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Sample records for digestiva aguda grave

  1. Pancreatitis aguda grave asociada a gangrena vesicular

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    Arroyo-Sánchez, Abel S; Aguirre-Mejía, Rosa Y; Echenique-Martínez, Sergio E

    2014-01-01

    Se presenta el caso un paciente diabético que desarrolló un cuadro de pancreatitis aguda grave asociada a gangrena vesicular, en el que se evaluó la aplicabilidad de los criterios de clasificación y manejo de la hoja de ruta para pancreatitis aguda, así mismo se proponen algunos tópicos que pudieran ser investigados a futuro We present a diabetic patient who developed severe acute pancreatitis associated to gallbladder gangrene, in this case we assessed the applicability of classification ...

  2. Resultados do tratamento da pancreatite aguda grave

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    Franz Robert Apodaca-Torrez

    Full Text Available OBJETIVO: Avaliar os resultados do Protocolo de Atendimento de pacientes com diagnóstico de pancreatite aguda grave. MÉTODOS: Foram analisados, consecutivamente, a partir de janeiro de 2002, idade, sexo, etiologia, tempo de internação, tipo de tratamento e mortalidade de 37 pacientes portadores de pancreatite aguda grave. RESULTADOS: A idade dos pacientes variou de 20 a 88 anos (média de 50 anos; 27% foram do sexo feminino e 73% do masculino. O tempo médio global de internação foi 47 dias. Treze pacientes foram tratados cirurgicamente; a média de operações realizadas foi duas por paciente. Ocorreram seis óbitos dentre os pacientes submetidos ao tratamento cirúrgico (46% e dois óbitos no grupo submetido somente ao tratamento clínico (8,3%. A mortalidade global foi 21% CONCLUSÃO: Após a modificação na forma de abordagem dos pacientes com pancreatite aguda grave, houve diminuição da mortalidade e uma tendência para a conduta expectante.

  3. O mosaico patogênico da pancreatite aguda grave

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    Márcio Cavalcante Carneiro

    Full Text Available A pancreatite aguda tem sido alvo de grandes discussões que vão desde o entendimento de sua fisiopatologia até a investigação de novas modalidades terapêuticas. Reconhece-se que a necrose pancreática e a falência orgânica múltipla - mormente associadas à infecção - representam os principais fatores determinantes da evolução para o óbito, mas, apesar dos grandes avanços em seu estudo, a doença permanece como um desafio para o clínico e o cirurgião. Deste modo, um melhor conhecimento dos mecanismos envolvidos em sua fisiopatologia pode ser a chave para um tratamento mais eficaz, principalmente em relação às formas graves, cuja letalidade ainda encontra-se substancialmente elevada. Baseado nestas considerações, o presente trabalho tem por objetivo a revisão bibliográfica da fisiopatologia, dos fatores patogênicos envolvidos na história natural da pancreatite aguda grave e dos eventos associados à síndrome da resposta inflamatória sistêmica e à sepse, esboçando-se assim o mosaico patogênico desta importante condição.

  4. Efeito da hipertermia na pancreatite aguda grave experimental

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    Maurício Gustavo Ieri Yamanari

    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.

  5. Cambios en la etiología, resultados y características de los pacientes con hemorragia digestiva aguda grave a lo largo del periodo 1999-2005 Changes in the etiology, outcome, and characteristics of patients with acute gastrointestinal bleeding between 1999 and 2005

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    A. Garrido

    2007-05-01

    Full Text Available Objetivos: analizar la evolución, a lo largo del periodo 1999-2005, de las siguientes variables de los pacientes ingresados por hemorragia digestiva (HD en una Unidad de Sangrantes: etiología, patología de base, consumo de AINE/anticoagulación y mortalidad. Material y métodos: durante el periodo 1999-2005 se ha estudiado la evolución de las siguientes causas de HD que requirieron ingreso en la Unidad de Sangrantes: ulcus duodenal (UD, ulcus gástrico (UG, hipertensión portal (HPT y otros. De igual forma se ha analizado la evolución en el porcentaje de enfermos ingresados con patología de base, consumo de fármacos AINE/anticoagulantes y mortalidad. Resultados: se han incluido 1.611 pacientes en el estudio con una edad media de 60,45 años (59,7-61,2, 76,41% hombres (74,3-78,5. La UD fue responsable del 22,20% de episodios (20,2-24,3, la UG del 18,40% (16,6-20,4 y la HPT del 33,60% (31,3-36,0. De forma global realizaban tratamiento con AINE el 34,5% (32,6-37,3, anticoagulación el 7,1% (6,0-8,6, presentaban patología de base el 72,6% (70,4-74,8 y la mortalidad global fue del 6,27% (5,16-7,59. A lo largo del periodo estudiado se constató un aumento de los pacientes con patología de base (p Objectives: to analyze the evolution of the following variables in patients admitted to a Blood Unit for gastrointestinal bleeding throughout 1999-2005: etiology, comorbid diseases, use of NSAIDs/anticoagulants, and mortality. Material and methods: we analyzed the evolution of the following causes of GIB that required admission to the Blood Unit from 1999 to 2005: duodenal ulcer (DU, gastric ulcer (GU, portal hypertension (PHT, and others. We also analyzed changes in the percentage of patients admitted with comorbid disease, use of NSAIDs/anticoagulants, and mortality. Results: 1,611 patients with a mean age of 60.45 years (59.7-61.2 were included in this study; 76.41% were males (74.3-78.5. DU was the cause of bleeding in 22.20% of cases (20

  6. Intoxicaciones agudas graves en un servicio de medicina intensiva durante doce años

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    César Palazón Sánchez

    2000-01-01

    Full Text Available Conocer 12 epidemiología de las u~tux~- aciones agudas graves en un servicio de medicina intensiva y evaluar el pronóstico de la PCR y mortalidad asociada a los distintos tóxicos.

  7. Intoxicaciones agudas graves en un servicio de medicina intensiva durante doce años

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    Palazón Sánchez C

    2000-01-01

    Full Text Available Fundamento: Conocer la epidemiología de las intoxicaciones agudas graves en un servicio de medicina intensiva y evaluar el pronóstico de la PCR y mortalidad asociada a los distintos tóxicos Métodos: Estudio retrospectivo realizado en el servicio de medicina intensiva polivalente de 10 camas, ubicado en un Hospital General de adultos. Período de estudio 12 años. Revisión de las historias clínicas de las personas ingresadas en el servicio de medicina intensiva por intoxicaciones agudas graves. Se recogieron datos demográficos, existencia de PCR al ingreso, necesidad de VM, complicaciones de las intoxicaciones agudas graves y mortalidad de la serie. Se realizó un análisis global y por año de estudio. El tratamiento estadístico de los datos se realizó con el paquete SPSS mediante la "t" de Student o la "chi" cuadrado, considerando valores significativos si p<0,05 Resultados: Se han incluido 233 sujetos, de los que 130 fueron varones. La estancia media fue de 4 días. El 63% de los pacientes fueron menores de 40 años (p<0,05. La intoxicación más frecuente fue la medicamentosa debida a un solo producto (72%. La supervivencia tras la PCR fue del 40% (4/10. La mortalidad global se situó en el 5,6% (n=13, habiendo precisado el 92% de los sujetos que posteriormente murieron, VM en algún momento de su ingreso en la unidad de cuidados intensivos. Conclusiones: En nuestro medio, la intoxicación más frecuente es la medicamentosa. La mortalidad se muestra dependiente del carácter de voluntariedad, pero independiente del tipo de tóxico (medicamentoso o no. La PCR asociada a las intoxicaciones agudas graves tiene, en nuestra serie, un mejor pronostico que la asociada a otras patologías. La VM asociada a las intoxicaciones agudas graves tiene una mortalidad baja (15,7%

  8. Nutritional support in patients with severe acute pancreatitis Soporte nutricional en pacientes con pancreatitis aguda grave

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    Mónica Marcela Peláez Hernández

    2007-04-01

    Full Text Available Severe acute pancreatitis is associated with a systemic inflammatory response leading to a hypermetabolic, hypercatabolic condition; for those reasons, patients suffering from this disease require an excellent artificial nutritional support in order to maintain the structural integrity and the function of vital organs with minimal pancreatic secretion. Total parenteral nutrition has been the standard practice in the treatment of patients with severe acute pancreatitis because of the favorable outcomes of early nutritional support while avoiding pancreatic stimulation; however, recent evidence suggests there are potentially greater benefits with enteral as compared with parenteral nutrition, including fewer septic and metabolic complications and lesser costs. That is why present guidelines for the management of acute pancreatitis recommend that enteral instead of parenteral nutrition be used in patients with severe acute pancreatitis. La pancreatitis aguda, especialmente en su forma grave, está asociada con una respuesta inflamatoria sistémica que lleva a un estado de hipermetabolismo e hipercatabolismo, en el que se requiere un excelente soporte nutricional que permita mantener la integridad estructural y la función de los órganos vitales con un estímulo mínimo de la secreción pancreática. La nutrición parenteral total era el soporte de elección, que permitía obtener todos los beneficios de la nutrición temprana sin estimular la secreción pancreática; pero la evidencia actual muestra mayores beneficios con la nutrición enteral, porque se asocia con menos complicaciones infecciosas y metabólicas y con disminución en los costos. Por ello las guías actuales de tratamiento de la pancreatitis aguda grave recomiendan como primera elección el soporte nutricional enteral.

