 17 to 75 years. Each patient was investigated by clinical assessment, biochemical and immunological assessment, thyroid ultrasound, technetium-99m thyroid scintigraphy and 24-h thyroid {sup 131}I uptake. Patients were then randomised into two treatment groups, one receiving 60 Gy and the other receiving 90 Gy thyroid tissue absorbed dose of radioiodine. The end-point markers were clinical and biochemical response to treatment. The median follow-up period was 37.5 months (range, 24-48 months). Among the 57 patients who completed final follow-up, a euthyroid state was achieved in 26 patients (46%), 27 patients (47%) were rendered hypothyroid and four patients (7%) remained hyperthyroid. Thirty-four patients (60%) remained hyperthyroid at 6 months after the initial radioiodine dose (median dose 126 MBq), and a total of 21 patients required additional radioiodine therapy (median total dose 640 MBq; range 370-1,485 MBq). At 6-month follow-up, of the 29 patients who received a thyroid tissue dose of 90 Gy, 17 (59%) remained hyperthyroid. By comparison, of the 28 patients who received a thyroid tissue dose of 60 Gy, 17 (61%) remained hyperthyroid. No significant difference in treatment response was found (P=0.881). At 6 months, five patients in the 90-Gy group were hypothyroid, compared to two patients in the 60-Gy group (P=0.246). Overall at 6 months, non-responders to low-dose therapy had a significantly larger thyroid gland mass (respective means: 35.9 ml vs 21.9 ml) and significantly higher levels of serum thyroglobulin (respective means: 597.6 {mu}g/l vs 96.9 {mu}g/l). Where low-dose radioiodine

  1. Enfermedad respiratoria grave en terapia intensiva durante la pandemia por el virus de influenza A (H1N1 2009

    Directory of Open Access Journals (Sweden)

    José Aquino-Esperanza

    2010-10-01

    Full Text Available Se describen pacientes hospitalizados en una unidad de terapia intensiva por enfermedad respiratoria aguda grave con características de influenza durante los primeros meses de la pandemia por influenza A(H1N1 2009 en la Argentina. Evaluamos datos clínicos, scores de gravedad, pruebas de laboratorio, microbiología y radiología torácica al ingreso, evolución y mortalidad hospitalaria, comparando pacientes con y sin confirmación de H1N1 por test de reacción de polimerasa en cadena, transcriptasa reversa (RT-PCR. Entre junio y julio de 2009 se internaron 31 pacientes adultos con una mediana de edad de 54 años (percentilo 25-75: 33-66. Presentaron test positivo para H1N1, 17 pacientes. Tenían al menos una condición concurrente 16 pacientes. La expresión radiográfica más frecuente fue infiltrados intersticio-alveolares bilaterales en 20 casos; 5 tenían consolidación lobar unilateral. La coinfección bacteriana (aislamiento de bacterias o IgM positiva para infecciones bacterianas, se demostró en 21 pacientes. Requirieron ventilación mecánica 23 pacientes y 18 desarrollaron síndrome de distrés respiratorio agudo (SDRA. La linfopenia y elevación de creatinina-fosfoquinasa fue frecuente (83% y 65%, respectivamente. Los 6 pacientes que murieron (19% eran mayores de 75 años o tenían cáncer o inmunodepresión. El tratamiento antiviral temprano (≤ 48 horas se asoció a menor necesidad de ventilación mecánica (54% vs. 89%; p: 0.043. No hubo diferencia significativa en las variables analizadas entre el grupo H1N1 positivo y el negativo, lo que sugiere tener igual enfoque terapéutico frente a una epidemia. La infección por H1N1 determinó falla respiratoria aguda y SDRA. La mortalidad ocurrió en pacientes añosos o con co-morbilidades graves.

  2. Sustained long-term improvement with clozapine in schizophrenia Clozapina na esquizofrenia grave: melhora duradoura e sustentada

    Directory of Open Access Journals (Sweden)

    RICARDO DE OLIVEIRA-SOUZA

    1999-03-01

    Full Text Available The present paper reports the long-term use of clozapine in a prospective sample of 46 chronic schizophrenics. In six months, 21 subjects had been excluded for a number of reasons. In four of them the reasons for exclusion were related to lack of response or adverse effects. The median daily clozapine dose was 400 mg in the remaining 25 patients. As a whole, there were remarkable improvements in core dimensions of psychopathology, global cognitive status, and level of functioning. We confirmed that clozapine is effective in a subgroup of schizophrenics with the severest forms of the disease. If tolerated after the first few months it leads to progressive gains in several domains of behavior. Clozapine should be tried in every patient with schizophrenia in whom positive symptoms, disorganization, or bizarre behavior are a matter of incapacitation despite efforts to keep them under control with other drugs.O presente estudo, prospectivo, relata o uso de longo-prazo da clozapina em 46 esquizofrênicos graves, com mais de cinco anos de doença. Com seis meses de uso da droga, 21 indivíduos haviam sido excluídos por diversas razões. Em quatro, a exclusão se deveu a efeitos adversos ou ausência de resposta. A dose mediana de clozapina foi de 400 mg nos demais 25 pacientes. No todo, observamos melhora em dimensões de psicopatologia, estado cognitivo global, e nível funcional. Concluímos que a clozapina é eficaz em um subgrupo de esquizofrênicos com formas graves da doença. Se tolerada depois dos primeiros meses, produz benefícios progressivos em diversos domínios do comportamento. Clozapina deve ser tentada em todo paciente com esquizofrenia incapacitado por sintomas positivos, desorganização, e/ou comportamentos bizarros, que persistem a despeito de esforços para mantê-los sob controle com outras drogas.

  3. Evaluation of radioiodine therapy with fixed doses of 10 and 15 mCi in patients with Graves disease; Avaliacao da radioiodoterapia com doses fixas de 10 e 15 mCi em pacientes com doenca de Graves

    Energy Technology Data Exchange (ETDEWEB)

    Canadas, Viviane; Vilar, Lucio; Moura, Eliane; Brito, Ana; Castellar, Enio [Universidade Federal de Pernambuco (UFPE), Recife, PE (Brazil). Hospital das Clinicas. Servico de Endocrinologia]. E-mail: vivi2207@ig.com.br

    2007-10-15

    The treatment options for the hyperthyroidism of Graves' disease are antithyroid drugs, surgery and radioiodine, none of which is considered ideal, as they do not act directly on the etiopathogenesis of the disease. Radioiodine has been increasingly used as the treatment of choice because it is a safe and definitive therapy whose administration is very easy. Some authors prefer to administer higher doses in order to deliberately induce hypothyroidism, while others recommend lower doses that result in a lower incidence of hypothyroidism and a greater incidence of euthyroidism. There is no consensus for the optimal regimen of fixed doses to be used and this is the main focus of the present study, where doses of 10 and 15 mCi of {sup 131}I were compared. Among the 164 patients analyzed, 61 (37.2%) were submitted to 10 mCi and 103 (62.8%) to 15 mCi. In the longitudinal analysis it was observed that remission of the hyperthyroidism was statistically different in the sixth month (p < 0.001), being higher in the group that used the dose of 15 mCi, but similar in both groups at 12 and 24 months. It may be concluded that the administration of fixed doses of 10 and 15 mCi of {sup 131}I brought about a similar remission of the hyperthyroidism after 12 months of treatment. Moreover, the remission rate of the hyperthyroidism had no association with age, sex or previous therapy with antithyroid drugs. (author)

  4. Chylous Ascites: A Rare Adverse Effect of Methimazole Treatment for Grave's Disease—A Case Report and Review of the Literature

    Science.gov (United States)

    Khoury, Tawfik; Schneider, Ronen

    2015-01-01

    A 40-year-old woman was admitted due to an urticarial rash that was attributed to recent onset of methimazole treatment for a diagnosis of Grave's disease. The patient had no prior significant medical history and used no medications, including over-the-counter or herbal medications. Her sister had Grave's disease. On admission, the patient received corticosteroids with improvement in her rash. On the second day of the hospitalization, the patient complained of abdominal discomfort. Abdominal ultrasound revealed a large amount of new onset ascites. Peritoneal tap yielded a milky fluid with high triglyceride level (12.2 mmol/L or 1080 mg/dL), consistent with chylous ascites. After discontinuation of the methimazole, the ascites disappeared. The patient later underwent therapeutic thyroidectomy, after which all features of thyrotoxicosis had improved. PMID:26366308

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

    Energy Technology Data Exchange (ETDEWEB)

    Kaise, Kazuro; Kaise, Nobuko; Yoshida, Katsumi; Fukazawa, Hiroshi; Mori, Koki; Yamamoto, Makiko; Sakurada, Toshiro; Saito, Shintaro; Yoshinaga, Kaoru (Tohoku Univ., Sendai (Japan). School of Medicine)

    1991-08-01

    The outcome of {sup 131}I therapy for 109 patients with Graves' disease was analysed according to pretreatment laboratory data including thyrotropin receptor antibody (TRAb) activities. Forty-five percent of patients became euthyroid, and 13% of patients became hypothyroid within one year after {sup 131}I therapy. Forty-two percent of patients remained hyperthyroid one year after {sup 131}I therapy. Pretreatment values for serum T{sub 4}, T{sub 3}, and the estimated weight of the thyroid were significantly higher in the hyperthyroid group. The mean for the TRAb index of the hyperthyroid group was significantly higher than that of the euthyroid group. Life table analysis revealed a significant effect of the TRAb index on the rate of hyperthyroidism after 3 months or later. These results appear to suggest that the TRAb index is one of the factors which influence the outcome of {sup 131}I therapy for Graves' disease. (author).

  6. Causas de la falta de adherencia a las guías terapéuticas para la neumonía grave

    OpenAIRE

    Simone Gattarello; Sergio Ramírez; José Rafael Almarales; Bárbara Borgatta; Leonel Lagunes; Belén Encina; Jordi Rello

    2015-01-01

    Objetivo: Valorar tasa de adherencia y causas de no adherencia a las guías terapéuticas internacionales para la prescripción antibiótica empírica en la neumonía grave en Latinoamérica. Métodos: Encuesta clínica realizada a 36 médicos de Latinoamérica donde se pedía indicar el tratamiento empírico en 2 casos clínicos ficticios de pacientes con infección respiratoria grave: neumonía adquirida en la comunidad y neumonía nosocomial. Resultados: En el caso de la neumonía comunitaria el tratamiento...

  7. Pre-Hispanic Mortuary Practices in Quebrada de Humahuaca (North-Western Argentina): Genetic Relatedness among Individuals Buried in the Same Grave.

    Science.gov (United States)

    Russo, M Gabriela; Mendisco, Fanny; Avena, Sergio A; Dejean, Cristina B; Seldes, Verónica

    2016-07-01

    Almost all pre-Hispanic societies from Quebrada de Humahuaca (north-western Argentina) buried their defuncts in domestic areas, demonstrating the importance of death and its daily presence among the living. Presumably, the collective graves contained related individuals, a hypothesis that can be tested through the study of ancient DNA. This study analyzes autosomal and uniparental genetic markers in individuals from two archaeological sites in Quebrada de Humahuaca occupied during the Late Formative (1450-1050 BP) and Regional Developments I (1050-700 BP) periods. Mitochondrial and Y-chromosome haplotypes were compared in order to establish possible maternal and paternal relatedness. Genotypes for 15 autosomal STRs were used to calculate pairwise relatedness coefficients and pedigree probabilities. High kinship levels among individuals buried in the same graves were found in both sites. Although only two particular cases were analyzed, these results represent an important contribution to the study of mortuary practices in the region by means of ancient DNA. PMID:27346733

  8. Insuficiência renal aguda em pacientes com sepse grave: fatores prognósticos = Acute renal injury in patients with severe sepsis: prognostic factors

    Directory of Open Access Journals (Sweden)

    Okamoto, Thábata Yaedu

    2012-01-01

    Conclusões: A insuficiência renal aguda foi ocorrência comum nos pacientes com sepse, fazendo parte de um quadro de disfunção de múltiplos órgãos e sistemas, particularmente nos pacientes com diagnóstico de choque séptico, estando associada a aumento da probabilidade de morte nesses pacientes graves. O uso de drogas vasoativas foi o único fator de risco para mortalidade em pacientes com sepse e insuficiência renal aguda que se manteve na análise multivariada. Estes resultados apontam para a importância do tratamento precoce dos quadros de sepse grave a tempo de prevenir a evolução para choque séptico e para insuficiência renal

  9. Increased percentage of L-selectin+ and ICAM-1+ peripheral blood CD4+/CD8+ T cells in active Graves' ophthalmopathy.

    Directory of Open Access Journals (Sweden)

    Alina Bakunowicz-Lazarczyk

    2009-05-01

    Full Text Available The purpose of the study was to evaluate the percentage of CD4+/CD8+ peripheral T cells expressing CD62L+ and CD54+ in patients with Graves' disease and to assess if these estimations could be helpful as markers of active ophthalmopathy. The study was carried out in 25 patients with Graves' disease (GD divided into 3 groups: 1/ 8 patients with active Graves' ophthalmopathy (GO (CAS 3-6, GO complaints pound 1 year, 2/ 9 patients with hyperthyroid GD without symptoms of ophthalmopathy (GDtox and 3/ 8 patients with euthyroid GD with no GO symptoms (GDeu. The control group consisted of 15 healthy volunteers age and sex matched to groups 1-3. The expression of lymphocyte adhesion molecules was evaluated by using three-color flow cytometry. In GO group the percentage of CD8+CD54+, CD8+CD62L+, CD4+CD54+ and CD4+CD62L+ T cells was significantly higher as compared to controls (p<0.001, p<0.05, p<0.01, p<0.001 respectively. The percentage of CD8+CD54+ T lymphocytes was also elevated in GO group in comparison to hyperthyroid GD patients (p< 0.05. CD4+CD62L+ and CD8+CD54+ percentages were also increased in GDtox and GDeu as compared to controls. We found a positive correlation between the TSHRab concentration and the percentage of CD8+CD62L+ T cells in all studied groups (r= 0.39, p<0.05 and between the TSHRab level and CAS (r= 0.77, p<0.05. The increased percentage of CD8+CD54+ and CD8+CD62L+ T cells in patients with Graves' ophthalmopathy may be used as a marker of immune inflammation activity.

  10. Eficácia e segurança de biológicos utilizados em psoríase moderada a grave

    OpenAIRE

    Godoy, Rangel Ray

    2013-01-01

    Resumo: A psoriase e uma doenca cronica que afeta principalmente o orgao cutaneo e que esta associada a varias comorbidades. Pacientes com a condicao moderada a grave da doenca eventualmente sao tratados por terapias sistemicas. Dentre estas, as nao biologicas estao associadas a desenvolvimento de eventos adversos em orgaos alvo e intolerancia ao tratamento. Os medicamentos biologicos sao tecnologias recentes, mais caras e com caracteristica de nao afetarem orgaos alvo. Este trabalho pretende...