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

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    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

  10. Insuficiência renal aguda em pacientes com sepse grave: fatores prognósticos = Acute renal injury in patients with severe sepsis: prognostic factors

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    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

  11. Factores de riesgo para infección respiratoria aguda baja grave en Bogotá, 2001.

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    María Belén Jaimes

    2003-09-01

    Full Text Available La gravedad de la infección respiratoria aguda (IRA es mayor en países en desarrollo, sobre todo entre grupos social y económicamente pobres. Las neumonías virales son las más comunes, especialmente en niños. Con el fin de medir algunos factores asociados con formas graves de infección respiratoria baja realizamos un estudio de casos y controles prospectivo y de base hospitalaria en Bogotá entre noviembre de 2000 y agosto de 2001. Los casos fueron niños entre 2 meses y 5 años que llenaban los criterios de la OMS para IRA grave o muy grave. Los controles eran niños con IRA en el mismo rango de edad, que consultaban al mismo hospital y que no presentaban tirajes. Se estudiaron 638 niños entre los 2 meses y los 5 años de edad (277 casos y 361 controles. Los factores más importantes fueron: vivienda en préstamo (OR=2,7; IC95%: 1,06-7,07, compartir la cama (OR=1,88; IC95%: 1,0-3,7, más de 9 personas en la misma casa (OR=1,82; IC95%: 1,0-3,51 y fumadores en la vivienda (OR=1,4; IC95%: 1,0-2,05. Se tomaron 114 muestras nasofaríngeas (niños con 3 días de haber iniciado síntomas y se obtuvieron virus en 98 de ellas, y se identificó el virus sincitial respiratorio en 41,8%, virus influenza A en 3,1% y virus influenza B en 1%. El 100% de los aislamientos positivos para influenza A y B fueron enviados al CDC en Atlanta, donde fueron clasificados como influenza A/PANAMA/2007/99-like e influenza B/SICHUAN/379/99-like, respectivamente.

  12. Uso do sulfato de magnésio venoso para tratamento da asma aguda grave da criança no pronto-socorro

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    Tânia Mara Baraky Bittar

    2012-03-01

    Full Text Available A asma aguda grave é uma emergência médica que deve ser diagnosticada e tratada rapidamente. O tratamento inicial inclui broncodilatadores e corticosteróides sistêmicos. Em casos graves, com fraca resposta ao tratamento padrão, o sulfato de magnésio venoso surge como opção terapêutica. O objetivo deste artigo foi revisar a literatura sobre o uso do sulfato de magnésio venoso na asma aguda em crianças no pronto-socorro no que se refere a eficácia, indicação, dosagem, efeitos adversos e contraindicações. Realizada revisão narrativa por meio das Bases de dados Medline, Lilacs e Cochrane Database of Systmatic Reviews, entre 2000 e 2010. Utilizados os descritores: asthma, children, emergency, magnesium sulfate. Incluídos oito ensaios clínicos controlados, três meta-análises, um estudo retrospectivo, oito artigos de revisão e um estudo transversal. A eficácia do magnésio venoso em crianças foi observada por vários autores, com raros efeitos adversos. Seu uso foi indicado para os pacientes com asma aguda moderada e grave que não responderam ao tratamento inicial com broncodilatador e corticosteróide. As contraindicações em pediatria são poucas. Entre elas estão insuficiência renal e bloqueio atrioventricular. Existem poucos relatos da interação do magnésio com drogas de uso pediátrico. Apesar da segurança, na prática, o magnésio venoso é pouco usado na asma aguda em pediatria. Na maioria das vezes, é indicado tardiamente para impedir falência respiratória e internação na unidade de cuidados intensivos. Os estudos demonstram que o magnésio venoso é uma droga eficaz e segura na criança com asma aguda grave, porém o seu uso no pronto-socorro ainda é limitado.

  13. Changes in the management of patients with severe acute pancreatitis Mudanças no manejo de doentes com pancreatite aguda grave

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    Tercio De Campos

    2008-09-01

    Full Text Available BACKGROUND: Severe acute pancreatitis is present in up to 25% of patients with acute pancreatitis, with considerable mortality. Changes in the management of acute pancreatitis in the last 2 decades contributed to reduce the mortality. AIM: To show the evolution in the management of severe acute pancreatitis, comparing two different approaches. METHODS: All patients with severe acute pancreatitis from 1999 to 2005 were included. We compared the results of a retrospective review from 1999 to 2002 (group A with a prospective protocol, from 2003 to 2005 (group B. In group A severe pancreatitis was defined by the presence of systemic or local complications. In group B the Atlanta criteria were used to define severity. The variables analyzed were: age, gender, etiology, APACHE II, leukocytes, bicarbonate, fluid collections and necrosis on computed tomography, surgical treatment and mortality. RESULTS: Seventy-one patients were classified as severe, 24 in group A and 47 in group B. The mean APACHE II in groups A and B were 10.7 ± 3.5 and 9.3 ± 4.5, respectively. Necrosis was seen in 12 patients (50% in group A and in 21 patients (44.7% in group B. Half of the patients in group A and two (4.3% in group B underwent to pancreatic interventions. Mortality reached 45.8% in group A and 8.5% in group B. CONCLUSION: A specific approach and a prospective protocol can change the results in the treatment of patients with severe acute pancreatitis.RACIONAL: A pancreatite aguda grave está presente em até 25% dos doentes com pancreatite aguda, com mortalidade considerável. Mudanças no tratamento da pancreatite aguda nas últimas duas décadas contribuíram para a redução da mortalidade destes doentes. OBJETIVO: Mostrar a evolução do manejo da pancreatite aguda, comparando duas diferentes abordagens. MÉTODOS: Todos os doentes com pancreatite aguda grave de 1999 a 2005 do Serviço de Emergência da Santa Casa de São Paulo, SP, foram incluídos. Os

  14. Caracterización epidemiológica de la infección respiratoria aguda grave y circulación viral en Boyacá, julio de 2012 a julio de 2013

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    García García, Constanza Marcela

    2014-01-01

    Objetivo. Caracterizar clínica y epidemiológicamente la Infección respiratoria aguda grave y circulación viral en Boyacá a partir de la vigilancia centinela entre Julio de 2012 y Julio de 2013. Metodología. Estudio descriptivo a partir de información del Sistema de Vigilancia en Salud Pública. La población estuvo conformada por 530 casos con muestra de hisopado nasofaríngeo de las Instituciones centinela en Tunja, las muestras se procesaron por inmunofluorescencia indirecta ...

  15. Estudo comparativo, prospectivo e randomizado do resultado de duas formas de tratamento clínico das lesões ligamentares primárias agudas e graves do tornozelo

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    Marcelo Pires Prado

    2013-01-01

    Objetivo: Este trabalho tem como objetivo a avaliação dos resultados funcionais, e da incidência da instabilidade articular mecânica, resultantes do tratamento clínico das lesões ligamentares primárias, agudas e graves do tornozelo (associada a instabilidade articular). Esta lesão é extremamente frequente e acomete indivíduos jovens, economicamente e fisicamente ativos, causando prejuízos pessoais e econômicos importantes. Existe dificuldade no adequado diagnóstico e heterogeneidade na escolh...

  16. Inhibition of cyclooxygenase-2 in experimental severe acute pancreatitis Inibição da Ciclo-Oxigenase-2 na pancreatite aguda grave experimental

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    José Luiz Jesus de Almeida

    2006-08-01

    Full Text Available BACKGROUND: The standard treatment for acute pancreatitis (AP is still based on supportive care. The search for a new drug that could change the natural history of the disease is a continuing challenge for many researchers. The aim of this study is to evaluate the effect of a cyclooxygenase-2 (COX-2 inhibitor on experimental AP in rats. METHODS: The animals were divided into 2 groups: Group 1 (n = 30-animals with taurocholate-induced AP treated with parecoxib (40 mg/kg. Group 2 (n = 30-animals with taurocholate-induced AP that received saline. The COX-2 inhibitor (parecoxib was injected immediately after AP induction, through the penis dorsal vein. The parameters evaluated were histology, serum levels of amylase, IL-6 and IL-10, and mortality rate. RESULTS: The serum levels of IL-6 and IL-10 in the parecoxib-treated group were lower than the control group. The amylase serum levels and the mortality rate remained unchanged in the treated animals. Histologic morphology also was unaltered, except for fat necrosis, which was higher in parecoxib-treated rats. CONCLUSION: Inhibition of Cox-2 decreases the systemic release of inflammatory cytokines, but has a poor effect on the direct pancreas injury caused by taurocholate.INTRODUÇÃO: O tratamento padrão para a pancreatite aguda permanece baseado em medidas de suporte. A busca por uma droga que altere a história natural da doença ainda é um desafio para muitos pesquisadores. O objetivo deste estudo é avaliar o efeito de um inibidor da COX-2 na pancreatite aguda grave experimental (PA em ratos. MÉTODO: Os animais foram divididos em dois Grupos: Grupo 1 (n=30 - animais com PA induzida por taurocolato e tratados com parecoxib (40mg/Kg. Grupo 2 (n=30 - animais com PA induzida por taurocolato que receberam solução salina. O inibidor de COX-2 (parecoxib foi injetado imediatamente após a indução, através da veia dorsal do pênis. Os parâmetros avaliados foram histologia, níveis séricos de

  17. Parenteral nutrition versus enteral nutrition in severe acute pancreatitis Nutrição parenteral versus enteral em pacientes com pancreatite aguda grave

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    Josiel Paiva Vieira

    2010-10-01

    Full Text Available PURPOSE: To compare the effect of parenteral versus enteral nutritional support in severe acute pancreatitis, with respect to efficacy, safety, morbidity, mortality and length of hospitalization. METHODS: The study was comprised of 31 patients, divided into a parenteral group (n=16 and an enteral group (n=15, who met severity criteria for abdominal tomography (Balthazar classes C, D, and E. The patients were compared by demographics, disease etiology, antibiotic prophylaxis, use or not of somatostatin, nutritional support, complications and disease progression. RESULTS: There was no statistical difference in the average duration of nutritional support, somatostatin, or antibiotics in the two groups. Imipenem was the drug of choice for prophylaxis of pancreatic infections in both groups. More complications occurred in the parenteral group, although the difference was not statistically significant (p=0.10. Infectious complications, such as catheter sepsis and infections of the pancreatic tissue, were significantly more frequent in the parenteral group (p=0.006. There was no difference in average length of hospitalization in the two groups. There were three deaths in the parenteral group and none in the enteral group. CONCLUSION: Enteral nutritional support is associated with fewer septic complications compared to parenteral nutritional support.OBJETIVO: Comparar o efeito do suporte nutricional parenteral versus enteral, em pancreatite aguda grave, com relação à eficácia, à segurança, à morbi-mortalidade e ao tempo de internação. MÉTODOS: Foram estudados 31 pacientes distribuídos em grupo parenteral (n=16, no período de 1995 a 1998 e grupo enteral (n=15, no período de 1999 a 2002, que preencheram os critérios de gravidade pela tomografia de abdome (Balthazar C,D,E. Os pacientes foram comparados quanto aos dados demográficos, etiologia, antibioticoprofilaxia, somatostatina, suporte nutricional, complicações e evolução. RESULTADOS

  18. Ventilação mecânica não invasiva na crise de asma aguda grave em crianças: níveis de evidências

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    Paula de Souza Silva

    2015-12-01

    Full Text Available RESUMO Objetivo: Avaliar a qualidade das evidências existentes para embasar diretrizes do emprego da ventilação mecânica não invasiva no manejo da crise de asma aguda grave em crianças não responsivas ao tratamento padrão. Métodos: Busca, seleção e análise de todos os artigos originais sobre asma e ventilação mecânica não invasiva em crianças, publicados até 1º de setembro de 2014, em todos os idiomas, nas bases de dados eletrônicas PubMed, Web of Science, Cochrane Library, Scopus e SciELO, encontrados por meio de busca pelos descritores "asthma", "status asthmaticus", "noninvasive ventilation", "bronchospasm", "continuous positive airway pressure", "child", "infant", "pediatrics", "hypercapnia", "respiratory failure", e das palavras-chave "BIPAP", "CPAP", "bilevel", "acute asthma" e "near fatal asthma". Os artigos foram qualificados segundo os graus de evidências do Sistema GRADE. Resultados: Foram obtidos apenas nove artigos originais. Destes, dois (22% apresentaram nível de evidência A, um (11% apresentou nível de evidência B e seis (67% apresentaram nível de evidência C. Conclusão: Sugere-se que o emprego da ventilação mecânica não invasiva na crise de asma aguda grave em crianças não responsivas ao tratamento padrão é aplicável à maioria desses pacientes, mas as evidências não podem ser consideradas conclusivas, uma vez que pesquisa adicional de alta qualidade provavelmente tenha um impacto modificador na estimativa de efeito.

  19. Lesão renal aguda séptica versus não séptica em pacientes graves: características e desfechos clínicos

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    Marília Galvão Cruz

    2014-12-01

    Full Text Available Objetivo: Descrever e comparar as características e os desfechos clínicos de pacientes com lesão renal aguda séptica e não séptica. Métodos: Coorte aberta com 117 pacientes graves com lesão renal aguda consecutivamente admitidos em unidade de terapia intensiva, sendo excluídos aqueles que apresentavam doença renal crônica em estágio avançado, transplante renal, internação ou morte em um período inferior a 24 horas. Presença de sepse e óbito intra-hospitalar representaram, respectivamente, a exposição e o desfecho principal. Análise de confundimento foi realizada com a regressão logística. Resultados: Não houve diferenças na média de idade entre os grupos com lesão renal aguda séptica e não séptica [65,30±(21,27 anos versus 66,35±12,82 anos; p=0,75]. Nos dois grupos, similarmente, observou-se predomínio do sexo feminino (57,4% versus 52,4%; p=0,49 e de afrodescendentes (81,5% versus 76,2%; p=0,49. Os pacientes com sepse apresentaram maiores médias de escore Acute Physiology and Chronic Health Evaluation II [21,73±7,26 versus 15,75± (5,98; p18,5 (OR: 9,77; IC95%: 3,73-25,58 foram associados ao óbito. Conclusão: Sepse foi um preditor independente para óbito. Existem diferenças entre as características e desfechos clínicos dos pacientes com lesão renal aguda séptica versus não séptica.

  20. Tratamento de grave hemorragia digestiva baixa sem uso de sangue em paciente dependente de hemodiálise: relato de casodoi: 10.20513/2447-6595.2016v56n2p51-53

    Directory of Open Access Journals (Sweden)

    Walberto Monteiro Neiva Eulálio Filho

    2016-12-01

    Full Text Available Trata-se de um relato de caso de uma paciente Testemunha de Jeová, feminina, 66 anos, com insuficiência renal crônica dialítica, apresentou episódio de grave enterorragia e choque hemorrágico. Como a paciente recusara transfusões de sangue foram adotadas condutas alternativas para estabilização hemodinâmica. Devido a sucessivas hemodiálises apresentou queda dos níveis de hemoglobina de 7,3 g/dl no pós-operatório imediato (POI para o valor mínimo atingido de 3,9 g/dl no 11º dia pós-operatório. Permaneceu internada recebendo altas doses de eritropoietina, ferro, vitamina B12 e ácido fólico até que os níveis de hemoglobina se reestabelecessem.

  1. Consideraciones éticas ante el paciente con hemorragia digestiva alta Ethical considerations regarding the patient with upper digestive bleeding

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    Martha Esther Larrea Fabra

    2009-03-01

    Full Text Available Se hace un análisis de la actuación que debe tener el personal de la salud ante una enfermedad aguda, como es el caso de la hemorragia digestiva, y de la repercusión que ésta tiene en las esferas física y psíquica del paciente y de sus familiares, así como de las alteraciones que puede ocasionar en la relación del hombre con su comunidad. Las consideraciones éticas sustentadas en la medicina basada en evidencias son de suma importancia para lograr la recuperación de estos pacientes graves y la mejor opción para que el enfermo recupere su salud de forma integral. Se hacen reflexiones respecto a los conceptos que sobre la ética médica han sido considerados y respecto a aquellos sobre los que se basa nuestra sociedad actual.An analysis is made of the way the health personal should act in the presence of an acute disease, such as digestive hemorrhage, of its impact on the physical and psychical spheres of the patients and their relatives, as well as of the disorders it may cause in the man-community relationship. The ethical considerations sustained on evidence-based medicine are very important to attain the recovery of these severe patients and they are the best option for the comprehensive recuperation of the patient's health. Reflections are made on the concepts of medical ethics that have been considered so far and on those on which our current society is based.

  2. Inalação contínua com fenoterol na criança com asma aguda grave: efeitos clínicos imediatos Continuous fenoterol inhalation by children with severe acute asthma: immediate clinical effects

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    Lourdes Z. Zanoni

    2002-09-01

    Full Text Available Objetivos: avaliar as alterações da freqüência cardíaca, da pressão arterial, do psiquismo e da saturação arterial de oxigênio, após a inalação contínua com fenoterol, na criança com asma aguda grave. Casuística e Métodos: foram estudados 30 pacientes com asma aguda grave, atendidos no PAM-Pediatria do Hospital Universitário - UFMS. Os pacientes receberam inalação contínua durante uma hora, com 0,5 mg/kg (2 gotas/kg de fenoterol. O psiquismo, a saturação arterial de oxigênio, a freqüência cardíaca e a pressão arterial foram avaliados antes, imediatamente após, e uma hora após a inalação com fenoterol. Resultados: 17 crianças eram do sexo masculino (56,6%, e 13 do sexo feminino (43,4%. Foi observado sonolência em 16 (53,3%, agitação psicomotora em 1 (3,3%, náusea e vômito em 12 pacientes (40%. A média da saturação arterial de oxigênio aumentou de 90,9 2,8% para 92,7 2,5% (pObjective: to evaluate the alterations of heart rate, blood pressure, psychological aspects and oxygen saturation after continuous fenoterol inhalation (0.5 mg/Kg by children with severe acute asthma. Methods: we studied 30 patients with severe acute asthma who were treated at the pediatric ward of Hospital Universitário - UFMS. The patients inhaled 0.5 mg/Kg of fenoterol (two drops/Kg during one hour. Psychological aspects, oxygen arterial saturation, heart rate and blood pressure were evaluated at three different moments: before, after and one hour after the fenoterol inhalation. Results: there were 17 males (56.6% and 13 females (43.4%. Sleepiness was observed in 16 (53.3%, psychomotor agitation in one (33% and nausea and vomiting in 12 patients (40%. The average of oxygen arterial saturation increased from 90.9 ± 2.8% to 92.7 ± 2.5% (P<0.05 after inhalation. There was statistically significant increase in the average heart rate before and after inhalation (139.5 ± 13.5 beats/min, 166.5 ± 11.1 beats/min, respectively, P<0.05. A

  3. O nefrologista como consultor ante a intoxicação aguda: epidemiologia das intoxicações graves no Rio Grande do Sul e métodos de aumento da depuração renal

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    José Alberto Rodrigues Pedroso