  11. Graves病患者ANA、ENA谱检测的临床意义%Clinical significance of ANA and ENA Profile in Diagnosis of Graves Disease

    Institute of Scientific and Technical Information of China (English)

    何永玲; 石青峰

    2012-01-01

    Objective To exptore the ctinicat significance of ANA and ENA profite in diagnosis of Graves disease. Methods ANA was measured by indirect immunoftuoreseenee,ENA profite was measured by Eurontine immunobtot assay. Resutts In the 140 samptes, poskives deteetion rate of ANA and ENA profite were 27.87% and 26.43% , respectivety, which were higher than those of the controts( 1.4% ,0,P <0.01). ANA pattems were mainty of spot type and homogeneous-nucteotar in patients with (Graves disease. ENA profite resuks indicated that the antinuetear antibodies were mainty anti-nRNP/Sm, anti-SSA,and anti-SSB. Conctusion Combined determination of ANA and ENA profite coutd confirm the types of auto antibodies in the serum of patients with (Graves disease, which coutd provide reference for diagnosis and treatment of Graves disease.%目的 探讨Graves病患者抗核抗体(ANA)和核抗原抗体(ENA)谱的临床应用价值.方法 ANA检测采用间接免疫荧光法,ENA谱检测采用欧蒙印迹法.结果 140例Graves病患者中,ANA及ENA谱阳性率分别为27.87%和26.43%,均高于对照组的1.4%及0%(P<0.01).Graves病患者中ANA阳性时的荧光模式主要是斑点型、核均质型,ENA谱阳性抗体种类出现较多的是抗nRNP/Sm抗体、抗SSA抗体、抗SSB抗体等.结论 检测Graves病患者ANA及ENA谱,能明确Graves病患者血清中的自身抗体种类,是Graves病的诊断和疗效观察的参考指标.

  12. Programa de Habilidades Sociales con personas con trastorno mental grave en una unidad de rehabilitación psiquiátroca de media estancia

    OpenAIRE

    Fernández Quiñones, María José

    2012-01-01

    Los programas de habilidades sociales son un componente realmente importante de la rehabilitación psicosocial con personas que padecen un trastorno mental grave. En este trabajo se pretende el diseño de un programa de habilidades que trate de dar respuesta a los problemas de socialización e integración comunitaria que presentan las personas que padecen dichos trastornos y dentro del contexto de atención residencial de media estancia.

  13. Bridge Technology with TSH Receptor Chimera for Sensitive Direct Detection of TSH Receptor Antibodies Causing Graves' Disease: Analytical and Clinical Evaluation.

    Science.gov (United States)

    Frank, C U; Braeth, S; Dietrich, J W; Wanjura, D; Loos, U

    2015-11-01

    Graves' disease is caused by stimulating autoantibodies against the thyrotropin receptor inducing uncontrolled overproduction of thyroid hormones. A Bridge Assay is presented for direct detection of these thyroid-stimulating immunoglobulins using thyrotropin receptor chimeras. A capture receptor, formed by replacing aa residues 261-370 of the human thyrotropin receptor with residues 261-329 from rat lutropin/choriogonadotropin receptor and fixed to microtiter plates, binds one arm of the autoantibody. The second arm bridges to the signal receptor constructed from thyrotropin receptor (aa 21-261) and secretory alkaline phosphatase (aa 1-519) inducing chemiluminescence. The working range of the assay is from 0.3 IU/l to 50 IU/l with a cutoff of 0.54 IU/l and functional sensitivity of 0.3 IU/l. Sensitivity and specificity are 99.8 and 99.1%, respectively, with a diagnostic accuracy of 0.998. The low grey zone is from 0.3-0.54 IU/l. The stimulatory character of the assayed antibodies is shown through a good correlation (r=0.7079, pGraves' disease, titers are increased in associated eye disease. In 3 hypothyroid patients with sera positive in the thyrotropin receptor competition assay and in the blocking bioassay, antibodies are not detected by the Bridge Assay, while the monoclonal blocking antibody K1-70 was detected. In Hashimoto disease thyrotropin receptor autoantibodies are detected in some patients, but not in goiter. This Bridge Assay delivers good diagnostic accuracy for identification of Graves' disease patients. Its high sensitivity may facilitate early detection of onset, remission, or recurrence of Graves' disease enabling timely adaption of the treatment.Human genes: TSHR, Homo sapiens, acc. no. M31774.1.

  14. Programa educativo «Trampolín» para adolescentes con problemas graves del comportamiento : perfil de sus participantes y efecto de la intervención

    OpenAIRE

    Orrego Álvarez, José Manuel; Paíno Piñeiro, María de las Mercedes; Fonseca Pedrero, Eduardo

    2016-01-01

    En el Programa Trampolín participan adolescentes con graves alteraciones del comportamiento y que son considerados por las autoridades educativas como el colectivo con más dificultad para la intervención escolar ordinaria. El presente trabajo tiene 2 objetivos: a) examinar el perfil comportamental, sociodemográfico, familiar y educativo de los alumnos participantes en el Programa Trampolín y b) analizar la eficacia del programa evaluando diversos indicadores de tipo educativo y sociofamiliar....

  15. La falsificación: un delito grave que pasa desapercibido/Counterfeiting: a serious crime that goes unnoticed

    Directory of Open Access Journals (Sweden)

    Sandro Calvani (Italia

    2015-01-01

    Full Text Available La asociación a la delincuencia organizada es en sí misma un “factor de riesgo” para la seguridad de los ciudadanos y para el orden público. La falsificación es una actividad delictiva peligrosa porque, al copiar productos, los falsificadores causan enormes daños al mercado y ponen en grave riesgo a los consumidores. Una de las consecuencias negativas de las economías son el resultado de la pérdida de ventas que sufren los legítimos productores cmoo0 resultado de la pérdida de ventas. Otras de las consecuencias: pérdidas de puestos de trabajo e incluso disminución de las oportunidades de desarrollo e innovación. The association of the organized crime is in itself a "risk factor" for the security of citizens and the public order. Counterfeiting is a dangerous criminal activity because copying products, counterfeiters cause enormous damage to the market and puts consumers at serious risk. One of the negative consequences of economies are the result of the loss of sales suffer lost sales result cmoo0 legitimate producers. Other consequences: losses of jobs and even decrease the opportunities of development and innovation.

  16. Derrame pericárdico grave. Ventana pericárdica percutánea con balón

    Directory of Open Access Journals (Sweden)

    Carlos A. Bruno

    2008-01-01

    Full Text Available La mayoría de los pacientes con derrame pericárdico crónico son mujeres y mayores de 50 años. En esta presentación se describe el caso de una paciente de 63 años con derrame pericárdico crónico grave, con antecedente de carcinoma de mama izquierda irradiado, diagnóstico presuntivo no confirmado de tuberculosis pulmonar e hipotiroidea sustituida. Ante la recurrencia del derrame luego de pericardiocentesis y el fracaso del tratamiento antiinflamatorio con AINE se decidió realizar una ventana pericárdica percutánea, sin que se presentaran complicaciones técnicas. Se inició tratamiento con colchicina y se evaluaron las posibles causas: tuberculosa, oncológica, secundaria a hipotiroidismo o por radiación. Por exclusión se llegó a la etiología radiante. Al mes de la realización de la ventana pericárdica no se observaba derrame pericárdico en el ecocardiograma.

  17. Modos de morar de pessoas com transtorno mental grave no Brasil: uma avaliação interdisciplinar

    Directory of Open Access Journals (Sweden)

    Juarez Pereira Furtado

    2013-12-01

    Full Text Available Apresentamos pesquisa avaliativa qualitativa sobre modos de morar de pessoas com transtorno mental grave, vinculadas às redes municipais de saúde mental de três cidades de grande porte. Realizamos observação participante de dez moradores e respectivos cuidadores de Serviços Residenciais Terapêuticos (SRT e acompanhamos o cotidiano de oito usuários de Centros de Atenção Psicossocial (CAPS que constituíram suas moradias por iniciativas próprias. Os moradores e usuários também foram entrevistados em profundidade. O material de campo foi analisado, segundo o método interpretativo, da perspectiva de arquitetos, antropólogos, psicanalistas e sanitaristas. Os resultados apontam carência de processos sistemáticos de reabilitação psicossocial dos moradores de SRT e despreparo dos cuidadores para lidarem com a complexidade de demandas para seu acompanhamento, além de baixo envolvimento dos CAPS com os SRT. Por outro lado, usuários ligados aos CAPS, que não moram em SRT, apresentaram criativa diversidade nos modos de constituir suas moradias e maior interação com a comunidade, embora alguns contem com o apoio de albergues e asilos para resolver suas necessidades. Algumas direções para a superação dos problemas encontrados são apontadas ao final do texto.

  18. Study of the expression for apoptosis factors of thyroid cells after arterial embolization to treat hyperthyroidism caused by Graved' disease

    International Nuclear Information System (INIS)

    Objective: To study the expressions of Fas, FasL, Bax,Bcl-2 and P53 in thyroid tissue and to analyzis (Semi-quantitative analysis)the relation between change of apoptosis in thyroid tissues and clinical therapeutic effect after thyroid arterial embolization in treating hyperthyroidism caused by Graves' disease with observation of apoptosis for 3 years. Methods: 15 patients undergone core needle biopsy of the thyroid gland were divided into three groups according to the amount of time elapsed after thyroid arterial embolization: A group, before thyroid arterial embolization, B group, 1 year group (including 7-day subgroup, 3-month subgroup, 6-month subgroup) and C group, 1 year subgroup and mom than 1 year subgroup after arterial embolization. Results: (1) After embolisation, 15 patients' symptoms and signs of hyperthyroidism disappeared or improved greatly with 9 long term released and 6 improved with small amount of ATD maintenance. (2) The positive staining of Fas and FasL located in endochylema and cell-membrane of thyroid tissue from patients treated with transcathter arterial embolization were higher than those not treated with transcathter arterial embolization (P0.05). (4) The positive cell and the staining of P53 in thyroid tissue had significant difference before and after thyroid arterial embolization (P<0.05). Conclusions: The extra-expression and the increased expression of Fas, FasL, Bax, P53 in thyroid tissue of patient with GD treated by thyroid arterial embolization are correlated with the effects of interventional therapy. (authors)

  19. Encephalopathy associated with autoimmune thyroid disease in patients with Graves' disease: clinical manifestations, follow-up, and outcomes

    LENUS (Irish Health Repository)

    Tamagno, Gianluca

    2010-04-28

    Abstract Background The encephalopathy associated with autoimmune thyroid disease (EAATD) is characterized by neurological\\/psychiatric symptoms, high levels of anti-thyroid antibodies, increased cerebrospinal fluid protein concentration, non-specific electroencephalogram abnormalities, and responsiveness to the corticosteroid treatment in patients with an autoimmune thyroid disease. Almost all EAATD patients are affected by Hashimoto\\'s thyroiditis (HT), although fourteen EAATD patients with Graves\\' disease (GD) have been also reported. Methods We have recorded and analyzed the clinical, biological, radiological, and electrophysiological findings and the data on the therapeutic management of all GD patients with EAATD reported so far as well as the clinical outcomes in those followed-up in the long term. Results Twelve of the fourteen patients with EAATD and GD were women. The majority of GD patients with EAATD presented with mild hyperthyroidism at EAATD onset or shortly before it. Active anti-thyroid autoimmunity was detected in all cases. Most of the patients dramatically responded to corticosteroids. The long term clinical outcome was benign but EAATD can relapse, especially at the time of corticosteroid dose tapering or withdrawal. GD and HT patients with EAATD present with a similar clinical, biological, radiological, and electrophysiological picture and require an unaffected EAATD management. Conclusions GD and HT equally represent the possible background condition for the development of EAATD, which should be considered in the differential diagnosis of all patients with encephalopathy of unknown origin and an autoimmune thyroid disease, regardless of the nature of the underlying autoimmune thyroid disease.

  20. Encephalopathy associated with autoimmune thyroid disease in patients with Graves' disease: clinical manifestations, follow-up, and outcomes.

    LENUS (Irish Health Repository)

    Tamagno, Gianluca

    2010-01-01

    BACKGROUND: The encephalopathy associated with autoimmune thyroid disease (EAATD) is characterized by neurological\\/psychiatric symptoms, high levels of anti-thyroid antibodies, increased cerebrospinal fluid protein concentration, non-specific electroencephalogram abnormalities, and responsiveness to the corticosteroid treatment in patients with an autoimmune thyroid disease. Almost all EAATD patients are affected by Hashimoto\\'s thyroiditis (HT), although fourteen EAATD patients with Graves\\' disease (GD) have been also reported. METHODS: We have recorded and analyzed the clinical, biological, radiological, and electrophysiological findings and the data on the therapeutic management of all GD patients with EAATD reported so far as well as the clinical outcomes in those followed-up in the long term. RESULTS: Twelve of the fourteen patients with EAATD and GD were women. The majority of GD patients with EAATD presented with mild hyperthyroidism at EAATD onset or shortly before it. Active anti-thyroid autoimmunity was detected in all cases. Most of the patients dramatically responded to corticosteroids. The long term clinical outcome was benign but EAATD can relapse, especially at the time of corticosteroid dose tapering or withdrawal. GD and HT patients with EAATD present with a similar clinical, biological, radiological, and electrophysiological picture and require an unaffected EAATD management. CONCLUSIONS: GD and HT equally represent the possible background condition for the development of EAATD, which should be considered in the differential diagnosis of all patients with encephalopathy of unknown origin and an autoimmune thyroid disease, regardless of the nature of the underlying autoimmune thyroid disease.

  1. Encephalopathy associated with autoimmune thyroid disease in patients with Graves' disease: clinical manifestations, follow-up, and outcomes.

    LENUS (Irish Health Repository)

    Tamagno, Gianluca

    2012-02-01

    BACKGROUND: The encephalopathy associated with autoimmune thyroid disease (EAATD) is characterized by neurological\\/psychiatric symptoms, high levels of anti-thyroid antibodies, increased cerebrospinal fluid protein concentration, non-specific electroencephalogram abnormalities, and responsiveness to the corticosteroid treatment in patients with an autoimmune thyroid disease. Almost all EAATD patients are affected by Hashimoto\\'s thyroiditis (HT), although fourteen EAATD patients with Graves\\' disease (GD) have been also reported. METHODS: We have recorded and analyzed the clinical, biological, radiological, and electrophysiological findings and the data on the therapeutic management of all GD patients with EAATD reported so far as well as the clinical outcomes in those followed-up in the long term. RESULTS: Twelve of the fourteen patients with EAATD and GD were women. The majority of GD patients with EAATD presented with mild hyperthyroidism at EAATD onset or shortly before it. Active anti-thyroid autoimmunity was detected in all cases. Most of the patients dramatically responded to corticosteroids. The long term clinical outcome was benign but EAATD can relapse, especially at the time of corticosteroid dose tapering or withdrawal. GD and HT patients with EAATD present with a similar clinical, biological, radiological, and electrophysiological picture and require an unaffected EAATD management. CONCLUSIONS: GD and HT equally represent the possible background condition for the development of EAATD, which should be considered in the differential diagnosis of all patients with encephalopathy of unknown origin and an autoimmune thyroid disease, regardless of the nature of the underlying autoimmune thyroid disease.