    2010-12-01

    Full Text Available Intoxicações acidentais e intencionais constituem- se em fonte significativa de morbimortalidade. Em emergências ou UTIs, frequentemente o Nefrologista é chamado como consultor para auxiliar na indicação de medidas de aumento da depuração renal de agentes tóxicos. Revisamos o emprego de diálise nas intoxicações agudas por medicamentos ou pesticidas, cujo suporte especializado toxicológico foi realizado por telefone pelo Centro de Informação Toxicológica do Rio Grande do Sul (CIT-RS. Avaliamos a correlação entre necessidade de diálise e óbitos em coorte retrospectivo (1998- 2000. Dos 36.055 atendimentos, 337 foram identificados como graves, 245 preenchendo os critérios de inclusão exigidos. A idade média foi 30 ± 18 anos; 53% mulheres. Medicamentos frequentemente envolvidos foram anticonvulsivantes e antidepressivos, entre outros; quanto aos pesticidas, organofosforados, bipiridílicos e glifosato. Métodos de aumento da eliminação incluíram alcalinização urinária (n = 37 e métodos dialíticos. Diálise entre intoxicações severas ocorreu em 4,5% (n = 11, 3,67 procedimentos/ano (1/22,7 relatos de casos severos. No grupo que dialisou, em 91%, a circunstância foi tentativa de suicídio (principalmente fenobarbital e paraquat. Dois casos requereram hemoperfusão (cloranfenicol e paraquat. Óbitos entre pacientes graves não submetidos a diálise ocorreram em 25,6%, versus 36,3% entre dialisados (RR = 0,89; IC 95% = 0,54-1,35. Os achados podem ser explicados pelo poder estatístico associado ao número de procedimentos realizados. O Nefrologista deve estar atento para situações que requerem o emprego de medidas dialíticas, ainda que não necessariamente para substituição renal, mas para aumento da depuração do agente tóxico.

  4. Apendicitis Aguda

    OpenAIRE

    Jorge Fallas González

    2012-01-01

    La apendicitis aguda, descrita desde 1886, es la emergencia quirúrgica más común. Tiene su mayor incidencia durante la adultez joven y su menor incidencia en niños y adultos mayores. Su diagnóstico se basa en una historia clínica completa, un examen físico bien orientado y en una adecuada interpretación de los exámenes de laboratorio y gabinete. A pesar de ser una entidad de resolución quirúrgica, su tratamiento engloba diferentes aspectos médicosAcute appendicitis, described since 1886, is t...

  5. Nutrición enteral total vs. nutrición parenteral total en pacientes con pancreatitis aguda grave Total enteral nutrition vs. total parenteral nutrition in patients with severe acute pancreatitis

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    M. Casas

    2007-05-01

    Full Text Available Objetivo: comparar la eficacia de la instauración precoz de nutrición enteral total (NET frente a nutrición parenteral total (NPT en pacientes con pancreatitis aguda grave (PAG. Métodos: estudio prospectivo aleatorio. Se incluyeron consecutivamente 22 pacientes con PAG aplicando los criterios APACHE II, valores de PCR y graduación de Balthazar en la TC. El grupo I (n = 11 recibió NPT y el grupo II (n = 12 NET. Se valoró la respuesta inflamatoria (PCR, TNF-alfa, IL-6, las proteínas viscerales (pre-albúmina, albúmina, la tasa de complicaciones (síndrome de respuesta inflamatoria sistémica, fallo multiorgánico, infecciones, las intervenciones quirúrgicas, la estancia hospitalaria y la mortalidad. Resultados: no hubo diferencias significativas en los primeros 10 días entre los dos grupos en la evolución de los criterios APACHE II, en las concentraciones de PCR, TNF-alfa e IL-6 ni tampoco en los valores de pre-albúmina y albúmina. Siete pacientes del grupo I presentaron complicaciones graves frente a 4 del grupo II. Requirieron intervención quirúrgica 3 pacientes del grupo I. La estancia hospitalaria fue similar en los dos grupos. Dos pacientes del grupo I fallecieron. Conclusiones: se ha observado una tendencia a una mejor evolución de los pacientes con PAG que utilizaron NET frente a los que utilizaron NPT.Objective: to compare the efficacy of early total enteral nutrition (TEN vs. total parenteral nutrition (TPN in patients with severe acute pancreatitis (SAP. Methods: a total of 22 consecutive patients with SAP were randomized to receive TPN (group I or TEN (group II. SAP was defined applying APACHE II score, C-reactive protein (CRP measurements and/or Balthazar CT scan score. Acute inflammatory response (CRP, TNF-alpha, IL-6, visceral proteins (pre-albumin, albumin, complications (systemic inflammatory response syndrome, multiorgan failure, infections, surgical interventions, length of hospital stay and mortality were

  6. Esofagitis necrotizante aguda: Una entidad inusual

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    Silvana E. Pramparo

    2010-12-01

    Full Text Available La esofagitis necrotizante aguda (ENA, también denominada esófago negro, es una rara enfermedad poco descripta en la literatura médica. Describimos el caso de un hombre de 80 años, con hemorragia digestiva alta quien desarrolló un esófago negro luego de un episodio de hipotensión. La necrosis fue confirmada histológicamente. Los pacientes se presentan con hematemesis y melena en más del 70% de los casos. Los hallazgos endoscópicos muestran una coloración negruzca de la mucosa esofágica. El diagnóstico se realiza con endoscopia y confirmación histológica. La mortalidad es alta (más del 50% aunque relacionada a las enfermedades de base del paciente. Por último, podemos decir que la sospecha es muy importante en el diagnóstico de ENA, particularmente en pacientes ancianos con enfermedades asociadas y evidencia de hemorragia digestiva alta. En este trabajo describimos las características clínicas, endoscópicas e histopatológicas de un paciente con ENA.

  7. Infección por metapneumovirus humano en niños hospitalizados por una enfermedad respiratoria aguda grave: Descripción clínico- epidemiológica A human metapneumovirus infection in hospitalized infant patients with severe acute respiratory tract infection: A clinical and epidemiological view

    OpenAIRE

    JAIME LOZANO C; LETICIA YÁÑEZ P; MICHELANGELO LAPADULA A; MÓNICA LAFOURCADE R; FELIPE BURGOS F; LUIS HERRADA H; ISOLDA BUDNIK O

    2009-01-01

    El metapneumovirus humano (hMPV) es un virus de reciente diagnóstico. Se asocia con infecciones respiratorias agudas altas y bajas (IRAb). Se efectuó un estudio prospectivo durante dos años con el objetivo de evaluar la tasa de circulación y los hallazgos clínicos asociados a la infección por hMPV en niños hospitalizados por una IRAb grave. Resultados: hMPV fue demostrado en 24 (10,5%) de los 229 niños enrolados. 42% de los pacientes con hMPV eran menores de 12 meses de edad y el 58% tenía al...

  8. Diarréia aguda grave associada à Escherichia coli enteropatogênica clássica (EPEC: características clínicas e perdas fecais em lactentes hospitalizados Severe acute diarrhea associated to classic enteropathogenic by clinical features and fecal losses in hospitalized infants

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    C.A.G. Oliva

    1997-12-01

    Full Text Available Escherichia coli enteropatogênica clássica (EPEC tem sido o agente enteropatogênico mais freqüentemente isolado nas fezes de lactentes, de baixo nível socioeconômico, hospitalizados com diarréia aguda grave, na cidade de São Paulo. OBJETIVOS. 1 Analisar as características clínicas de lactentes do sexo masculino, hospitalizados com diarréia aguda grave associada à EPEC; 2 quantificar suas perdas fluidas fecais, ingestão de fórmulas alimentares e variações de peso corporal durante a evolução intra-hospitalar. CASUÍSTICA E MÉTODOS. Estudaram-se 38 lactentes do sexo masculino. Foram avaliadas as características clínicas e epidemiológicas dos pacientes e a freqüência dos diferentes sorogrupos de EPEC identificados. As crianças foram mantidas em cama metabólica, e balanços metabólicos diários foram obtidos durante toda a duração do quadro diarréico. Os lactentes permaneceram, em média, 5,8 dias em estudo metabólico. Duzentos e vinte balanços diários foram acumulados e analisados. RESULTADOS. O grupo estudado apresentou como principais características clínicas: idade inferior a 12 meses, peso insuficiente ao nascer; desmame precoce e formas graves de desnutrição protéico-calórica. O sorogrupo O111 foi o mais freqüentemente identificado (68,4%, sendo a idade dos pacientes com tal agente significativamente maior que a dos portadores do sorogrupo O55. A média dos volumes fecais diários foi de 66mL/kg/dia, havendo diferenças segundo dias de estudo. A média de ingestão diária de fórmulas alimentares foi de 85,2mL/kg/dia. Leite de vaca foi a dieta mais precocemente utilizada e as crianças que dela fizeram uso apresentaram volumes fecais maiores que os que receberam caseinato ou nutrição parenteral e incremento de peso corporal menor que os que utilizaram hidrolisado protéico ou NPT. CONCLUSÕES. Os sorogrupos de EPEC acarretaram perdas fluidas fecais de moderada e grave intensidade nos lactentes

  9. Lesiones bucales relacionadas con las enfermedades digestivas

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    José A. Pacho Saavedra

    2006-09-01

    Full Text Available Muchas de las lesiones de la mucosa en la cavidad bucal están relacionadas con trastornos anatómicos y funcionales de los órganos del aparato digestivo; algunas forman parte del cuadro clínico de la entidad y otras aparecen como complicaciones de estas. Generalmente son de orígenes inmunológicos, nutricionales o carenciales. Estas lesiones son difíciles de tratar, por lo que es importante conocer las características clínicas que faciliten una adecuada interpretación y al mismo tiempo ofrecer una conducta terapéutica correcta. Se presenta una revisión actualizada de las características semiológicas de las lesiones bucales que forman parte del cuadro clínico de diversas enfermedades digestivas, con el fin de que los médicos generales, clínicos, estomatólogos y gastroenterólogos puedan diagnosticarlas y brindar mejor orientación y tratamiento a los pacientes.Many of the lesions of the mucosa in the oral cavity are related to anatomical and functional disorders of the organs of the digestive system. Some of them are part of the clinical picture of the entity and others appear as complications of them. Generally, they have an immunological, nutritional, or deficiency origin. These lesions are difficult to be treated and that's why it is important to know the clinical characteristics making easy an adequate interpretation, and to follow a suitable therapeutic conduct at the same time. An updated review of the semiological features of the oral lesions corresponding to the clinical picture of diverse digestive diseases is presented, so that the general physicians, clinicians, stomatologists and gastroenterologists be able to diagnose and give a better guidance and treatment to the patients.