  2. Enhancement of CD4(+) T cell response and survival via coexpressed OX40/OX40L in Graves' disease.

    Science.gov (United States)

    Wang, Qin; Shi, Bi-Min; Xie, Fang; Fu, Zhao-Yang; Chen, Yong-Jing; An, Jing-Nan; Ma, Yu; Liu, Cui-Ping; Zhang, Xue-Kun; Zhang, Xue-Guang

    2016-07-15

    OX40/OX40L pathway plays a very important role in the antigen priming T cells and effector T cells. In the present study, we aimed to examine the involvement of OX40/OX40L pathway in the activation of autoreactive T cells in patients with Grave's disease (GD). We found that OX40 and OX40L were constitutively coexpressed on peripheral CD4(+) T cells from GD patients using flow cytometry analysis. The levels of OX40 and OX40L coexpression on CD4(+) T cells were shown to be correlated with TRAbs. Cell proliferation assay showed that blocking OX40/OX40L signal inhibited T cell proliferation and survival, which suggested that OX40/OX40L could enhance CD4(+) T cell proliferation and maintain their long-term survival in GD by self-enhancing loop of T cell activation independent of APCs. Confocal microscopy and coimmunoprecipitation analysis further revealed that OX40 and OX40L formed a functional complex, which may facilitate signal transduction from OX40L to OX40 and contribute to the pathogenesis of GD. PMID:27107937

  3. Topiramate and severe metabolic acidosis: case report Acidose metabólica grave por topiramato: relato de caso

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    Jayme E. Burmeister

    2005-06-01

    Full Text Available Topiramate infrequently induces anion gap metabolic acidosis through carbonic anhydrase inhibition on the distal tubule of the nephron - a type 2 renal tubular acidosis. We report on a 40 years old woman previously healthy that developed significant asymptomatic metabolic acidosis during topiramate therapy at a dosage of 100mg/day for three months. Stopping medication was followed by normalization of the acid-base status within five weeks. This infrequent side effect appears unpredictable and should be given careful attention.Topiramato pode produzir raramente uma acidose metabólica através da inibição da anidrase carbônica no túbulo distal do néfron - acidose tubular renal do tipo 2. Relatamos o caso de mulher de 40 anos previamente saudável que desenvolveu quadro de acidose metabólica assintomática grave, sem outra etiologia identificável, durante uso de topiramato na dose de 100mg/dia por três meses. Este efeito colateral, embora infrequente, parece ser imprevisível e requer atenção cuidadosa.

  4. Concomitant Graves' disease and primary hyperparathyroidism: the first case report in mainland of China and literature review

    Institute of Scientific and Technical Information of China (English)

    肖海鹏; 余斌杰; 王深明; 陈国锐

    2002-01-01

    @@ Concurrent Graves' disease and primary hyperparathyroidism in the same patient is rare, probably accounts for hypercalcemia in no more than 1 percent of thyrotoxic patients.1 Hypercalcemia may be noted during the course of hyperthyroidism in as many as 22 percent of cases.2 The cause of hypercalcemia in a thyrotoxic patient might be due to the activation of osteoclastic bone resorption3,4 by the excess thyroid hormone, as the severity of hyperthyroidism correlates positively with osteoclastic activity in trabecular and cortical bone.5 In 1936, Noble JF et al reported the first case in the world.6 To our knowledge, only 49 such cases have been described in the literature until the year of 1989.7 No case has been reported again afterward. The occurrence of hypercalcemia in a patient with hyperthyroidism may present a challenging diagnostic problem. In this communication, we described the first case in mainland of China with hypercalcemia caused by concurrent hyperthyroidism and primary hyperparathyroidism, and the clinical and laboratory characteristics were studied before and after therapy with anti-thyroid medication.

  5. Infliximab no tratamento da artrite psoriásica grave Infliximab in treatment of severe psoriatic arthritis

    Directory of Open Access Journals (Sweden)

    Adriano Jaime Consorte Loyola

    2005-10-01

    Full Text Available A artrite psoriásica tem sido reconhecida como doença imunomediada, em que há participação de células T produtoras de citocinas (fator de necrose tumoral-alfa. O infliximab é anticorpo monoclonal que se liga e inativa o fator de necrose tumoral-alfa. Relata-se um caso de artrite psoriásica grave, refratária a várias terapêuticas sistêmicas, tratado com infliximab 5mg/kg, em infusão venosa de três horas, nas semanas 0, 2, 6 e 14, associado com baixa dose de metotrexato, que apresentou excelente resposta terapêutica.Psoriatic arthritis has been recognized as an auto-immune disease in which there is participation of the cytokine-producing T cells (tumor necrosis factor-alpha. Infliximab is a monoclonal antibody that binds to and inactivates tumor necrosis factor-alpha. Reported is a case of severe psoriatic arthritis which was unresponsive to multiple systemic therapies and treated with an intravenous infusion of infliximab, 5mg/Kg in three hours, in weeks 0,2,6 and 14, associated with a low dose of methotrexate, with an excellent therapeutical response.

  6. Polymorphisms in TSHR and IL1RN genes and the risk and prognosis of Graves' disease in Tunisian population

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    Ines ZAABER

    2015-12-01

    Full Text Available Graves' disease (GD is a complex genetic autoimmune thyroid diseases (AITD. TSHR is considered as candidate gene in GD. IL1RN gene shown to be related to the pathogenesis of a number of autoimmune diseases. These finding prompted us to investigate the association of TSHR and IL1RN genes polymorphism with the risk and the prognosis of GD in Tunisia. A total of 249 healthy controls and 68 GD were genotyped for TSHR D727E and IL1RNVNTR polymorphism. No significant difference was found for D727E polymorphism between GD patients and healthy controls. For IL1RNVNTR, we found an association between GD and IL1RN A1A2 genotype. TSHR polymorphism was associated with GD susceptibility in patients older than 40 years. We found for the first time an association of IL1RNVNTR polymorphism with the production of anti-thyroglobulin and anti-thyroid peroxidase antibody at the onset of disease. These preliminary results suggest that TSHR polymorphism may be a risk factor for late onset of GD, and that IL1RNVNTR polymorphism may be associated with GD susceptibility and may represent prognostic factor for predicting the severity of GD. [Biomed Res Ther 2015; 2(12.000: 418-425

  7. Miastenia grave com resposta eletrográfica de síndrome miastênica: relato de um caso

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    Lineu Cesar Werneck

    1985-06-01

    Full Text Available Relato de caso de paciente de 61 anos de idade, com história progressiva de astenia, episódios de disfagia, disfonia e diplopia que flutuavam conforme a atividade, que respondeu ao uso de anticolinesterásicos e corticoesteróides. A investigação eletrográfica foi típica de síndrome miastênica (Eaton-Lambert. Investigação radiológica e laboratorial repetida três vezes em período de 7 anos procurando neoplasia foi sempre negativa. Biópsia de músculo revelou atrofia de fibras do tipo II. Testes de estimulação repetitivos em três ocasiões diferentes no período de 7 anos, foram compatíveis a síndrome miastênica (incremento de até 418% e em uma ocasião foi típico de miastenia grave (decremento abaixo de 20%. São discutidos os achados eletrofisiológicos em relação aos da literatura.

  8. 131I治疗单叶Graves’病的临床分析%The clinical analysis of 131I treatment in the single leaf Graves, disease

    Institute of Scientific and Technical Information of China (English)

    张怡; 袁卫红

    2014-01-01

    Objective The single leaf Graves, and the double leaves Graves, patients were observed in 60 cases after 131I treatment, and observe the clinical and fol ow-up data of patients, analysis and comparison of 131I in the treatment of the single leaf Graves, and the double leaves Graves, in patients with clinical efficacy. Method Two groups of patients were adopted 131I treatment, fol ow-up observation were performed after treatment, compared with the 131I treated thyroid narrowing effect degree and treatment situation, to analyze the 131I treatment effect in the single leaf Graves , and the double leaves Graves,. Result The single leaf Graves, 131I treatment group: before and after the treatment of thyroid volume reduction of the statistical y significant difference. 43 cases were cured (71.7%), improved in 13 cases (21.7%), invalid 4 cases (6.6%), effective rate was 93.3%, the cure rate was 71.7%. The double leaves Graves, 131I treatment group: 46 cases were cured (76.7%), improved in 11 cases (18.3%), invalid 3 cases (5%), effective rate was 95%, the cure rate was 76.7% .Conclusion For the single leaf Graves, disease take 131I treatment, the curative effect of treatment with 131I in the double leaves Graves, disease withnot significant difference. The single leaf Graves, patients in thyroid tissue, thyroid scintigraphy in the uptake function hyperfunction of the leaf were reassessed, adopted the 131I treatment, as long as the treatment dose properly, adhere to individualized treatment plan, strengthening fol ow-up after treatment, can achieve effective results. 131I treatment of Graves, disease, has the advantages of simple, effective, safe,and economy.%目的:分别观察60例经过131I治疗的单叶Graves,病患者和双叶Graves,病患者的临床和随访资料,分析和比较131I治疗单叶Graves,病和双叶Graves,病患者的临床疗效。方法两组患者分别采取131I治疗,治疗后均进行随访观察,通过对比131I治疗后甲状

  9. Prediction of post-treatment hypothyroidism using changes in thyroid volume after radioactive iodine therapy in adolescent patients with Graves' disease

    Directory of Open Access Journals (Sweden)

    Fukata Shuji

    2011-11-01

    Full Text Available Abstract Background The goal of iodine-131 therapy for pediatric Graves' disease is to induce hypothyroidism. However, changes in post-treatment thyroid volume have not been investigated in pediatric and/or adolescent patients. Objective The aim of this retrospective study was to examine whether changes in thyroid volume predict post-treatment hypothyroidism in adolescent Graves' disease patients. Patients and Methods We used ultrasonography to examine changes in thyroid volume, and also assessed thyroid functions, at 0, 1, 3, 5, 8 and 12 months after iodine-131 treatment in 49 adolescents ranging in age from 12 to 19 years retrospectively. Based on thyroid function outcome at 12 months, patients were divided into two groups: 29 patients with overt hypothyroidism requiring levothyroxine replacement and 20 without overt hypothyroidism. We compared changes in post-radioiodine thyroid volume between the two groups. Results About 90% of patients whose thyroid volume at 3 months after iodine-131 administration was less than 50% of the original volume were hypothyroid by one year after treatment (positive predictive value 88%, sensitivity 75.9%, specificity 85.0%. Conclusions We believe ultrasonographic measurement of thyroid volume at 3 months after iodine-131 to be clinically useful for predicting post-treatment hypothyroidism in adolescent Graves' disease patients.

  10. Digging up the recent Spanish memory: genetic identification of human remains from mass graves of the Spanish Civil War and posterior dictatorship.

    Science.gov (United States)

    Baeta, Miriam; Núñez, Carolina; Cardoso, Sergio; Palencia-Madrid, Leire; Herrasti, Lourdes; Etxeberria, Francisco; de Pancorbo, Marian M

    2015-11-01

    The Spanish Civil War (1936-1939) and posterior dictatorship (until 1970s) stands as one of the major conflicts in the recent history of Spain. It led to nearly two hundred thousand men and women executed or murdered extra-judicially or after dubious legal procedures. Nowadays, most of them remain unidentified or even buried in irretraceable mass graves across Spain. Here, we present the genetic identification of human remains found in 26 mass graves located in Northern Spain. A total of 252 post-mortem remains were analyzed and compared to 186 relatives, allowing the identification of 87 victims. Overall, a significant success of DNA profiling was reached, since informative profiles (≥ 12 STRs and/or mitochondrial DNA profile) were obtained in 85.71% of the remains. This high performance in DNA profiling from challenging samples demonstrated the efficacy of DNA extraction and amplification methods used herein, given that only around 14.29% of the samples did not provide an informative genetic profile for the analysis performed, probably due to the presence of degraded and/or limited DNA in these remains. However, this study shows a partial identification success rate, which is clearly a consequence of the lack of both appropriate family members for genetic comparisons and accurate information about the victims' location. Hence, further perseverance in the exhumation of other intact graves as well as in the search of more alleged relatives is crucial in order to facilitate and increase the number of genetic identifications. PMID:26378723

  11. Subsídios para a diversificação de moradias destinadas a pessoas com transtorno mental grave no Brasil: uma revisão

    Directory of Open Access Journals (Sweden)

    Juarez Pereira Furtado

    2013-09-01

    Full Text Available Com as críticas ao chamado manicômio, diversas iniciativas de moradia para egressos de hospitais psiquiátricos precisaram ser implementadas em diferentes países. Neste artigo, a partir de revisão narrativa, analisamos os antecedentes e a constituição de moradias para pessoas com transtorno mental grave implementadas no Brasil, pelo Sistema Único de Saúde. Identificamos pouca discussão sobre os limites do programa de Serviços Residenciais Terapêuticos (SRTs e a quase inexistência de discussões sobre alternativas para as necessidades de moradia de pacientes graves ligados aos Centros de Atenção Psicossocial (Caps. Subsidiados por reflexões oriundas da experiência canadense, discutimos a necessidade e os caminhos possíveis de ampliação não só quantitativa, mas, sobretudo, qualitativa, das formas de apoio às moradias de pessoas com transtorno mental grave no Brasil.

  12. I-131 Treatment of Graves' Disease in an Unsuspected First Trimester Pregnancy; the Potential for Adverse Effects on the Fetus and a Review of the Current Guidelines for Pregnancy Screening

    OpenAIRE

    Barrett Mark; DeSimone Shane; Tran Phuong; Bachrach Bert

    2010-01-01

    Graves' disease is a thyroid-specific autoimmune disorder in which the body makes antibodies to the thyroid-stimulating hormone receptor leading to hyperthyroidism. Therapeutic options for the treatment of Graves' disease include medication, radioactive iodine ablation, and surgery. Radioactive iodine is absolutely contraindicated in pregnancy as exposure to I-131 to the fetal thyroid can result in fetal hypothyroidism and cretinism. Here we describe a case of a female patient with recurrent...

  13. Descriptive, metallographic and chemical study of cooper-alloy points found at the grave of one member of the Sican elite, Lambayeque - Peru, using optical microscopy techniques and neutron activation analysis

    International Nuclear Information System (INIS)

    This paper offers a description as well as physical and morphological analyses of 489 points found inside the grave of one of the elite members of Sican (900 - 1110 dC). A metallographic study of one of the points is also carried out, plus the multielemental-quantitative chemical analysis of twelve items from the same grave. In addition, four points of the same culture from the Museo Nacional de Arqueologia, Antropologia e Historia of Peru are also analyzed

  14. Intervention Protocol to Address the Difficult Airway. An Alternative for the Anesthesiologist’s Performance Protocolo de intervención para abordar la vía aérea difícil: alternativa en el modo de actuación del anestesiólogo

    Directory of Open Access Journals (Sweden)

    Fernando Márquez Ercia

    2012-02-01

    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.

  15. Terapia comunitária como recurso de abordagem do problema do abuso do álcool, na atenção primária Terapia comunitaria como medio de abordar el problema del abuso de alcohol en la atención primaria Community Therapy as a Method to Address the Problem of Alcohol Abuse in Primary Care

    Directory of Open Access Journals (Sweden)

    Francinete Alves de Oliveira Giffoni

    2011-06-01

    Full Text Available Este estudo teve por objetivo identificar potencialidades da terapia comunitária (TC como recurso de abordagem do problema do abuso do álcool na atenção primária, sob a perspectiva de um usuário. A pesquisa foi realizada na sede do Projeto Quatro Varas, Fortaleza, CE. Empregou-se a abordagem qualitativa de cunho etnográfico, utilizando entrevista semiestruturada e observação participante. Dos 20 participantes da terapia entrevistados, um foi escolhido para entrevista de aprofundamento. Construíram-se dois núcleos temáticos: os efeitos da terapia na abordagem do alcoolismo e terapia como recurso de apoio social, na abordagem dos problemas relacionados ao uso de álcool. Resultados indicam que o diálogo estabelecido na terapia promove ressignificação da problemática e redirecionamento de itinerários terapêuticos, no sentido da gestão da própria vida e busca da cidadania. Conclui-se que a TC favorece a formação de teia de relações sistêmicas, que amplia a compreensão dos problemas decorrentes do uso de álcool, constituindo-se em efetiva estratégia para sua abordagem no campo da saúde comunitária.Este estudio tuvo como objetivo identificar el potencial de la terapia comunitaria (TC como medio de abordar el problema del abuso de alcohol en la atención primaria desde la perspectiva del usuario. La investigación fue realizada en la Sede del Proyecto Cuatro Varas, Fortaleza-CE, Brasil. Fue empleado un abordaje cualitativo de tipo etnográfico, utilizando la entrevista semiestructurada y la observación participante. De los 20 participantes de la terapia entrevistados, uno fue escogido para la entrevista en profundidad. Construimos dos núcleos temáticos: los efectos de la terapia en el abordaje del alcoholismo y la terapia como recurso de apoyo social en el abordaje de los problemas relacionados al uso de alcohol. Los resultados indican que el diálogo establecido en la terapia promueve resignificación de la problem

  16. O mundo da criança portadora de asma grave na escola El mundo del niño portador de asma grave en la escuela Daily life of children with acute asthma in school settings

    Directory of Open Access Journals (Sweden)

    Regina Issuzu Hirooka de Borba

    2009-01-01

    Full Text Available OBJETIVO: Compreender o significado que a criança asmática grave e sua família atribuem à doença e suas implicações na escola. MÉTODOS: Estudo de caso qualitativo, desenvolvido no ambulatório de pediatria de um hospital do Município de São Paulo. Foram estudadas três crianças e seus familiares, utilizando observação participante, entrevista e brinquedo terapêutico dramático. RESULTADOS: As demandas do tratamento e as freqüentes crises de asma influenciaram no cotidiano da criança na escola como: falta às aulas; deixar de aprender; restrinção nas brincadeiras e relacionamento conflituoso com colegas. CONSIDERAÇÕES FINAIS: Tendo em vista as dificuldades encontradas pelas crianças em freqüentar a escola e conviver com os colegas, recomenda-se um trabalho conjunto entre os profissionais de saúde e da educação, assegurando a manutenção da educação formal e do convívio social salutar.OBJETIVO: Comprender el significado que el niño asmático grave y su familia atribuyen a la enfermedad y sus implicancias en la escuela. MÉTODOS: Se trata de un estudio de caso cualitativo, desarrollado en el consultorio externo de pediatría de un hospital del Municipio de Sao Paulo. Fueron estudiados tres niños y sus familiares, utilizando la observación participante, entrevista y juego terapéutico dramático. RESULTADOS: Las demandas del tratamiento y las frecuentes crisis de asma influenciaron en el cotidiano del niño en la escuela como: falta a las clases; dejar de aprender; restricción en los juegos y relación conflictiva con sus colegas. CONSIDERACIONES FINALES: Teniendo en vista las dificultades encontradas por los niños para frecuentar a la escuela y convivir con sus colegas, se recomineda un trabajo conjunto entre los profesionales de salud y de educación, asegurando la manutención de la educación formal y de la convivencia social saludable.OBJECTIVES: To understand the meaning of asthma and its implications in daily

  17. Ejercicio y la detección del mal agudo de montaña grave Exercise and the detection of severe acute mountain sickness

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    Adrián Garófoli

    2010-02-01

    Full Text Available El mal agudo de montaña (MAM es un conjunto de síntomas inespecíficos padecidos por sujetos que ascienden rápidamente desde baja a alta altura sin adecuada aclimatación. Usualmente es autolimitado, pero las formas graves (edema pulmonar y cerebral pueden causar la muerte. La hipoxemia exagerada en reposo está relacionada con el desarrollo de MAM pero su valor predictivo es limitado. Dado que el ejercicio en altura se acompaña de mayor hipoxemia y síntomas, postulamos el valor predictivo de un simple test de ejercicio para pronosticar MAM grave. Se estudió el valor predictivo de la saturación de oxígeno en reposo y ejercicio submáximo a 2.700 m y 4 300 m en 63 sujetos que ascendían al cerro Aconcagua (6 962 m. Se consideró desaturación de oxígeno con ejercicio a una disminución = 5% respecto al reposo. Se utilizó la escala de Lake-Louise para establecer la presencia de MAM grave. Seis sujetos presentaron MAM grave (9.5% y requirieron evacuación. La saturación de oxígeno en reposo a 2.700 m no fue significativa para clasificar sujetos que luego desarrollaron MAM grave. Por el contrario, la asociación de desaturación durante el ejercicio a 2.700 m más la saturación inapropiada en reposo a 4.300 m fue significativa para clasificar a los sujetos que desarrollaron MAM grave con un valor predictivo positivo de 80% y un valor predictivo negativo del 97%. Nuestros resultados son relevantes para el montañismo y sugieren la adición de un simple test de ejercicio en la predicción del MAM grave.Acute mountain sickness (AMS is a group of non-specific symptoms, seen in subjects that ascend from low to high altitude too quickly, without allowing sufficient time to acclimatize. Usually it is self-limiting, but the severe forms (pulmonary and cerebral edema can be fatal. Exaggerated hypoxemia at rest is related to later development of AMS but its predictive value is limited. Since exercise at altitude induces greater hypoxemia and

  18. Bases técnicas para la aplicación del sistema de análisis de peligro y puntos críticos de control (HACCP desde la granja de ponedoras hasta la recepción y distribución de huevos para el consumo

    Directory of Open Access Journals (Sweden)

    Yanetsy Pérez Pérez; Alcides Pérez Bello

    2006-09-01

    Full Text Available Para garantizar alimentos de calidad, ysin riesgos para la salud pública, debenemplearse sistemas de producción dealimentos seguros, "desde el productorhasta el consumidor", lo que reduce loscostos de producción por concepto deinspección y decomiso de productoscontaminados o deteriorados, y elconsiguiente impacto económico, políticoy social. Es con este objetivo que serealiza un estudio de identificación yanálisis de riesgos biológicos, químicos yfísicos en una granja avícola deponedoras y el centro de acopio ydistribución de huevos comerciales de laprovincia Villa Clara; lo que permitió ladeterminación de los riegos, los PuntosCríticos de Control (PCC, suscorrespondientes Límites Críticos (LC ylas posibles desviaciones de estosúltimos, los procedimientos de vigilanciay monitoreo y la propuesta de medidas oacciones correctivas que constituyen lasbases técnicas para la implementacióndel Sistema de Análisis de Peligro yPuntos Críticos de Control (HACCP, en laproducción de huevos comerciales;previa decisión de las autoridadesempresariales correspondientes.Palabras claves: ABSTRACT.The used of Food Safety System "fromproducer to consumer" is to obtainsafety food, reduce the risks of publichealth and the cost of the food. Thereduction of the costs of inspection,forfeiture of contaminated ordeteriorated food is important to reduceeconomical, political and social impact.Our paper is to identify and analyzebiological, chemical and physical risks inthe poultry farm. The reception anddistribution of eggs in Villa Clara wereanalyzed too. The hazards, CriticalControl Points (PCC, Critical Limits (LCand its deviations were identified in theprocess, as well as the monitoryprocedures and correctives actions astechnical basis to implement the HazardAnalysis and Critical Control PointsSystem (HACCP associated with theeggs production. The implementation ofthe system depends on the decision ofthe enterprises authorities.Key words: Hazards

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

    International Nuclear Information System (INIS)

    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 Graves hyperthyroidism (7 males, 13 females, average age (46.60 ±9.55) years) 2, 4, 6, and 24 h after intake of the radioiodine capsule. A scintillation probe was positioned at the center of the inferior edge of the thyroid cartilage 25 cm away for 2 min, which was defined as the standard manipulation (test 1). Then, the probe was moved either 5 cm backward (test 2) or 5 cm higher (test 3) compared with test 1. Variants of RAIU, Teff as well as dose calculations were acquired by different combinations (CⅠ-Ⅸ) of 4 h and 24 h-RAIU, according to the above 3 manipulations (C Ⅰ-Ⅲ: test 1 for RAIU4h, test 1, 2, 3 for RAIU24h respectively; C Ⅳ-Ⅵ: test 2 for RAIU4h, test 1, 2, 3 for RAIU24h respectively; CⅦ-Ⅸ: test 3 for RAIU4h, test 1, 2, 3 for RAIU24h respectively). Paired t test was used to compare the statistical differences between C H-Ⅸ to C Ⅰ. Results: RAIU24h of test 2 (68.08% ± 7.88%) and test 3 (62.18% ± 7.45%) were significantly lower than that of test 1 (78.05% ± 8.31%; t=12.15, 14.37, respectively, both P<0.01). Teffs of C Ⅱ (4.42 ± 0.73) d, CⅢ (3.76 ±0.53) d, CⅤ (5.59 ±0.46) d, CⅥ (4.47 ±0.44) d, CⅧ (5.94 ±0.54) d and CⅨ (5.45 ±0.66) d were significantly different from that of C Ⅰ (5.04 ±0.56) d which was defined as standard (t: 3.86-13.64, all P<0.01). Among the 180 131I dose values calculated by different Teff and RAIU values induced from C Ⅰ-Ⅸ combinations, 74.4% (119/160) were over-calculated while 9.4% (15/160) were under-calculated. Taking one patient as an example,the changes of RAIU24h (decreased up to 26.0%) and the percentage of Teff deviation(66.9%,ranged from-47.5% to 19.4%) led to an over-calculated 131I dosage by as high as 129

  20. Traumatismo cranioencefálico grave em crianças e adolescentes Severe traumatic braininjury in children and adolescents

    Directory of Open Access Journals (Sweden)

    Luís Fernando Andrade de Carvalho

    2007-03-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Apresentar uma revisão crítica do traumatismo cranioencefálico (TCE em crianças e adolescentes, enfocando o trauma grave, as taxas e os aspectos relacionados com a mortalidade e as principais medidas terapêuticas. CONTEÚDO: Revisão sistemática dos artigos incluídos no MEDLINE, SciELO e Lilacs, no período compreendido entre 1985 e 2006, utilizando as seguintes palavras-chave: traumatic brain injury, craniocerebral trauma, children e mortality, além dos principais livros-texto sobre o assunto. Foram analisados também os Guidelines of Brain Trauma Foundation de 2000 e 2003, sendo selecionados os principais trabalhos citados. O traumatismo cranioencefálico é uma das principais causas de morte e seqüelas em crianças e adolescentes. As taxas de mortalidade variaram entre 10% e 55%, principalmente em razão dos critérios de seleção utilizados, da gravidade dos pacientes e dos locais onde foram realizados os estudos. Em geral, a mortalidade em crianças foi menor que as descritas em pacientes adultos. Os principais fatores relacionados com a mortalidade em crianças foram a pontuação na escala de coma de Glasgow, a hipotensão arterial, o edema e ingurgitamento cerebral difusos e a baixa pressão de perfusão encefálica. O tratamento do TCE grave visa a correção dos fatores relacionados com a lesão cerebral secundária. CONCLUSÕES: Os fatores relacionados com melhor prognóstico em crianças ainda permanecem inconclusivos, havendo algumas divergências entre os estudos. Grande parte destes fatores é corrigível ou evitável, com reanimação hídrica inicial agressiva, tratamento cirúrgico em tempo hábil, monitorização e cuidados intensivos adequados.BACKGROUND AND OBJECTIVES: Present a critical review of traumatic brain injury (TBI in children and adolescents, focusing on severe TBI, the mortality and the factors related with poor outcome. CONTENTS: It was made a systematic review in MEDLINE

  1. Changes of the serum IL-18 and TRAb in patients with Graves' disease after 131I treatment within one year

    International Nuclear Information System (INIS)

    To investigate immunological function change in Graves' disease (GD) patients with hypothyroidism within one year after 131I treatment, and evaluate the relationship between the 131I treatment and autoimmune thyroid disease. Serum levels of IL-18, TRAb and TPOAb in 41 patients with GD were determined by EIA, IRMA and CLIA, thyroid weight (TDW) were measured by B ultrasonic instrument. The patients were divided into two groups based on whether appear the early hypothyroidism after 131I treatment during 6-12 months graded as: the hypothyroidism group in 13 and the recovery group in 28; 25 healthy people as control group. Results showed that the serum levels of IL-18 and TRAb in hypothyroidism group and recovery group were significantly increased before 131I treatment compared with control group (P3, FT4, sTSH, TDW and 131I dosage were not significant differences (P>0.05). The serum levels of IL-18 in two groups were decreased (P131I treatment (P3, FT4, TDW(r=0.372 P131I therapy and 6/13 after therapy, and in the recovery group were 10/28 before therapy and 12/28 after therapy. These data suggest that radiation has a little influence on GD patients for adjusting immune system during 6-12 months after 131I treatment. The changes of serum IL-18 and combine with serum TRAb and TPOAb might be valuable implication for assessing the effect and prognosis of 131I treatment in patients with GD hyperthyroidism. (authors)

  2. Chemokine (C-C motif ligand 20, a potential biomarker for Graves' disease, is regulated by osteopontin.

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    Xiaoli Li

    Full Text Available CONTEXT: Graves' disease (GD is a common autoimmune disease involving the thyroid gland. The altered balance of pro- and anti-inflammatory cytokines plays an important role in the pathogenesis of GD. Chemokine (C-C motif ligand 20 (CCL20 is important for interleukin-17 (IL-17 signal activation and a potent chemoattractant for Th17 cells. Meanwhile, Osteopontin (OPN, a broadly expressed pleiotropic cytokine, has been implicated in GD through inducing Th1-involved response to enhance the production of proinflammatory cytokines and chemokines, but little is known about the role of OPN in regulating CCL20 and IL-17 signaling. OBJECTIVE: This study sought to explore the possibility of CCL20 level as a biomarker for GD, as well as investigate the role of OPN in regulating CCL20 production. METHODS: Fifty untreated GD patients, fifteen euthyroid GD patients, twelve TRAb-negative GD patients and thirty-five healthy control donors were recruited. OPN, CCL20 and other clinical GD diagnosis parameters were measured. CD4+T cells were isolated from peripheral blood mononuclear cells (PBMCs using antibody-coated magnetic beads. Enzyme-linked immune-sorbent assay and quantitative polymerase chain reaction were used to determine CCL20 expression level. RESULTS: We found that the plasma CCL20 level was enhanced in GD patients and decreased in euthyroid and TRAb-negative GD patients. In addition, CCL20 level correlated with GD clinical diagnostic parameters and plasma OPN level. Moreover, we demonstrated that recombinant OPN and plasma from untreated GD patients increased the expression of CCL20 in CD4+T cells, which could be blocked by OPN antibody. Furthermore, we found that the effect of OPN on CCL20 expression was mediated by β3 integrin receptor, IL-17, NF-κB and MAPK pathways. CONCLUSIONS: These results demonstrated that CCL20 might serve as a biomarker for GD and suggested the possible role of OPN in induction of CCL20 expression.