  10. Hemorragia digestiva alta secundária a hamartoma de glândulas de Brunner: relato de caso e revisão da literatura = Upper gastrintestinal bleeding due to Brunner’s gland hamartoma: case report and literature review

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    Lul, Rodrigo Mayer

    2013-01-01

    Conclusões: Apesar do hamartoma de glândulas de Brunner ser uma lesão benigna e rara, de crescimento indolente e comumente assintomática, pode provocar quadros graves como o descrito neste relato, devendo ser sempre lembrado como diagnóstico diferencial em casos de hemorragia digestiva alta

  11. Impacto de la introducción de la vacuna contra el rotavirus en la hospitalización por gastroenteritis aguda grave en el Hospital del Niño de la Ciudad de Panamá Impact of rotavirus vaccine introduction on hospital admissions for severe acute gastroenteritis at the Children's Hospital in Panama City

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    Javier Nieto Guevara

    2008-09-01

    Full Text Available OBJETIVOS: Determinar si la introducción de la vacunación infantil contra el rotavirus en Panamá permitió reducir la tasa de hospitalización por gastroenteritis en niños menores de 5 años. MÉTODOS: Estudio observacional de corte transversal en dos períodos: del 1 de enero al 31 de agosto de 2005 (antes de la introducción de la vacunación contra el rotavirus y del 1 de enero al 31 de agosto de 2007 (un año después de la introducción. Se estudiaron todos los niños y niñas entre 2 meses y 5 años de edad hospitalizados con diagnóstico de gastroenteritis aguda grave en la sala de corta estancia de gastroenteritis del Hospital del Niño, en Ciudad de Panamá, Panamá. Las variables fueron: número de episodios de gastroenteritis, número de casos hospitalizados por gastroenteritis aguda grave, días de hospitalización y uso de antibióticos, según dos grupos de edad (de 2 meses a 1 año y de más de 1 año a 5 años. Se calculó el riesgo relativo (RR con intervalos de confianza de 95% (IC95% y un nivel de significación P OBJECTIVES: To determine if infant rotavirus vaccination in Panama has reduced the rate of hospital admission for gastroenteritis among children under 5 years of age. METHODS: An observational, cross-sectional study of two time periods: 1 January-31 August 2005 (prior to initiating rotavirus vaccination and 1 January-31 August 2007 (one year after introducing rotavirus vaccination. All the children from 2 months-5 years of age admitted with a diagnosis of acute gastroenteritis to the short-stay gastroenteritis area of the Children's Hospital in Panama City, Panama, were studied. The variables were: number of gastroenteritis episodes; number of cases admitted for severe acute gastroenteritis; number of days hospitalized; and antibiotics treatment for each of the two age groups (2 months-1 year and >1-5 years. The relative risk (RR was calculated with a 95% confidence interval (95%CI and a significance level of P

  12. Notas sobre apendicitis aguda

    OpenAIRE

    Méndez S., Martín

    2011-01-01

    Hacer un buen diagnóstico, tener el valor de la responsabilidad operando precozmente los enfermos, en los cuales después de minucioso examen se cree o se tiene certeza de una apendicitis aguda, es uno de los méritos de todo buen cirujano. Sin duda tendrá que luchar contra todo, la familia, el enfermo y los allegados; pero si triunfa y vence logrará éxitos y salvará vidas. Parece fácil diagnosticar unaapendicitis aguda y sin embargo, es necesario decirlo claro, nada hay tan complicado y en oca...

  13. Pneumonia eosinofílica aguda com evolução para síndroma de dificuldade respiratória aguda: caso clínico

    OpenAIRE

    J.P.F. Baptista; P.C. Casanova; J.P.A. Sousa; P.J. Martins; A. Simões; V. Fernandes; J. Souto; J.J. Costa; A. Rebelo; L. Carvalho; J. Pimentel

    2004-01-01

    RESUMO: Os autores apresentam um caso de pneumonia eosinofílica aguda (PEA) associada a síndroma de dificuldade respiratória aguda grave num adolescente previamente saudável, medicado com nitrofurantoína. A PEA deve ser incluída no diagnóstico diferencial da pneumonia adquirida na comunidade, bem como na lista das patologias causadoras de síndroma de dificuldade respiratória aguda, e o seu diagnóstico deve ser sugerido pela presença de alveolite eosinofílica no líquido de lavagem broncoalveol...

  14. Graves' Disease

    Science.gov (United States)

    ... 2011 survey of clinical practice patterns in the management of Graves' disease. Journal of Clinical Endocrinology and Metabolism. 2012 Dec;97( ... 30 a.m. to 5 p.m. eastern time, M-F Follow Us NIH… Turning Discovery Into ... Disease Urologic Diseases Endocrine Diseases Diet & Nutrition ...

  15. Insuficiencia respiratoria aguda

    OpenAIRE

    Gutiérrez Muñoz, Fernando R.

    2010-01-01

    La función respiratoria básica es el intercambio gaseoso de oxígeno y dióxido carbono; lo que implica un perfecto equilibrio y control entre los componentes del sistema respiratorio. a insuficiencia respiratoria aguda (IRA) es la incapacidad del sistema respiratorio de cumplir su función básica, que es el intercambio gaseoso de oxígeno y dióxido de carbono. Basic respiratory function is gas exchange of oxygen and carbon dioxide, which implies a perfect balance and control between the compo...

  16. Notas sobre apendicitis aguda

    Directory of Open Access Journals (Sweden)

    Martín Méndez S.

    1933-04-01

    apendicitis aguda y sin embargo, es necesario decirlo claro, nada hay tan complicado y en ocasiones tan oscuro. Sin duda, a medida que los conocimientos clínicos se extienden, se va iluminando el campo, antes inexplorado, de la cirugía apendicular, y hoy día casi todos los médicos y cirujanos tienen un criterio científico muy bien formado para lograr hacer un buen diagnóstico y aconsejar o llevar a cabo una intervención quirúrgica.

  17. Gingivitis ulceronecrosante aguda

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    Eduardo de la Teja-Ángeles

    2015-11-01

    Full Text Available La gingivitis ulcerativa necrosante, conocida por sus siglas en inglés como GUN (anteriormente se le conocía como enfermedad de Vincent o “boca de trinchera” por afectar a soldados en guerra, es una enfermedad poco frecuente.1-6 Se caracteriza por ser una infección aguda y dolorosa en la que las encías sangran, hay necrosis de las papilas interdentales y ataque al estado general.

  18. Classificação de gravidade na pancreatite aguda

    Directory of Open Access Journals (Sweden)

    Tercio De Campos

    Full Text Available De acordo com a Classificação de Atlanta a pancreatite aguda pode ser dividida, baseado em sua severidade, em uma forma leve ou grave. Uma série de aspectos têm sido discutidos nos últimos anos, tais como, quantas categorias de gravidade devem ser consideradas; se o doente com falência orgânica é igual ao doente com necrose infectada; qual o papel da falência orgânica transitória; e como avaliar a falência orgânica. A reunião de revista"Telemedicina Baseada em Evidência - Cirurgia do Trauma e Emergência" (TBE-CiTE realizou uma avaliação crítica de artigos relacionados a este tema, considerando três artigos recentes que delinearam duas grandes revisões publicadas nos últimos meses. Estes artigos sugerem a classificação de gravidade em três ou quatro categorias, ao invés de pancreatite aguda leve ou grave, além de discutir qual o melhor escore para avaliar a falência orgânica. As seguintes recomendações foram propostas: (1 A pancreatite aguda deve ser classificada em quatro categorias: leve, moderada, grave e crítica, o que permite uma melhor determinação das características dos doentes; (2 Avaliação de falência orgânica com um escore de gravidade, preferencialmente algum que avalie diretamente cada falência orgânica, tais como o SOFA e o MODS (Marshall. O SOFA parece ter maior acurácia, mas o MODS tem melhor aplicabilidade devido à facilidade de uso.