  3. Standisation of I-131 treatment of Graves` disease in Australian patients, with an intent to optimise radiation dose and treatment

    Energy Technology Data Exchange (ETDEWEB)

    Howarth, D.; Lan, L.; Allen, L.; Thomas, P. [John Hunter Hospital, Newcastle NSW (Australia). Department of Nuclear Medicine

    1998-06-01

    Full text: This study was part of an international multi-centre randomised outcome study under the auspices of the International Atomic Energy Agency, with the aim of standardising iodine-131 (I-131) therapy in Graves disease. Following Hunter Area Ethics Committee approval, patients were enrolled into the study and investigated by clinical assessment, biochemistry, immunology, thyroid ultrasound, technetium 99m thyroid scintigraphy and 24 hour I- 131 uptake measurement. Patients were randomised into two treatment groups: those receiving 60 Gy or 90 Gy thyroid doses of radioiodine. Outcome was determined clinically and biochemically. All patients tolerated radioiodine therapy well. Five patients had clinical exacerbation of thyrotoxicosis after radioiodine but only two required modification of therapy. At six months after radioiodine, 47% of patients remained hyperthyroid, 40 were euthyroid and 13% were hyperthyroid. Four of the hyperthyroid patients were re-treated with additional radioiodine. Significantly more patients who received a 90 Gy thyroid dose became hypothyroid compared to those who received 60 Gy, and significantly more patient who received 60 Gy remained hyperthyroid compared to those who received 90 Gy. Serial thyroid function tests demonstrated transient hypothyroidism in 47% of patients at 1-3 months after radioiodine treatment, most likely representing thyroid stunning. It is concluded that 90 Gy is an insufficient thyroid dose to render more than 53% of patients euthyroid or hypothyroid at 6 months after radioiodine therapy after such therapy a longer period may be required to achieve euthyroidism, during which most patients may require additional therapy with anti-thyroid medications

  4. Diagnosis and differential diagnosis of Graves' orbitopathy in MRI; Diagnose und Differenzialdiagnose der endokrinen Orbitopathie in der MRT

    Energy Technology Data Exchange (ETDEWEB)

    Daubner, D.; Spieth, S.; Engellandt, K.; Kummer, R. von [Universitaetsklinikum Carl Gustav Carus, Technische Universitaet Dresden, Abteilung Neuroradiologie, Institut und Poliklinik fuer Radiologische Diagnostik, Dresden (Germany)

    2012-06-15

    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.) [German] Die Bildgebung der endokrinen Orbitopathie (EO) umfasst radiologische und nuklearmedizinische Verfahren, die je nach Methode Aussagen zur Verteilung und Aktivitaet der Erkrankung liefern. Die Magnetresonanztomographie (MRT) ist nicht nur zur Diagnosestellung hilfreich, sondern auch in der Lage, die aktive von der inaktiven Form anhand des intramuskulaeren Oedems zu unterscheiden. Das Verfahren eignet sich deshalb auch zur Aktivitaetsbeurteilung und zur Bewertung einer Therapie im Verlauf. Die Erkrankung fuehrt zu einer typischen Verdickung des Muskelbauchs der extraokulaeren Augenmuskeln, wobei die Mm. rectus inferior, rectus medialis und levator palpebrae am haeufigsten betroffen sind. Signalveraenderungen des intra- und extrakonalen Fettgewebes sind moeglich, und eine bilaterale Manifestation ist haeufig. Die Differenzialdiagnose umfasst neben anderen

  5. A questionnaire survey on the management of Graves' orbitopathy in China:A comparison with Europe and Latin-America

    Institute of Scientific and Technical Information of China (English)

    Shu-Hang Xu; Xing-Jia Li; Guo-Fang Chen; Quan-Xi Zheng; Yu Yang; Yong-Xin Hu; Kun Wang; Chao Liu

    2015-01-01

    Objective: Management of Graves' orbitopathy (GO) continues to be a challenge to clinical endocrinologists. In the last few years, surveys on GO management have succeeded in elucidating trends in Europe and Latin America. To determine how endocrinologists in China assess and treat patients with GO and gain insight into how to make the management of this disease more uniform and standardized. Methods: Based on the questionnaire used in the European survey on GO, a questionnaire in China was drafted and circulated to the members of Chinese Society of Endocrinology (CSE) during the annual meeting. Results: A total of 124 valid responses were analysed. Almost all respondents (94.4%) claimed that a multidisciplinary approach for GO management was valuable. Over 80% of the participants advocated the assessment of exophthalmometry, vision, visual fields by perimetry, eye movements, and fundoscopy. Glucocorticoids were preferred as the first-line therapy by 92.7% of respondents, among them, 59.7% choose the intravenous route. The treatment strategy for GO with intravenous glucocorticoids therapy still remains debatable. Anti-thyroid drugs (ATDs) were the most common choice (72.6%) for first-line therapy of coexisting hyperthyroidism. Treatment options for GO were very similar among Chinese, Latin-American and Eu-ropean respondents, whereas radioactive iodine and surgical treatment were more often indicated for co-existing hyperthyroidism in China. Conclusion: The appropriate treatment for patients with GO is controversial even among thyroid specialists. Further training of thyroid specialists, easier access of patients to multidisciplinary centres and establishment of practice guidelines are required for the management of this condition in China. Copyright © 2015, Chinese Medical Association Production. Production and hosting by Elsevier B.V. on behalf of KeAi Communications Co., Ltd. This is an open access article under the CC BY-NC-ND license (http

  6. Morbidade materna grave em um hospital universitário de referência municipal em Campinas, Estado de São Paulo Severe maternal morbidity at a local reference university hospital in Campinas, São Paulo, Brazil

    Directory of Open Access Journals (Sweden)

    Adriana Gomes Luz

    2008-06-01

    Full Text Available OBJETIVO: avaliar a prevalência e os fatores de risco associados à morbidade materna grave numa maternidade terciária. MÉTODOS: trata-se de um estudo de corte transversal dos casos de morbidade materna grave atendidos no Hospital e Maternidade Celso Pierro entre outubro de 2005 e julho de 2006, identificados a partir dos livros de controle das unidades de internação, pronto atendimento e centro obstétrico. Foram estudadas gestantes e puérperas que apresentavam condições definidoras de morbidade materna grave a partir dos diagnósticos clínicos segundo critérios propostos por Waterstone. Posteriormente, os casos de maior gravidade clínica, chamados de morbidade extremamente grave, foram reclassificados utilizando-se os critérios definidores de Mantel, baseados em disfunção orgânica e manejo. RESULTADOS: foram identificadas 114 mulheres com morbidade materna grave entre 2.207 partos, com razão de outra morbidade grave e morbidade extremamente grave de 44,9 e 6,8 casos por 1.000 partos, respectivamente. A média da idade gestacional no parto foi de 35 semanas e 87% das mulheres vieram de área de cobertura da maternidade no município. A hipertensão (pré-eclâmpsia grave representou 96% de outras morbidades graves e a hemorragia esteve presente em 60% dos casos de morbidade extremamente grave, seguida de hipertensão. A prevalência de morbidade extremamente grave entre os casos de morbidade grave não se associou com estado marital, escolaridade, idade materna, tipo de parto, gestações, idade gestacional e distrito de saúde de moradia. CONCLUSÕES: as outras morbidades graves foram 6,6 vezes mais freqüentes que os casos extremamente graves, sem diferenças entre os grupos por fatores de risco epidemiológicos.PURPOSE: to assess the prevalence and risk factors associated with near miss and other severe maternal morbidity at a reference tertiary maternity. METHODS: this is a cross-sectional study on severe maternal morbidity

  7. Peligros biológicos e inocuidad de alimentos

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    Alfredo Rodríguez Matos

    2005-09-01

    Full Text Available I.- Introducción Cuando un consumidor adquiere un alimento, descuenta que la inocuidad o seguridad del mismo está siempre presente, las expectativas y actitudes de los consumidores están dirigidas a exigir el derecho a la protección de la seguridad, la salud y la información básica sobre los alimentos que el mercado pone a su alcance. En opinión de Erro (2002, la inocuidad se transforma entonces en una “necesidad implícita” que obviamente se pretende satisfacer, pero la toma de conciencia de esto se da, lamentablemente, cuando aquella dejó de estar presente. Remitiéndonos a lo expresado por el Codex Alimentarius (1997, indica que las enfermedades de transmisión alimentaria y los daños provocados por los alimentos son, en el mejor de los casos desagradables, y en el peor pueden ser fatales. El deterioro de los alimentos ocasiona pérdidas, es costoso y puede influir negativamente en el comercio y la confianza de los consumidores. Por consiguiente, es imprescindible un control eficaz de la higiene, a fin de evitar los daños ocasionados por los alimentos y por el deterioro de los mismos, para la salud y la economía. Todos, fabricantes, elaboradores, manipuladores y consumidores de alimentos, tienen la responsabilidad de asegurarse de que los alimentos sean inocuos y aptos para el consumo. La responsabilidad del control de los riesgos microbiológicos recae sobre los individuos que intervienen en todas las fases de la cadena alimentaria, desde la explotación agrícola o ganadera hasta el consumidor final. Visto desde esta óptica el análisis de riesgos debería aplicarse dentro de un contexto estratégico, organizativo y operacional reconocido. Si bien en el proceso pueden haber elementos comunes, en el establecimiento de un nivel apropiado de protección los enfoques de esos sectores pueden presentar las máximas diferencias (FAO 2003.

  8. Severe scorpion envenomation in Brazil: clinical, laboratory and anatomopathological aspects Escorpionismo grave no Brasil: aspectos clínicos, laboratoriais e anatomopatológicos

    Directory of Open Access Journals (Sweden)

    Palmira Cupo

    1994-02-01

    Full Text Available Scorpion stings in Brazil are important not only because of their incidence but also for their potential ability to induce severe, and often fatal, clinical situations, especially among children. In this report we present the clinical and laboratory data of 4 patients victims of scorpion stings by T. serrulatus, who developed heart failure and pulmonary edema, with 3 of them dying within 24 hours of the sting. Anatomopathologic study of these patients revealed diffuse areas of myocardiocytolysis in addition to pulmonary edema. The surviving child presented enzymatic, electrocardiographic and echocardiographic changes compatible with severe cardiac involvement, which were reversed within 5 days. These findings reinforce the need for continuous monitoring of patients with severe scorpion envenoming during the hours immediately following the sting.Os acidentes escorpiônicos no Brasil, assumem grande importancia não só pela sua incidência como pela sua potencialidade em induzir quadros clínicos graves, muitas vezes fatais, principalmente em crianças. Apresentamos neste relato os dados clínicos e laboratoriais de 4 pacientes vítimas de escorpionismo, causado pelo T. serrulatus, que evoluíram com falência cardíaca e edema pulmonar, sendo que 3 foram a óbito dentro das primeiras 24 horas após acidente. O estudo anátomopatológico desses pacientes revelou áreas de miocardiocitólise, além do edema pulmonar. Na criança que sobreviveu foram detectadas alterações enzimáticas, eletro e ecocardiográficas compatíveis com grave comprometimento cardíaco, reversíveis dentro de 5 dias. Tais achados reafirmam a necessidade de monitorização contínua no paciente com escorpionismo grave, nas horas subsequentes ao envenenamento.

  9. Análise do filme lacrimal e sua relação com a largura da fenda palpebral e a exoftalmia na oftalmopatia de Graves Tear film analysis and its relation with palpebral fissure height and exophthalmos in Graves' ophthalmopathy

    Directory of Open Access Journals (Sweden)

    Maria Vitoria Oliveira Moura Brasil

    2005-10-01

    Full Text Available OBJETIVO: Avaliar qualidade do filme lacrimal pelo corante rosa bengala e sua estabilidade por meio do tempo de ruptura, relacionando com a largura da fenda palpebral e a exoftalmia em pacientes com oftalmopatia de Graves. MÉTODOS: Foram estudados 54 olhos de 27 pacientes com oftalmopatia de Graves, tanto em fase inflamatória quanto em fase crônica. A avaliação consistiu de análise qualitativa do filme lacrimal pelo corante rosa bengala por meio da classificação de van Bijsterveld, análise da estabilidade do filme lacrimal pelo tempo de ruptura, medida da largura da fenda palpebral e exoftalmometria. A análise estatística foi realizada com o teste do Qui-quadrado. RESULTADOS: Entre os 27 pacientes estudados, 77,8% eram do sexo feminino e 22,2% do masculino. A idade média foi de 44,26 anos (DP 12,67. O tempo médio de doença foi de 5,85 anos (DP 4,47 e o de oftalmopatia foi de 5,81 anos (DP 5,37. Dos 54 olhos em estudo, 37% apresentaram teste positivo pela escala de graduação de van Bijsterveld, 33,3% tempo de ruptura do filme lacrimal menor que 5 segundos, 57,4% largura da fenda palpebral maior que 11 mm e 55,6% exoftalmometria maior que 19 mm. Quando relacionamos o tempo de ruptura do filme lacrimal menor que 5 segundos com a largura da fenda palpebral maior que 11 mm encontramos odds ratio igual a 11,2 (p=0,0008. As demais relações estudadas não mostraram significância estatística. CONCLUSÕES: O olho seco diagnosticado pela coloração com rosa bengala e pelo tempo de ruptura do filme lacrimal ocorre com freqüência na oftalmopatia de Graves. A largura da fenda palpebral correlaciona-se com o tempo de ruptura do filme lacrimal na oftalmopatia de Graves. Seu aumento pode levar à instabilidade do filme lacrimal.PURPOSE: To evaluate tear film quality by rose bengal staining and its stability by breakup time, relating with palpebral fissure height and exophthalmos in patients with Graves' ophthalmopathy. METHODS: We studied

  10. Mujer joven con hipertiroidismo asociado a insuficiencia tricuspídea grave Young woman with hyperthyroidism associated with severe tricuspid regurgitation

    OpenAIRE

    Ariel K. Saad; Ana A. Pisarevsky; Diego R. González; Manuel Vázquez Blanco; Enrique Petrucci

    2008-01-01

    Las manifestaciones cardiovasculares del hipertiroidismo son frecuentes, y en ocasiones dominan el cuadro clínico. Con frecuencia, la enfermedad se manifiesta por un estado circulatorio hiperdinámico, con disminución de la resistencia vascular periférica, aumento de la volemia y del volumen minuto cardíaco. La dilatación de las cavidades cardíacas con insuficiencia tricuspídea grave e insuficiencia cardíaca derecha sin hipertensión pulmonar constituye una forma inusual de presentación. Se pre...

  11. Osteosíntesis y artrolisis en el tratamiento de las fracturas supra e intercondíleas graves del codo en el adulto

    OpenAIRE

    Fernández Sabaté, Alfons; Ferrer Escobar, Humberto; Alvarez Gonzalez, A.; Latorre Marti, J.; Orduña Serra, Modesto

    1982-01-01

    Los autores estudian la evoluciónen el tratamiento de las fracturas graves de la extremidad distal del hiimero hasta llegar a la técnica actual de la osteosíntesis estable. Presentan y analizan una serie de 21 fracturas condíleas, supracondíleas y supraintercondíleas tratadas quirtirgicamente mediante abordaje por vía transolecraniana, osteosíntesis con placas y tornillos y fijación del olécranon con compresión. La movilización precoz postoperatoria favorece la obtención de un buen arco móvil...

  12. Ciclofosfamida: eficaz no tratamento do quadro cutâneo grave da esclerose sistêmica Cyclophosphamide: effective in the treatment of severe cutaneous involvement in systemic sclerosis

    OpenAIRE

    Patrícia Andrade de Macedo; Cláudia Teresa Lobato Borges; Romy Beatriz Christmann de Souza

    2009-01-01

    INTRODUÇÃO: A esclerose sistêmica (ES) é uma doença reumatológica caracterizada por inflamação autoimune, vasculopatia e fibrose da pele e de vários órgãos. Poucos tratamentos são considerados eficazes para a doença com intenso envolvimento de pele como a ES na forma difusa. Portanto, avaliamos a eficácia da ciclofosfamida no tratamento de pacientes com ES difusa grave. PACIENTES E MÉTODOS: Nove pacientes com ES difusa (Critérios do Colégio Americano de Reumatologia [ACR]) com escore de Rodna...

  13. Intervenci??n psicol??gica grupal, basada en la aceptaci??n y el entrenamiento en comunicaci??n, con familiares de personas con trastorno mental grave

    OpenAIRE

    Gloria M. Roldán; Isabel C. Salazar; Laura Garrido; Ana M. Cuevas-Toro

    2015-01-01

    Se evalu?? la eficacia de un programa de intervenci??n grupal en la disminuci??n de problemas psicol??gicos de familiares que conviven con pacientes con trastorno mental grave. Participaron ocho madres y un padre cuyos hijos recib??an tratamiento en un Hospital de D??a de Salud Mental. Se les aplic?? el ???Inventario de ansiedad de Beck???, el ???Inventario de depresi??n de Beck II???, la ???Escala de estr??s percibido???, el ???Cuestionario de salud SF-36???, el ???Inventario de estrategias ...

  14. Mujer joven con hipertiroidismo asociado a insuficiencia tricuspídea grave Young woman with hyperthyroidism associated with severe tricuspid regurgitation

    Directory of Open Access Journals (Sweden)

    Ariel K. Saad

    2008-02-01

    Full Text Available Las manifestaciones cardiovasculares del hipertiroidismo son frecuentes, y en ocasiones dominan el cuadro clínico. Con frecuencia, la enfermedad se manifiesta por un estado circulatorio hiperdinámico, con disminución de la resistencia vascular periférica, aumento de la volemia y del volumen minuto cardíaco. La dilatación de las cavidades cardíacas con insuficiencia tricuspídea grave e insuficiencia cardíaca derecha sin hipertensión pulmonar constituye una forma inusual de presentación. Se presenta el caso de una joven paciente, portadora de enfermedad de Graves Basedow, sin antecedentes cardiovasculares, que evoluciona en el transcurso de un mes con edema de miembros inferiores, palpitaciones, diarrea, pérdida de peso y fiebre. Al examen clínico se evidencian taquicardia con pulso irregular, signos de insuficiencia cardíaca derecha acompañado de un intenso soplo regurgitante que aumentaba con la inspiración. Por radiografía de tórax y ecocardiograma se constata cardiomegalia e insuficiencia tricuspídea grave sin hipertensión pulmonar. El cuadro se resuelve en forma rápida luego del tratamiento con propranolol, corticoides y diuréticos, con reversión de la arritmia y franca mejoría de los signos y síntomas. Se analizan en forma breve los efectos de las hormonas tiroideas en el aparato cardiovascular y se postulan probables mecanismos fisiopatológicos de la insuficiencia cardíaca en el hipertiroidismo.Cardiovascular manifestations of hyperthyroidism are frequent and sometimes are relevant in the clinical picture. Usually an hyperdynamic circulatory state hallmarks the disease with low peripheral resistance, increased intravascular volume and cardiac output. However, right chamber dilatation with tricuspid valve regurgitation and cardiac failure are unusual. We present the case of a young woman with Graves-Basedow disease without cardiovascular history who complained about palpitations, peripheral edemas, weight loss and

  15. Maltrato físico grave con ingreso en Cuidados Intensivos Pediátricos Severe physical abuse with admission to Pediatric Intensive Care Unit

    OpenAIRE

    González Sánchez, M.; M. Montes Granda; A. Vivanco Allende; A. Concha Torre; C. Rey Galán

    2013-01-01

    Introducción. El maltrato infantil es un problema de salud pública. Varios estudios han señalado que este diagnóstico se incrementa de forma alarmante. El objetivo de este estudio es describir la forma de presentación de los casos de maltrato físico infantil que precisaron ingreso en una Unidad de Cuidados Intensivos Pediátricos (UCIP). Métodos. Estudio descriptivo retrospectivo (1995-2011). Se incluyeron los casos de maltrato físico grave que precisaron ingreso en la UCIP. Se analizaron dato...

  16. Optimización de la mecánica respiratoria en el tratamiento de soporte ventilatorio de pacientes con insuficiencia respiratoria aguda grave

    OpenAIRE

    Morán Chorro, Indalecio

    2013-01-01

    Esta tesis se articula como compendio de publicaciones. En ella se incluyen tres estudios originales y una revisión que se enmarcan en una misma línea de investigación clínica enfocada a analizar la implementación de diferentes estrategias durante la ventilación mecánica invasiva de pacientes con insuficiencia respiratoria aguda grave. Las maniobras estudiadas se han dirigido a la optimización individual de los parámetros ventilatorios, a la mejora del intercambio de gases y a la minimización...

  17. Tratamiento de la hepatitis alcohólica grave: corticoides frente a nutrición enteral. Efectos a corto y largo plazo

    OpenAIRE

    Rodríguez Iglesias, Pilar

    2000-01-01

    Descripció del recurs: 13 març 2002 Títol obtingut de la pantalla digitalitzada Antecedentes: El espectro clínico de la hepatitis alcohólica es muy variable, desde formas leves, que se recuperan fácilmente con la abstinencia enólica, hasta formas graves, en las que la tasa de mortalidad puede llegar hasta el 40%. En las últimas tres décadas se han ensayado numerosas estrategias terapéuticas, y los corticosteroides se han investigado ampliamente. A pesar de que algunos estudios no observ...

  18. Telangiectasia hemorrágica hereditária: uma causa rara de anemia grave Hereditary hemorrhagic telangiectasia: a rare cause of severe anemia

    OpenAIRE

    José Wellington Alves dos Santos; Tiago Chagas Dalcin; Kelly Ribeiro Neves; Keli Cristina Mann; Gustavo Luis Nunes Pretto; Alessandra Naimaier Bertolazi

    2007-01-01

    Telangiectasia hemorrágica hereditária é uma doença autossômica dominante na qual comunicações arteriovenosas afetam comumente pele, superfícies mucosas, pulmões, cérebro e trato gastrointestinal. As manifestações comuns desta doença são epistaxe, sangramento gastrointestinal, e malformações arteriovenosas cerebrais e pulmonares. Apesar de a epistaxe e o sangramento gastrointestinal poderem causar anemia, a telangiectasia hemorrágica hereditária raramente é diagnosticada com anemia grave. Nes...

  19. Usabilidad de un programa de rehabilitación neuropsicológica por ordenador "Gradior" en personas con enfermedad mental grave y prolongada

    OpenAIRE

    Fumero Vargas, Georgina

    2015-01-01

    [ES]La usabilidad es un factor clave en el desarrollo de aplicaciones exitosas de software interactivo. Por ello la importancia de medir el nivel de usabilidad en un programa de rehabilitación neuropsicológica Gradior en personas con enfermedad mental grave y prolongada (EMGyP). El objetivo de este estudio es valorar la usabilidad, satisfacción y pedagogía del software de rehabilitación neuropsicológica por ordenador Gradior con la intención de obtener información relevante del im...

  20. Opiniones de los profesionales del ámbito sanitario acerca de la definición de trastorno mental grave: un estudio cualitativo

    OpenAIRE

    S. Conejo Cerón; P. Moreno Peral; J.M. Morales Asencio; A. Alot Montes; J.M. García-Herrera; M.J. González López; C. Quemada González; J. Requena Albarracín; B. Moreno Küstner

    2014-01-01

    Fundamento: Aunque a lo largo de los años se han propuesto diferentes definiciones de trastorno mental grave (TMG), aún existe una gran controversia a la hora de obtener una definición consensuada. El objetivo de este trabajo fue analizar la opinión de un grupo de profesionales de la red pública de servicios sanitarios sobre cuáles son los criterios que se deben tener en cuenta en la definición de TMG. Método: Estudio cualitativo en el cual se llevaron a cabo 5 grupos focales con profesionale...

  1. Myasthenia gravis and thymoma: evaluation of 41 patients Miastenia grave e timoma: avaliação de 41 pacientes

    Directory of Open Access Journals (Sweden)

    JOSÉ LAMARTINE DE ASSIS

    1999-03-01

    Full Text Available We evaluated the epidemiological, clinical, laboratory and therapeutical aspects of 41 patients with thymomatous myasthenia gravis. Thirty five patients (85.36% were submitted to thymectomy. Follow-up ranged from two to 18 years. Diagnosis of thymoma was based upon clinical investigations and CT scan of the anterior mediastinum and in 11 patients supported by immunological tests of anti-striated muscle antibodies with a positive result in more than 80% of cases. Histopathologic examination of all thymomectomized patients confirmed the diagnosis of thymoma. There was a significant predominance of benign over malignant thymoma. Occurred higher prevalence of male patients and of patients over 40 years of age. The therapeutical strategy to control myasthenic clinical findings was the same as that for non-thymomatous myasthenia gravis. The corticosteroids associated to cytotoxic drugs were less often used. Radiotherapy of the anterior mediastinum was more often used in patients having invasive tumors submitted to surgery or not. With regard to survival and control of myasthenia gravis, especially in younger patients and in those submitted to early surgery, results of treatment were surprisingly favorable.Avaliamos 41 pacientes com miastenia grave timomatosa sob os aspectos epidemiológico, clínico e terapêutico. Trinta e cinco pacientes (85,36% foram timectomizados. O seguimento clínico variou de dois meses até 18 anos. O diagnóstico do timoma foi fundamentado no estudo de imagem do mediastino (tomografia axial computadorizada e, em 11 pacientes, complementado com a determinação sérica de anticorpos para músculo estriado com resultado positivo em mais de 80% dos casos e confirmado pelo exame anátomo-patológico do timo realizado em todos os pacientes operados. Ocorreu predomínio significante de timomas benignos sobre timomas malignos, forma clínica generalizada severa, frequente envolvimento do sexo masculino e, em pacientes com mais de

  2. Evaluation of radiotherapy of patients with Graves' disease treated with fixed activities of 555 MBq of Iodine-131

    International Nuclear Information System (INIS)

    Graves' disease treatment is done by radioiodine therapy (RIT), which destroys cells of the thyroid and reduces the synthesis of T3 and T4; and surgery. In Brazil, applies RIT with fixed activities. Studies show that RIT should be based on individual biokinetics. There is controversy regarding the use of fixed activities or calculated. This study was conducted at the HC-UFPE in the period 2006-2010. Of the overall sample of 132 patients that entered the study, twenty-five of them formed a group chosen to estimate the maximum uptake of 131I and thyroid mass, to calculate the activity to be administered and the absorbed dose. All the patients were treated with fixed activities of 555 MBq 131I. Observed that 28% of patients received radioactivities above, 72% received radioactivities below, and nobody received no radioactivity as a real need. The group obtained an average rate of cure of (76 ± 5) % at 24 months of follow up, less than those obtained under the same conditions biokinetics and mean follow-up interval, among many, who have used doses of 250 Gy and 350 Gy and achieved cure rates approximately 90%. Doses received totaled 9,166 Gy, and 6,698 Gy were necessary, therefore were wasted 2,468 Gy. Were risk factors observed: extrapolation of interval of the thyroid function tests of three to six months to one to three years; economic difficulties, interfamily, socio emotional and to perform the tests requested and great distances between homes and hospital; among others; may be limitations that led to the contraposition that higher activities of 131I promote greater cure rate of GD. Results of univariate analysis - were statistically significant risk factors: female, thyroid mass between 31 g and 60 g and duration of the GD before of RIT > five years (p < 0.05). The factors sex and thyroid mass are consistent with other studies. The results suggest the use of optimized activities based on individual dosimetric parameters and the implementation of more effective

  3. Nuclear targeting of IGF-1 receptor in orbital fibroblasts from Graves' disease: apparent role of ADAM17.

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    Neil Hoa

    Full Text Available Insulin-like growth factor-1 receptor (IGF-1R comprises two subunits, including a ligand binding domain on extra- cellular IGF-1Rα and a tyrosine phosphorylation site located on IGF-1Rβ. IGF-1R is over-expressed by orbital fibroblasts in the autoimmune syndrome, Graves' disease (GD. When activated by IGF-1 or GD-derived IgG (GD-IgG, these fibroblasts produce RANTES and IL-16, while those from healthy donors do not. We now report that IGF-1 and GD-IgG provoke IGF-1R accumulation in the cell nucleus of GD fibroblasts where it co-localizes with chromatin. Nuclear IGF-1R is detected with anti-IGF-1Rα-specific mAb and migrates to approximately 110 kDa, consistent with its identity as an IGF-1R fragment. Nuclear IGF-1R migrating as a 200 kDa protein and consistent with an intact receptor was undetectable when probed with either anti-IGF-1Rα or anti-IGF-1Rβ mAbs. Nuclear redistribution of IGF-1R is absent in control orbital fibroblasts. In GD fibroblasts, it can be abolished by an IGF-1R-blocking mAb, 1H7 and by physiological concentrations of glucocorticoids. When cell-surface IGF-1R is cross-linked with (125I IGF-1, (125I-IGF-1/IGF-1R complexes accumulate in the nuclei of GD fibroblasts. This requires active ADAM17, a membrane associated metalloproteinase, and the phosphorylation of IGF-1R. In contrast, virally encoded IGF-1Rα/GFP fusion protein localizes equivalently in nuclei in both control and GD fibroblasts. This result suggests that generation of IGF-1R fragments may limit the accumulation of nuclear IGF-1R. We thus identify a heretofore-unrecognized behavior of IGF-1R that appears limited to GD-derived fibroblasts. Nuclear IGF-1R may play a role in disease pathogenesis.