  19. Hepatitis viral aguda

    Directory of Open Access Journals (Sweden)

    Héctor Rubén Hernández Garcés

    1998-10-01

    Full Text Available Se realizó una revisión bibliográfica de las hepatitis virales agudas sobre aspectos vinculados a su etiología. Se tuvieron en cuenta además algunos datos epidemiológicos, las formas clínicas más importantes, los exámenes complementarios con especial énfasis en los marcadores virales y el diagnóstico positivoA bibliographical review of acute viral hepatitis was made taking into account those aspects connected with its etiology. Some epidemiological markers, the most important clinical forms, and the complementary examinations with special emphasis on the viral markers and the positive diagnosis were also considered

  20. Utilidad del test rápido de ureasa para la identificación de Helicobacter pylori en pacientes con hemorragia digestiva de origen péptico. Clínica Ortega de Huancayo 2015

    OpenAIRE

    Trujillo Cunyas, José Antonio

    2016-01-01

    Antecedentes: Helicobacter pylori juega un rol importante en la fisiopatología del desarrollo de la enfermedad ulcero péptica y sus complicaciones graves como la hemorragia digestiva siendo un factor de riesgo independiente que ocasiona el sangrado; la identificación de la bacteria en esta condición clínica se ve limitada por la disminución de la sensibilidad de la histología y test rápido de ureasa métodos utilizados para su diagnóstico. Objetivo: Identificar y valorar los resultados del tes...

  1. Algunas observaciones sobre la apendicitis aguda en los niños

    Directory of Open Access Journals (Sweden)

    Luis Piñeros Suárez

    1940-03-01

    Full Text Available La apendicitis aguda en los niños, presenta actitudes particulares que diferencian de la apendicitis aguda del adulto y que vienen a formar grupos clínicos casi exclusivamente de la infancia. De una manera general, las formas más graves, las formas fulminantes de la apendicitis aguda se encuentran especialmente en la infancia y en estas formas graves llama poderosamente la atención, la falta de relación entre los signos clínicos observados y la importancia de las lesiones encontradas en el apéndice y el peritoneo, pues en los niños con signos de intensidad media y sin que se hayan presentado los síntomas que en el adulto caracterizan las formas graves de apendicitis, podemos encontrar en las operaciones practicadas en las primeras 24 a 36 horas, peritonitis generalizadas, formas de apendicitis gangrenosas, que no son frecuentes en el adulto y mucho menos en un lapso de tiempo tan corto.

  2. Evaluación de un modelo de atención quirúrgica urgente en los resultados de eficacia, seguridad y eficiencia en el tratamiento de la apendicitis aguda

    OpenAIRE

    Pareja Ciuro, Felipe Jose

    2016-01-01

    Introducción La apendicitis aguda es la urgencia quirúrgica más frecuente de la especialidad. Según las estadísticas mundiales esla causa principal de abdomen agudo quirúrgico y por tanto, sus resultados pueden reflejar en gran medida la calidad de la atención en el ámbito de la cirugía digestiva urgente y podrían ser utilizados como indicador de calidad para evaluar la gestión de las urgencias quirúrgicas. Mediante este estudio queremos evaluar si la existencia de un modelo organizativo ...

  3. Incidencia de la enfermedad diarreica aguda en menores de cinco años

    Directory of Open Access Journals (Sweden)

    Mayelín Ávila Labrada

    2015-05-01

    Full Text Available La enfermedad diarreica aguda es motivo frecuente de consulta pediátrica, representando un problema grave de salud pública. Los agentes infecciosos son causa frecuente de diarrea aguda. Se realizó un estudio descriptivo, retrospectivo sobre la prevalencia de la enfermedad diarreica aguda en menores de cinco años, atendidos en la clínica “Simón Bolívar” en la ciudad de Mariara del municipio Diego Ibarra, Carabobo, Venezuela; en el periodo comprendido entre enero de 2008 y diciembre de 2012, lo cual ofreció información de cinco años completos. La prevalencia de la enfermedad diarreica aguda disminuyó significativamente en el intervalo 2009-2011, sin embargo, se caracterizó por tener la mayor prevalencia en los años extremos, 2012 y 2008, por ese orden. Los varones y los del grupo de uno a cuatro años fueron los que más incidieron en cada uno de los años estudiados

  4. Bases moleculares de la depleción de glutatión y de la necrosis celular en la pancreatitis aguda. Papel de las proteín quinasas activadas por mitógenos.

    OpenAIRE

    Pereda Cervera, Javier

    2006-01-01

    RESUMEN La pancreatitis aguda es el proceso inflamatorio agudo del páncreas con afectación variable de otros tejidos regionales y sistemas orgánicos alejados. Es una enfermedad con una incidencia relativamente elevada en España y en el resto del mundo y con una mortalidad entre el 10 y el 45% de los casos graves de la enfermedad. Los mecanismos moleculares por los que una pancreatitis aguda se desarrolla, así como aquellos que conducen a una pancreatitis grave, aún no están del todo esclar...

  5. Ataxias agudas en la infancia

    Directory of Open Access Journals (Sweden)

    Yaline Betancourt Fursow

    2013-09-01

    Full Text Available La ataxia cerebelosa aguda infantil (ACAI es la forma más frecuente de complicación neurológica por el virus de la varicela.Descritas dentro del grupo de las cerebelitis agudas. Los objetivos de este estudio fueron: evaluar la presentación clínica, manejo y seguimiento de niños hospitalizados con ACAI en un hospital pediátrico terciario donde la inmunización para varicela no está disponible (parte I y describir los diagnósticos diferenciales de la cerebelitis aguda (parte II. Estudiamos 95 pacientes. Los criterios diagnósticos de ataxia aguda se basaron en: pérdida aguda de la coordinación o dificultad para la marcha con o sin nistagmo asociado y duración menor de 48 horas, en un niño previamente sano. Estos criterios se cumplían en todos los casos valorados, excepto en las ataxias secundarias a ingesta de tóxicos, en los que la duración debía ser menor de 24 horas para su inclusión en el estudio. Se registraron los datos en una historia clínica pediátrica y neurológica. Entre los pacientes inmunosuprimidos la incidencia mayor fue la complicación por varicela. La mayoría de los pacientes fueron varones. El rango de edad fue la preescolar, 5 años . El intervalo entre la presentación del rash y el ingreso fue de 1 a 3 días. El estudio de LCR se practicó en 59.5% de los casos. La TAC y la resonancia magnética cerebral (RM presentaron edema en el 33.3%. El aciclovir endovenoso fue utilizado en 23 pacientes; pero no hubo diferencias significativas en las manifestaciones clínicas y seguimiento entre tratados y no tratados. La ataxia fue la primera manifestación clínica. La estadía hospitalaria fue de 4 días (rango: 2-11 días.

  6. NGAL urinária em pacientes sem e com lesão renal aguda em unidade de terapia intensiva

    Directory of Open Access Journals (Sweden)

    Mirian Watanabe

    2014-12-01

    Full Text Available Objetivo: Avaliar a eficácia diagnóstica e prognóstica da lipocalina associada à gelatinase neutrofílica urinária em pacientes de unidade de terapia intensiva. Métodos: Estudo do tipo coorte, prospectivo, longitudinal desenvolvido em uma unidade de terapia intensiva clínica especializada em cardiologia. Os pacientes foram estratificados segundo os grupos sem e com lesão renal aguda, acompanhados a partir das primeiras 24 horas de internação até a alta hospitalar ou óbito. A creatinina sérica, o fluxo urinário e a lipocalina associada à gelatinase neutrofílica urinária foram coletadas em dois períodos: 24 horas e 48 horas de admissão. Resultados: Foram avaliados 83 pacientes clínicos da unidade de terapia intensiva, com predomínio do gênero masculino (57,8%. Os pacientes foram agrupados em sem lesão renal aguda (N=18, com lesão renal aguda (N=28 ou com lesão renal aguda grave (N=37. Entre os pacientes com lesão renal aguda e lesão renal aguda grave, foram prevalentes os portadores de doenças crônicas, em uso de ventilação mecânica e em terapia de substituição renal, além daqueles com maiores taxas de permanência na unidade de terapia intensiva e hospitalar, e maior mortalidade. O grupo com lesão renal aguda não apresentou alteração significativa da creatinina sérica nas primeiras 24 horas na unidade de terapia intensiva, apesar dos níveis elevados de lipocalina associada à gelatinase neutrofilica urinária demonstrados nos grupos com lesão renal aguda e lesão renal aguda grave (p<0,001. Níveis elevados de lipocalina associada à gelatinase neutrofílica urinária na amostra foram associados ao óbito. Conclusão: A elevação nos níveis de lipocalina associada à gelatinase neutrofílica urinária antecede as variações da creatinina sérica em pacientes com lesão renal aguda e pode ser associada ao óbito.

  7. Nutrição na pancreatite aguda : monografia : Nutrition in acute pancreatitis

    OpenAIRE

    Oliveira, Joana da Silva

    2009-01-01

    Resumo da tese:A pancreatite aguda (PA) é uma doença inflamatória aguda do pâncreas de etiologia multifactorial e pode ter atingimento local (PA ligeira a moderada) ou sistémico (PA grave). A magnitude da lesão pancreática, a presença e extensão da necrose e de infecção determinam o grau de gravidade. Prever a gravidade é fundamental para direccionar antecipadamente a terapêutica médica e nutricional. Na sua maioria, os episódios de PA são ligeiros a moderados, de resolução espontânea, enquan...

  8. Genetics Home Reference: Graves disease

    Science.gov (United States)

    ... Email Facebook Twitter Home Health Conditions Graves disease Graves disease Printable PDF Open All Close All Enable Javascript to view the expand/collapse boxes. Description Graves disease is a condition that affects the function of ...