  4. Value of normalization analysis of thyroid scans on 131I treatment planning for Graves' disease

    International Nuclear Information System (INIS)

    Objective: To explore the value of normalization analysis of thyroid scans on 131I treatment planning for Graves' disease. Methods: Patients with hyperthyroidism treated by 131I were retrospectively analyzed. Sixty cases with thyroid glands less than 35 g and without thyroid nodules were enrolled. Raw data of thyroid scans were re-processed using a software for normalization and magnification. Correlation between total dose,the number of treatments and other factors, such as area ratios of bilateral lobes, bilateral radioactive counts, bilateral gray scales and multifocal uptake patterns, were analyzed using step-by-step regression analysis. Correlations between normal thyroid function, hypothyroidism and the above mentioned factors were analyzed using multiple linear regression analysis. Results: Fifty percent (30/60) of cases were cured after a single-dose treatment, and the remaining 50% required multiple treatments. In addition to thyroid mass and radioactive iodine uptake, total dose correlated with gender (F=4.23, P=0.050), area ratio of bilateral lobes (F=6.20, P=0.020) and multifocal uptake pattern (F=5.12, P=0.033). The number of treatments correlated with ratio of bilateral gray scales (F=8.89, P=0.006) and multifocal uptake pattern (F=4.98, P=0.034). According to outcomes, patients were divided into a normal thyroid function group and a hypothyroidism group. 131I dose correlated with the area ratio of bilateral lobes (F=10.42, P=0.018) and ratio of bilateral gray scales in the normal thyroid function group (F=10.66, P=0.017); whereas in the hypothyroidism group, the clinical outcome correlated with thyroid mass (F=7.65, P=0.013) and multifocal uptake pattern (F=8.01, P=0.011). Conclusions: Computer aided normalization analysis is useful for 131I dose calculation in the treatment of hyperthyroidism. For patients with significantly unbalanced bilateral radiotracer distribution, increasing the dose and the number of treatments should be suggested. For

  5. Comparacao dos criterios RIFLE, AKIN e KDIGO quanto a capacidade de predicao de mortalidade em pacientes graves

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    Talita Machado Levi

    2013-12-01

    Full Text Available Objetivo: A lesão renal aguda é uma complicação comum em pacientes gravemente enfermos, sendo os critérios RIFLE, AKIN e KDIGO utilizados para sua classificação. Esse trabalho teve como objetivo a comparação dos critérios citados quanto à capacidade de predição de mortalidade em pacientes gravemente enfermos. Métodos: Estudo de coorte prospectiva, utilizando como fonte de dados prontuários médicos. Foram incluídos todos os pacientes admitidos na unidade de terapia intensiva. Os critérios de exclusão foram tempo de internamento menor que 24 horas e doença renal crônica dialítica. Os pacientes foram acompanhados até a alta ou óbito Para análise dos dados, foram utilizados os testes t de Student, qui-quadrado, regressão logística multivariada e curva ROC. Resultados: A média de idade foi de 64 anos, com mulheres e afrodescendentes representando maioria. Segundo o RIFLE, a taxa de mortalidade foi de 17,74%, 22,58%, 24,19% e 35,48% para pacientes sem lesão renal aguda e em estágios Risk, Injury e Failure, respectivamente. Quanto ao AKIN, a taxa de mortalidade foi de 17,74%, 29,03%, 12,90% e 40,32% para pacientes sem lesão renal aguda, estágio I, estágio II e estágio III, respectivamente. Considerando o KDIGO 2012, a taxa de mortalidade foi de 17,74%, 29,03%, 11,29% e 41,94% para pacientes sem lesão renal aguda, estágio I, estágio II e estágio III, respectivamente. As três classificações apresentaram resultados de curvas ROC para mortalidade semelhantes. Conclusão: Os critérios RIFLE, AKIN e KDIGO apresentaram-se como boas ferramentas para predição de mortalidade em pacientes graves, não havendo diferença relevante entre os mesmos.

  6. Evaluation of radiotherapy of patients with Graves' disease treated with fixed activities of 555 MBq of Iodine-131

    Energy Technology Data Exchange (ETDEWEB)

    Silva, Jose M.F. da; Filho, Joao A.; Junior, Manoel R. de S.; Mendonca, Keyla M.C., E-mail: josemarcosfs@yahoo.com.br, E-mail: jaf@ufpe.br, E-mail: manoel@de.ufpe.br, E-mail: keylamcm@yahoo.com.br [Universidade Federal de Pernambuco (UFPE), e-mail: Recife, PE (Brazil)

    2013-07-01

    Graves' disease treatment is done by radioiodine therapy (RIT), which destroys cells of the thyroid and reduces the synthesis of T{sub 3} and T{sub 4}; and surgery. In Brazil, applies RIT with fixed activities. Studies show that RIT should be based on individual biokinetics. There is controversy regarding the use of fixed activities or calculated. This study was conducted at the HC-UFPE in the period 2006-2010. Of the overall sample of 132 patients that entered the study, twenty-five of them formed a group chosen to estimate the maximum uptake of {sup 131}I and thyroid mass, to calculate the activity to be administered and the absorbed dose. All the patients were treated with fixed activities of 555 MBq {sup 131}I. Observed that 28% of patients received radioactivities above, 72% received radioactivities below, and nobody received no radioactivity as a real need. The group obtained an average rate of cure of (76 ± 5) % at 24 months of follow up, less than those obtained under the same conditions biokinetics and mean follow-up interval, among many, who have used doses of 250 Gy and 350 Gy and achieved cure rates approximately 90%. Doses received totaled 9,166 Gy, and 6,698 Gy were necessary, therefore were wasted 2,468 Gy. Were risk factors observed: extrapolation of interval of the thyroid function tests of three to six months to one to three years; economic difficulties, interfamily, socio emotional and to perform the tests requested and great distances between homes and hospital; among others; may be limitations that led to the contraposition that higher activities of {sup 131}I promote greater cure rate of GD. Results of univariate analysis - were statistically significant risk factors: female, thyroid mass between 31 g and 60 g and duration of the GD before of RIT > five years (p < 0.05). The factors sex and thyroid mass are consistent with other studies. The results suggest the use of optimized activities based on individual dosimetric parameters and the

  7. Impacto do internamento em unidade de cuidados intensivos na amplitude de movimento de pacientes graves: estudo piloto

    Directory of Open Access Journals (Sweden)

    Balbino Rivail Ventura Nepomuceno Júnior

    2014-03-01

    Full Text Available Objetivo: Aferir a amplitude de movimento articular de pacientes graves durante o internamento numa unidade de cuidados intensivos. Métodos: Estudo prospectivo e longitudinal, realizado em uma unidade de cuidados intensivos de um hospital público da cidade de Salvador (BA, no período de setembro a novembro de 2010. A principal variável avaliada foi a amplitude de movimento articular passiva, por meio da goniometria dos cotovelos, joelhos e tornozelos, no momento da admissão e na alta. Todos os pacientes internados no período foram incluídos, sendo excluídos aqueles com tempo de internamento <72 horas e com reduções da amplitude de movimento articular na admissão. Resultados: A amostra foi composta por 22 indivíduos, com idade média de 53,5±17,6 anos, tempo de internamento na unidade de cuidados intensivos de 13,0±6,0 e de ventilação mecânica de 12,0±6,3 dias. O APACHE II foi 28,5±7,3, sendo que a maioria dos pacientes era independente funcional previamente ao internamento, com índice de Barthel prévio de 88,8±19. As perdas de amplitude de movimento articular foram 11,1±2,1°; 11,0±2,2°; 8,4±1,7°; 9,2±1,6°; 5,8±0,9° e 5,1±1,0°; para cotovelos, joelhos e tornozelos, respectivamente do lado direito e esquerdo (p<0,001. Conclusão: Houve uma tendência de decréscimo nas amplitudes de movimento de grandes articulações, como tornozelo, joelho e cotovelo, durante o internamento em unidade de cuidados intensivos.

  8. Graves眼病的糖皮质激素治疗%Corticosteroids for treatment of Graves' ophthalmopathy

    Institute of Scientific and Technical Information of China (English)

    甘世斌; 毛羽翔; 陈丹云; 陈依彤; 岳书帆

    2014-01-01

    Graves' ophthalmopathy (GO) is an inflammatory eye disease that develops in the orbit in association with autoimmune thyroid disorders.Symptoms include mainly proptosis and extraocular muscle dysfunction due to involvement of both extraocular muscle and orbital fat.Corticosteroid theraphy can relieve GO via both immunomodulation and anti-inflammation.This review focuses on issues of the efficacy,side effects,and indications of corticosteroid therapy given by orally,subconjunctival / retrobulbar injections,versus intravenously.Corticosteroid therapy,when given orally,is more effective than given subconjunctivally,and given intravenously seemed to be the most effective,whereas more side effects in the treatment of GO.GO should be treated as early as possible,especially in patients with active inflammation to prevent the development or progression of GO.Corticosteroid therapy should be made in light of the risk-benefit ratio.%Graves眼病是指自身免疫性甲状腺疾病引起的眼眶炎症,主要累及眼外肌和球后脂肪产生突眼或眼外肌功能障碍.糖皮质激素通过免疫抑制和抗炎作用可使Graves眼病得到不同程度的缓解.本综述比较了口服、局部注射和静脉注射糖皮质激素三种治疗方法的疗效、副作用及用药指征,显示口服用药效果优于局部用药,静脉给药似乎优于口服,但副作用较大.发现Graves眼病需及早治疗,尤其是活动性眼病更需要治疗,防止眼病恶化,治疗时需权衡糖皮质激素的风险与获益.

  9. A comparative study of influential factors correlating with early and late hypothyroidism after 131Ⅰtherapy for Graves' disease

    Institute of Scientific and Technical Information of China (English)

    WANG Ren-fei; TAN Jian; ZHANG Gui-zhi; MENG Zhao-wei; ZHENG Wei

    2010-01-01

    Background 131Ⅰ therapy is recognized as the simplest, safest, least expensive, and most effective treatment, and accepted by more and more patients. However its curative effect is influenced by many factors, therefore there are some difficulties for doctors to establish individual treatment strategy. The aims of this study were to determine the incidence of early and late hypothyroidism after 131Ⅰ treatment for Graves' disease (GD) and to compare their correlation, to observe and analyze the influential factors and to understand the predictabilities of them.Methods Five hundred GD patients (144 males, 356 females; age (41.2±12.3) years) received 131Ⅰ treatment for the first time. The therapeutic procedure was carried out as the following: undergoing 131Ⅰ uptake test to obtain maximum of thyroid uptake value and effective half-life (EHL) time; estimating the thyroid's weight by ultrasonography; determination of thyroid hormones and correlative antibodies; pre-therapy physical examination; thyroid imaging; calculating 131Ⅰtherapeutic dosage; per os uptake of the determined 131Ⅰ dosage; follow-up appraisal of curative effect. The observing parameters included age, gender, thyroid weight, GD duration, condition of onset, state of disease, course of treatment, EHL time, maximum of thyroid uptake value, 131Ⅰ dosage and titer of correlative antibodies. We sorted out the data and used both univariate and multivariate analysis to evaluate them statistically.Results The incidence rates of early and late hypothyroidism were 33.2% and 6.6% respectively after 131Ⅰ treatment and approximately 22.2% cases of late hypothyroidism developed from early hypothyroidism. The influential factors of early hypothyroidism included course of GD, the highest thyroid uptake ratio of 131Ⅰ, EHL time and thyroid microsome antibody (TMAb), etc. A multivariate analysis on late hypothyroidism showed that female patients, with recurrence after anti-thyroid drug treatment and

  10. Association of turnover of goggled-eye due to Graves' disease treated by 131I with the blood levels of TRAb, TGA and TMA%Graves'眼病131I治疗后突眼的转归与TRAb及TGA、TMA的关系

    Institute of Scientific and Technical Information of China (English)

    黄茂政; 孙焕福

    2006-01-01

    目的探讨131I治疗Graves'病后突眼的转归与TRAb及TGA、TMA的关系,为临床治疗Graves'病后突眼提供理论参考.方法选择伴有突眼的Graves'病患者78例进行131I治疗,在治疗后第3、6、12个月进行随访,检测其TRAb及TGA、TMA浓度.结果治疗前TRAb及TGA、TMA水平高者,治疗后眼病获得改善的可能性较大;而治疗前TRAb及TGA、TMA水平低者,治疗后其活性变化不大,眼病的改善也不明显,差异有显著性.结论 TRAb及TGA、TMA水平与突眼的发生和转归关系密切.