  9. Pneumonia aguda fibrinosa e organizante

    Directory of Open Access Journals (Sweden)

    Cláudia Santos

    2010-07-01

    Full Text Available Resumo: O padrão histológico de Pneumonia Aguda Fibrinosa e Organizante (AFOP – Acute Fibrinous And Organizing Pneumonia, descrito por Beasley em 2002, caracteriza-se pela existência de fibrina intra-alveolar sob a forma de bolas de fibrina e pneumonia organizativa difusa. A apresentação clínica desta doença intersticial pulmonar pode ser aguda ou subaguda, diferindo no entanto dos outros padrões histológicos habitualmente associados a lesão pulmonar aguda – Lesão Alveolar Difusa (DAD, Pneumonia Organizativa (OP e Pneumonia Eosinofílica (EP.A propósito deste tema, os autores fazem uma revisão da literatura e descrevem o caso clínico de um doente de 44 anos, com aspectos imagiológicos e evolução pouco habituais. Abstract: The histologic pattern of Acute Fibrinous and Organizing Pneumonia (AFOP, described by Beasley in 2002, is characterized by the existence of intra alveolar fibrin in the form of fibrin “balls” and diffuse organizing pneumonia. Presenting symptoms of this interstitial pulmonary disease can be acute or subacute. However, it differs from the well-recognized histologic patterns of acute pulmonary lesion – Diffuse Alveolar Damage (DAD, Organizing Pneumonia (OP and Eosinophilic Pneumonia (EP.The authors carry out a review of the literature concerning this topic and describe the clinical case of a 44-year-old patient with unusual imaging features and outcome. Palavras-chave: AFOP, bolas de fibrina, pneumonia organizativa, Key-word: AFOP, fibrin balls, organizing pneumonia

  10. Miastenia grave y miastenia grave ocular

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    Rosa María Naranjo Fernández

    Full Text Available La miastenia grave es una enfermedad caracterizada por debilidad y fatiga de los músculos voluntarios debido a una trasmisión anómala a nivel de la unión neuromuscular. La prevalencia es aproximadamente de 5 casos/100 000 personas. La miastenia grave puede ser bulbar, ocular o generalizada.Existen formas clínicas en la infancia como son la miastenia neonatal transitoria, la miastenia congénita y la miastenia juvenil. Los músculos oculares, faciales y bulbares son los más frecuentes afectados por la enfermedad. Cuando los síntomas se limitan a la musculatura cercana al ojo se denomina miastenia grave ocular. Una vez el oftalmólogo diagnostica o sospecha la miastenia grave, un neurólogo generalmente dirige la comprobación y tratamiento. El papel del oftalmólogo continúa siendo importante, además de chequear la motilidad y disfunción palpebral y proporcionar el alivio sintomático para estos desórdenes, debe estar alerta a la posibilidad de ambliopía.

  11. Hepatite aguda colestática pelo propiltiouracil: relato de caso

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    PAROLIN Mônica Beatriz

    2000-01-01

    Full Text Available Propiltiouracil é uma droga amplamente utilizada no tratamento do hipertiroidismo. A hepatotoxicidade é um dos efeitos colaterais mais raros e também mais graves associados a ela. Relata-se um caso de hepatite aguda colestática que acomete um jovem de 15 anos em uso de propiltiouracil para tratamento de hipertiroidismo. Causas virais, metabólicas e autoimunes foram excluídas e a biopsia hepática revelou achados histopatológicos sugestivos de hepatite colestática induzida por droga. Com a suspensão da droga, houve remissão dos sintomas e normalização progressiva das provas de função hepática. Raramente, os pacientes em uso de propiltiouracil podem desenvolver injúria hepática grave.

  12. Methylene blue improves hemodynamic shock but increases lipoperoxidation in severe acute pancreatitis pig model Azul de metileno melhora as condições hemodinâmicas do choque circulatório, mas aumenta a peroxidação lipídica em um modelo suino de pancreatite aguda grave

    Directory of Open Access Journals (Sweden)

    Roberto Ferreira Meirelles Jr

    2008-01-01

    Full Text Available PURPOSE: Study hemodynamic pattern and lipoperoxidation during methylene blue (MB treatment on taurocholate - enterokinase induced acute pancreatitis (AP. METHODS: Thirty pigs were equally divided in control group; MB group; AP group; MB previous AP group; and MB after 90 min of induced AP group. MB was given iv in a bolus dose (2mg.kg-1 followed by maintenance dose (2 mg.kg-1.h-1. Hemodynamic parameters were recorded continuously during 180 min by Swan-Ganz catheter. Blood samples were taken every 60 min to determine arterial and venous nitrate, malondialdehyde (MDA and amylase. Pancreatic tissue was removed for histopathologic study. RESULTS: In AP group MBP and CO decreased over time 33% (p0.05 serum MDA when associated to AP. After induced AP, MB did not reverse MBP and CO decrease. There was no difference in serum amylase and necro-hemorrhagic findings with MB treatment. CONCLUSIONS: In this taurocholate-induced AP model MB treatment delayed hemodynamic shock and decreases serum nitrate levels but increases serum MDA levels. No volemic replacement was done and it may have been a mitigated factor to a poor tissue perfusion and impairment microcirculation. Further investigations are needed to elucidate MB treatment role during AP treatment.OBJETIVO: estudar o perfil hemodinâmico e a lipoperoxidação durante o tratamento com azul de metileno (AM de pancreatite aguda (PA induzida por taurocolato-enteroquinase. MÉTODOS: Trinta porcos foram igualmente divididos em: grupo controle, grupo AM; grupo PA; grupo AM prévio à PA; grupo AM após 90 minutos após a indução da PA. O AM foi administrado sob a forma de bolus EV (2mg.kg-1 seguido por dose de manutenção (2 mg.kg-1.h-1. Os parâmetros hemodinâmicos foram registrados continuamente durante 180 min com auxílio de cateter de Swan-Ganz. Amostras sanguíneas foram colhidas a cada 60 min para a determinação arterial e venosa de nitrato, malondialdeido (MDA and amilase. Removeu-se tecido

  13. Infarto esplénico secundario a pancreatitis aguda Splenic infarction secondary to acute pancreatitis

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    J. J. Arenal Vera

    2008-05-01

    Full Text Available Fundamento y objetivo: la estrecha relación anatómica del páncreas con los vasos esplénicos y el bazo es responsable de complicaciones esplénicas en el curso de la pancreatitis aguda. El objetivo es presentar dos casos clínicos de pancreatitis aguda grave que sufrieron infarto esplénico como complicación de la enfermedad pancreática. Pacientes, participantes: en un periodo de tres meses, dos pacientes fueron diagnosticados de infarto esplénico secundario a pancreatitis aguda. En ambos casos el diagnóstico y seguimiento evolutivo del infarto esplénico se hizo a través de tomografía axial computerizada. Resultados: en el primer paciente, las imágenes muestran de forma inequívoca la afectación de la arteria esplénica por el proceso inflamatorio pancreático. En el segundo, no se pudo demostrar afectación de los vasos esplénicos, por lo que la única posible explicación etiológica es un incremento de coagulabilidad intravascular. Conclusiones: sería recomendable añadir las complicaciones esplénicas al conjunto de complicaciones graves extrapancreáticas de la pancreatitis aguda. La tomografía axial computerizada es de gran utilidad para la detección y seguimiento de las complicaciones esplénicas de la pancreatitis aguda.Background and objective: the close anatomic relationship of the pancreas with the splenic vessels and the spleen is responsible for splenic complications in the course of acute pancreatitis. Our objective was to report two cases of severe acute pancreatitis complicated by splenic infarction. Patients: in a three-month period of time two patients were diagnosed with splenic infarction secondary to acute pancreatitis. In both cases splenic infarction diagnosis and follow-up were carried out using computed tomography. Results: in the first case images clearly showed a narrowing of the splenic artery due to the inflammatory pancreatic condition. In the second case no involvement of the splenic vessels could

  14. Sertralina e pancreatite aguda: relato de caso Sertraline and acute pancreatitis: a case-report

    Directory of Open Access Journals (Sweden)

    André Malbergier

    2004-03-01

    Full Text Available A pancreatite aguda é uma patologia grave e com considerável morbidade e mortalidade. Vários fatores são apontados como possíveis causas de pancreatite aguda. Neste relato, será apresentado um caso de pancreatite aguda com possível associação causal com um inibidor seletivo de recaptura de serotonina: sertralina. Após um mês de tratamento com sertralina, uma paciente do sexo feminino, 55 anos, desenvolveu forte dor abdominal e elevação da amilase sérica. Após internação e retirada da sertralina, seus sintomas remitiram e os níveis de amilase voltaram ao normal. Pela potencial gravidade do quadro e pelo amplo uso desta medicação, tal associação deve ser lembrada em investigações de casos de pancreatite aguda.Acute pancreatitis is a severe disease with considerable morbidity and mortality. Many risk factors are causally related to acute pancreatitis. In this report, a case of acute pancreatitis with possible causal relationship with the use of a selective serotonin reuptake inhibitor, sertraline, will be discussed. After one month of treatment with sertraline, a female patient, 55 years-old, developed a severe abdominal pain and showed a serum amylase elevation. She was admitted to the hospital and the use of sertraline was interrupted. After that, the symptoms remitted and the serum amylase level returned to normal. Because of the potential severity of this disease and the widespread use of sertraline, this association should be reminded when investigating possible causes for acute pancreatitis.

  15. Højfolkets Grave

    DEFF Research Database (Denmark)

    2007-01-01

    For the special exhibition 'Højfolkets Grave - Oak Coffins from Borum Eshøj' on Moesgaard Museum in 2007: The development of 3D graphics which was displayed on a big screen in the exhibition. The animation shows - in a very stylistic way - the design principles behind the construction of Bronze Age...