  11. Reversão de amaurose por neuropatia óptica em orbitopatia de Graves após descompressão orbitária: relato de caso Reversal of blindness due to Graves' optic neuropathy after orbital decompression: case report

    Directory of Open Access Journals (Sweden)

    Valmor Rios Leme

    2003-12-01

    Full Text Available OBJETIVO: Descrever o caso de uma paciente portadora de orbitopatia de Graves com baixa visual no olho esquerdo há 9 meses e amaurose no direito há 20 dias secundária à neuropatia óptica. MÉTODOS: Foi realizada descompressão orbitária bilateral ínfero-medial por via transconjuntival. RESULTADOS: Após a cirurgia a paciente evoluiu lentamente com melhora progressiva da acuidade visual, obtendo 20/20 em ambos os olhos ao cabo de 10 meses. CONCLUSÕES: A descompressão orbitária é eficaz em restabelecer a visão em casos de amaurose por neuropatia óptica da orbitopatia de Graves com até 20 dias de instalação.PURPOSE: To describe a patient with Graves' orbitopathy who presented with loss of vision of the left eye for 9 months and amaurosis of the right eye for 20 days. METHODS: Bilateral inferomedial transnconjunctival orbital decompression was performed. RESULTS: After orbital decompression, vision slowly improved and ten months after the surgery the vision was normal in both eyes. CONCLUSIONS: Orbital decompression can reestablish optic nerve function at least 20 days after amaurosis.

  12. Implantación y evaluación del análisis de peligros y puntos de control críticos (APPCC en las industrias tinerfeñas productoras de Gofio Implementation and evaluation of critical hazards and check points analysis (CHCPA in gofio-producing industries from Tenerife

    Directory of Open Access Journals (Sweden)

    J. M.ª Caballero Mesa

    2006-04-01

    Full Text Available Objetivo: Implantar de manera satisfactoria el Sistema de Análisis de Peligros y Puntos de Control Críticos. Ámbito: la Isla de Tenerife. Sujetos: 15 industrias. Intervención: se procedió realizando visitas a las fábricas productoras de gofio, con el fin de asesorar a los empresarios y operarios de las mismas, posteriormente se valoró la intervención verificando condiciones higiénico-sanitarias de la industria y la correcta aplicación del Sistema de Autocontrol establecido. Resultados: Después de la intervención de asesoramiento, se observa que determinados parámetros tenidos en cuenta desde el punto de vista higiénico-sanitario se han corregido, como modificar sus instalaciones para adecuarlas a las normativas vigentes o pedir que los proveedores certifiquen las materias primas. En cuanto al proceso de producción del alimento, la intervención fue efectiva para que más de la mitad de las industrias redujeran el tiempo de aquellas fases más susceptibles de contaminación y para que se llevaran a cabo los de registros de control que se establecieron. Conclusiones: Todas las industrias instauraron el sistema de autocontrol mediante cuadros de registros de cada una de las fases de elaboración. El 86% de las industrias han introducido materiales más higiénicos. Un 60% aplicaron una reducción en los plazos de tiempo intermedios en las fases de producción. Un 26% realizaron alguna sustitución de maquinaria obsoleta, modernizando las instalaciones.Objective: To satisfactorily implement the critical hazards and check points analysis. Setting: Tenerife Island Subjects: 15 industries Intervention: visits to gofio-manufacturing industries were done with the aim of giving advice to employers and workers, and thereafter, the intervention was assessed verifying the hygiene and sanitary conditions of the industry and the correct application of the established auto-control system. Results: After the advising intervention, we observed that

  13. Flower and fruit production and insect pollination of the endangered Chilean tree, Gomortega keule in native forest, exotic pine plantation and agricultural environments Producción de flores y frutas y polinización por insectos de Gomortega keule en bosque nativo y en terrenos agrícolas, un árbol chileno en peligro de extinción

    Directory of Open Access Journals (Sweden)

    TONYA A LANDER

    2009-01-01

    Full Text Available This study was undertaken to discover whether patterns of flower and fruit production for Gomortega keule, an endangered Chilean tree, differ between exotic pine plantation, agricultural and native forest environments. A pilot study was also undertaken to identify the primary pollinators of G. keule. Although similar proportions of G. keule trees flowered in the agricultural and native forest áreas, more trees in the agricultural sites produced fruit compared to trees in the native forest sites. Flowering and fruiting of G. keule was extremely rare in the exotic pine plantations. Our data show that G. keule flowers are predominantly visited by syrphid flies in March-April, and that syrphids carry a greater proportion of G. keule pollen than the other insects collected. Native forest and low intensity agricultural systems appear to provide habitat in which syrphids forage and G. keule is able to produce fruit successfully, but exotic pine plantation does not; suggesting that a landscape made up of a mosaic of different landuse types is not necessarily inimical to the continued reproduction of G. keule, but that the combination and types of landuses and intensity of management must be carefully considered.El presente estudio fue realizado con el objetivo de establecer si los patrones de producción de flores y frutos de Gomortega keule (Gomortegaceae, un árbol chileno en peligro de extinción, son diferentes entre áreas de plantaciones de pinos exóticos, terrenos agrícolas y áreas de bosque nativo. También fue llevado a cabo un estudio piloto para identificar los principales polinizadores de G. keule. A pesar de que en tierras agrícolas y en áreas de bosque nativo floreció una proporción similar de árboles de G. keule, en zonas agrícolas fructificó una mayor proporción en comparación con los árboles de áreas de bosque nativo. La floración y fructificación de G. keule fue extremadamente rara en las áreas de plantaciones de

  14. Perfil cognitivo de los pacientes con traumatismo craneoencefálico grave: un estudio a los dos años de evolución

    Directory of Open Access Journals (Sweden)

    Enrique Moraleda-Barreno

    2011-07-01

    Full Text Available Las alteraciones cognitivas de los sujetos con traumatismos craneoencefálicos (TCE han sido estudiadas ampliamente en fase aguda y post-aguda. El objetivo del presente trabajo es obtener el perfil cognitivo de los pacientes con TCE graves a los dos años de evolución. La muestra de estudio estuvo compuesta por 42 sujetos adultos con TCE cerrado grave, a los que se les realizó una evaluación neuropsicológica que abarcó un amplio número de funciones cognitivas. Se comparó la ejecución de los sujetos con las puntuaciones estándar para la población normal. Los resultados mostraron una disminución generalizada de todas las funciones cognitivas evaluadas: inteligencia general, atención, visuopercepción y razonamiento visual, memoria, aprendizaje, funciones verbales, destrezas académicas, visuoconstrucción y funciones ejecutivas. La atención compleja es, con diferencia, la función más afectada. Esto tiene repercusiones importantes en la rehabilitación cognitiva de estos pacientes.

  15. The massacre mass grave of Schöneck-Kilianstädten reveals new insights into collective violence in Early Neolithic Central Europe.

    Science.gov (United States)

    Meyer, Christian; Lohr, Christian; Gronenborn, Detlef; Alt, Kurt W

    2015-09-01

    Conflict and warfare are central but also disputed themes in discussions about the European Neolithic. Although a few recent population studies provide broad overviews, only a very limited number of currently known key sites provide precise insights into moments of extreme and mass violence and their impact on Neolithic societies. The massacre sites of Talheim, Germany, and Asparn/Schletz, Austria, have long been the focal points around which hypotheses concerning a final lethal crisis of the first Central European farmers of the Early Neolithic Linearbandkeramik Culture (LBK) have concentrated. With the recently examined LBK mass grave site of Schöneck-Kilianstädten, Germany, we present new conclusive and indisputable evidence for another massacre, adding new data to the discussion of LBK violence patterns. At least 26 individuals were violently killed by blunt force and arrow injuries before being deposited in a commingled mass grave. Although the absence and possible abduction of younger females has been suggested for other sites previously, a new violence-related pattern was identified here: the intentional and systematic breaking of lower limbs. The abundance of the identified perimortem fractures clearly indicates torture and/or mutilation of the victims. The new evidence presented here for unequivocal lethal violence on a large scale is put into perspective for the Early Neolithic of Central Europe and, in conjunction with previous results, indicates that massacres of entire communities were not isolated occurrences but rather were frequent features of the last phases of the LBK. PMID:26283359

  16. Sanguineous Pericardial Effusion and Cardiac Tamponade in the Setting of Graves' Disease: Report of a Case and Review of Previously Reported Cases

    Science.gov (United States)

    2016-01-01

    Introduction. Pericardial effusion in the setting of hyperthyroidism is rare. We present a patient with Graves' disease who developed a sanguineous pericardial effusion and cardiac tamponade. Case Description. A 76-year-old man presenting with fatigue was diagnosed with Graves' disease and treated with methimazole. Two months later, he was hospitalized for uncontrolled atrial fibrillation. Electrocardiography showed diffuse low voltage and atrial fibrillation with rapid ventricular rate. Chest radiograph revealed an enlarged cardiac silhouette and left-sided pleural effusion. Thyroid stimulating hormone was undetectable, and free thyroxine was elevated. Diltiazem and heparin were started, and methimazole was increased. Transthoracic echocardiography revealed a large pericardial effusion with cardiac tamponade physiology. Pericardiocentesis obtained 1,050 mL of sanguineous fluid. The patient progressed to thyroid storm, treated with propylthiouracil, potassium iodine, hydrocortisone, and cholestyramine. Cultures and cytology of the pericardial fluid were negative. Thyroid hormone markers progressively normalized, and he improved clinically and was discharged. Discussion. We found 10 previously reported cases of pericardial effusions in the setting of hyperthyroidism. Heparin use may have contributed to the sanguineous nature of our patient's pericardial effusion, but other reported cases occurred without anticoagulation. Sanguineous and nonsanguineous pericardial effusions and cardiac tamponade may be due to hyperthyroidism.

  17. Fetal death due to upper airway compromise complicated by thyroid storm in a mother with uncontrolled Graves' disease: a case report

    Directory of Open Access Journals (Sweden)

    Yildizhan Recep

    2009-05-01

    Full Text Available Abstract Introduction We report an unusual case of upper airway compromise complicated by thyroid storm in a pregnant woman with Graves' disease, ending with the in utero death of the fetus. This complication might have developed due to upper airway edema as a result of poorly controlled hyperthyroidism. Case presentation A 41-year-old Turkish woman at 27 weeks' gestation suffering from Graves' disease was referred to our emergency department with a diagnosis of respiratory arrest. She was unconscious and had been intubated. Her laboratory results were compatible with thyrotoxicosis. The patient had suffered from respiratory difficulty for a long time and had stopped using her antithyroid medications after the first trimester of pregnancy. One day before, she had visited an obstetrician because her respiratory distress had increased. At that time, her fetus was still alive. She was given oxygen therapy and then sent home. With a presumptive diagnosis of thyroid storm, she was admitted to the intensive care unit and treated with aggressive medical therapy. The baby was found to be no longer alive and was delivered vaginally after labor induction. The mother was discharged 10 days later with maintenance therapy. Conclusion Hyperthyroidism during pregnancy warrants very close attention and should almost always be treated with appropriate antithyroid medications. Maternal respiratory distress in such patients can be an early sign of impending upper airway compromise and thyroid storm, which can endanger the mother and fetus unless prompt and aggressive therapy is initiated.

  18. Bilateral cortical atrophy after severe brain trauma and extradural homatoma Atrofia cortical bilateral após traumatismo cranioencefálico grave e hematoma extradural

    Directory of Open Access Journals (Sweden)

    Paulo Roberto Louzada

    2007-12-01

    Full Text Available We report the case of a severe head injured 43-year old male patient with a large extradural hematoma, Glasgow Coma Scale 3 and dilated fixed pupils. Patient was promptly submitted to surgical evacuation of the lesion, but remained in persistent vegetative state in the post-operative time. Head computed tomography scans performed before surgery, and at early and late post-operative periods comparatively revealed extreme bilateral cortical atrophy. Late consequences of severe head trauma drastically affect the prognosis of patients, being its prevention, and neuroprotection against secondary injury still a therapeutical challenge for neurosurgeons.Relatamos o caso de um paciente de 43 anos, com traumatismo cranioencefálico grave, com grande hematoma extradural, Escala de Coma de Glasgow 3 e pupilas fixas e dilatadas. O paciente foi prontamente submetido à evacuação cirúrgica da lesão mas permaneceu em estado vegetativo persistente no período pós-operatório. As TC de crânio realizadas antes da cirurgia e nos períodos pós-operatórios precoce e tardio revelaram comparativamente extrema atrofia cerebral bilateral. As conseqüências tardias do traumatismo craniano grave afetam drasticamente o prognóstico dos pacientes, sendo sua prevenção, e a neuroproteção contra a injúria secundária ainda um desafio terapêutico para os neurocirurgiões.

  19. Grave complicação do tratamento de epistaxe: relato de caso Severe complication in the treatment of epistaxis: a case report

    Directory of Open Access Journals (Sweden)

    Carlos Z. Arbulú

    2004-01-01

    Full Text Available Epistaxe é uma afecção muito comum, sendo geralmente autolimitada ou tratada com medidas mais conservadoras como compressão local, compressas frias, controle da pressão arterial, cauterização sob anestesia local (química ou termo-elétrica ou tamponamento nasal anterior. Contudo, podem se apresentar como quadros graves e de difícil tratamento, sendo necessárias medidas mais agressivas como tamponamento nasal antero-posterior, ligadura arterial cirúrgica ou embolização. Apresentamos o caso de um paciente de 49 anos de idade que cursou com epistaxe de difícil controle e evoluiu com uma grave complicação relacionada ao tratamento realizado em outro serviço.Epistaxis is a very usual disorder, it is usually self-restricted or controlled with conservative measures as local compression, cold gauze, arterial pressure control, cauterization under local anesthesia (chemical or thermoelectric or anterior nasal packing. However, it could be presented as severe cases, and more aggressive measures could be necessary, like posterior nasal packing, arterial ligation or embolization. We present one case of a forty-nine-year-old patient with epistaxis who developed a severe treatment complication from another department.

  20. Perfil epidemiológico e evolução clínica pós-parto na pré-eclâmpsia grave Epidemiological profile and postpartum outcome in severe preeclampsia

    OpenAIRE

    Brena Carvalho Pinto de Melo; Melania Maria Ramos Amorim; Leila Katz; Isabela Coutinho; Giselly Veríssimo

    2009-01-01

    OBJETIVOS: Descrever o perfil epidemiológico e o comportamento dos níveis tensionais no puerpério de mulheres admitidas durante a gravidez com pré-eclâmpsia grave. MÉTODOS: Realizou-se uma análise secundária de um estudo de coorte, com gestantes acima de 28 semanas de gestação, com diagnóstico de pré-eclâmpsia grave, sem trabalho de parto, admitidas na maternidade do Instituto Materno-Infantil Prof. Fernando Figueira (IMIP), entre novembro de 2006 e setembro de 2007. Pacientes com hipertensão...