  16. Management of Graves' ophthalmopathy

    NARCIS (Netherlands)

    Wiersinga, Wilmar M.

    2007-01-01

    Management of Graves' ophthalmopathy is preferably done in a multidisciplinary setting. Smoking is associated with worse disease outcome. (131)I therapy for hyperthyroidism can also worsen ophthalmopathy, especially if administered during active disease or to patients who smoke or have severe

  17. Leucemia congénita aguda

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    Nilvia Esther González García

    2011-06-01

    Full Text Available La leucemia aguda durante el período neonatal es poco frecuente de evolución rápida y pronóstico sombrío. Sus características clínicas y biológicas difieren de las encontradas en niños de mayor edad, y su inicio se caracteriza por afectación cutánea, hepatoesplenomegalia, hiperleucocitosis e infiltración del sistema nervioso central. Se han observado pacientes con formas tanto mieloides como linfoides, pero la leucemia mieloide aguda parece predominar en esta etapa de la vida. Se presenta el caso de un paciente con leucemia congénita clasificada morfológicamente, con aparición de manifestaciones clínicas de enfermedad hematológica desde el nacimiento y diagnóstico de leucemia linfoblástica aguda congénita.

  18. Hemorragia digestiva alta severa por úlceras de Cameron. Reporte de caso

    Directory of Open Access Journals (Sweden)

    Carolina Salinas

    2016-01-01

    Full Text Available Se reporta el caso de una mujer anciana con hemorragia digestiva alta y choque hipovolémico secundario a úlceras de Cameron. Dado que estas lesiones se caracterizan por presentar cuadros crónicos de hemorragia sin aparente repercusión, se hace una revisión de esta exótica causa de sangrado digestivo masivo con repercusión hemodinámica. Estas ulceras se deben a abrasión de la mucosa por la contracción del diafragma durante los movimientos respiratorios, lo que genera pérdidas crónicas de sangre.

  19. Hemorragia digestiva: manejo fundamentado na medicina baseada em evidências

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    José Roberto Alves

    2008-03-01

    Full Text Available A Hemorragia Digestiva Alta (HDA é uma doença de alta prevalência e mortalidade. Nos últimos anos, várias centros e sociedades médicas de todo o mundo buscam a padronização de condutas fundamentada em uma medicina baseada em evidências. Assim, pretendemos sintetizar as condutas terapêuticas para a HDA com o propósito de melhor atualizar e capacitar os médicos que diariamente lidam com essa patologia.

  20. Fístula bilio-duodenal pós colecistite aguda: Relato de caso

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    Marina Araújo Fonte Boa

    2016-12-01

    Full Text Available As fístulas biliares internas espontâneas são comunicações estabelecidas entre qualquer segmento da árvore biliar e dos órgãos abdominais. Elas constituem uma afecção rara apesar de compreender uma complicação da colecistite, patologia freqüente da prática cirúrgica. As fístulas bilioentericas ocorrem em 3-5% dos doentes com colelitíase, sendo 68% destas bilioduodenais. O objetivo desse manuscrito é relatar um caso de fístula bilioduodenal complicada com hemobilia e hemorragia digestiva, descrevendo a conduta adotada. Os dados foram coletados entre dezembro/2015 a abril/2016 através da analise de prontuário fornecido pelo Hospital Universitário Sul Fluminense (HUSF. Trata-se de um paciente masculino, 75 anos, atendido no HUSF-Vassouras/RJ com diagnóstico sindrômico de abdome agudo inflamatório por colecistite aguda, submetido a tratamento conservador para regressão da inflamação peri-colecística, diminuindo assim, o risco de lesões iatrogênicas da árvore biliar em posterior cirurgia. Evoluiu com melena, que foi investigada por endoscopia digestiva alta onde foi observada úlcera de bulbo duodenal com drenagem de secreção purulenta pela sua luz; e tomografia computadorizada de abdome que evidenciou presença de aerobilia indicando presença de fístula bileodigestiva. O tratamento conservador consistiu-se em antibioticoterapia e reposição volêmica, optado devido à remissão do quadro de colecistite após desobstrução pela fístula, devido à hemorragia que cessou espontaneamente e também pelo risco da realização do procedimento cirúrgico em paciente idoso com intensa resposta inflamatória sistêmica. Não é comum na literatura médica a ocorrência de fístulas biliodigestivas com sinais e sintomas hemorrágicos. O quadro clínico geralmente é inespecífico e frequentemente atrasado devido à falta de sinais e sintomas patognomônicos.

  1. Esofagitis necrotizante aguda: Una entidad inusual Acute esophageal necrosis: An unusual entity

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    Silvana E. Pramparo

    2010-12-01

    Full Text Available La esofagitis necrotizante aguda (ENA, también denominada esófago negro, es una rara enfermedad poco descripta en la literatura médica. Describimos el caso de un hombre de 80 años, con hemorragia digestiva alta quien desarrolló un esófago negro luego de un episodio de hipotensión. La necrosis fue confirmada histológicamente. Los pacientes se presentan con hematemesis y melena en más del 70% de los casos. Los hallazgos endoscópicos muestran una coloración negruzca de la mucosa esofágica. El diagnóstico se realiza con endoscopia y confirmación histológica. La mortalidad es alta (más del 50% aunque relacionada a las enfermedades de base del paciente. Por último, podemos decir que la sospecha es muy importante en el diagnóstico de ENA, particularmente en pacientes ancianos con enfermedades asociadas y evidencia de hemorragia digestiva alta. En este trabajo describimos las características clínicas, endoscópicas e histopatológicas de un paciente con ENA.Acute esophageal necrosis (AEN, also designated black esophagus, is a rare disorder that is poorly described in the medical literature. We present the case of an 80 years old man, with upper gastrointestinal bleeding who developed a black esophagus after hypotensive episodes. Necrosis was confirmed histologically. Hematemesis and melena are present in more than 70% of the cases. Endoscopic findings show black discoloration of the distal esophagus with proximal extension ending sharply at the gastroesophageal junction. Diagnosis is reached endoscopically with histological support. Mortality is high (up to 50% even though related to the patient's underlying condition. Finally, we may say that to keep in mind the posibility of AEN is a key factor in its diagnosis, particularly in older patients with associated morbidity and evidence of upper gastrointestinal bleeding. In the present report we describe the clinical, endoscopic and histophatological characteristics of a patient with a

  2. Insuficiencia renal aguda en pacientes de la Unidad de Cuidados Intensivos, Hospital Regional de Cuilapa, Santa Rosa, Guatemala

    Directory of Open Access Journals (Sweden)

    Ronald J. Ajcalon

    2017-03-01

    Full Text Available La insuficiencia renal aguda, es una condición común en la Unidad de Cuidados Intensivos de Adultos (UCIA y probablemente una consecuencia de la enfermedad crítica que se asocia a resultados clínicos adversos, altos costos y una mortalidad de más del 50%, sobre todo si se requiere tratamiento de reemplazo renal. El objetivo fue determinar la incidencia de insuficiencia renal aguda en pacientes ingresados a la UCIA. El estudio fue prospectivo, longitudinal, observacional, en 101 pacientes ingresados en la UCIA del Hospital Regional de Cuilapa. Se diagnosticaron 101 pacientes durante el periodo de estudio con insuficiencia renal aguda represento el 27.4% del total de pacientes internados (368 en el servicio en un año. La incidencia de mortalidad en pacientes que requieren terapia de reemplazo renal y se encuentran en ventilación mecánica es del 100%. Del total de pacientes estudiados, según la escala Akin, se encontró que el 49.5% de los pacientes correspondían a grado II, aunque el grado I también fue frecuente (29%, y que el 22 % de los pacientes correspondían a grado III. La patología que mayormente se asoció al desarrollo de insuficiencia renal aguda fue sepsis grave con un 31%, seguido de pacientes sometidos a cirugía mayor e hipovolemia con el 21 y 18% respectivamente. Se halló una incidencia aumentada de insuficiencia renal aguda comparado con estadísticas internacionales, cuya etiología fue mayormente causada por procesos sépticos.

  3. Microchimerism in Graves' Disease

    Science.gov (United States)

    Galofré, Juan C.

    2012-01-01

    Microchimerism is the presence of cells from one individual in another genetically distinct individual. Pregnancy is the main cause of natural microchimerism through transplacental bidirectional cell trafficking between mother and fetus. The consequences of pregnancy-related microchimerism are under active investigation. However, many authors have suggested a close relationship linking fetal microchimerism and the development of autoimmune diseases. It has been more than ten years now since the demonstration of the presence of a significant high number of fetal microchimeric cells residing in thyroid glands from operated patients with Graves' disease. This intrathyroidal fetal microchimerism is an attractive candidate mechanism for the modulation of Graves' disease in pregnancy and the postpartum period. PMID:22577597

  4. Pneumonia aguda fibrinosa e organizante

    Directory of Open Access Journals (Sweden)

    C. Damas

    2006-09-01

    Full Text Available Resumo: A designação acute fibrinous and organizing pneumonia (AFOP foi proposta por Beasley et al para os casos em que as características histopatológicas das lesões não se enquadravam em outras situações clínicas (agu-das ou subagudas conhecidas. A presença de fibrina intra alveolar e de pneumonia organizativa, com distribuição difusa, é a principal alteração histológica associada a esta entidade.Os autores descrevem o caso de um doente do sexo masculino, com o diagnóstico de AFOP, por bióp-sia pulmonar cirúrgica. O doente teve uma apresentação subaguda, apresentando por queixas principais tosse, dor torácica e febre. TAC torácica mostrou infiltrados bilaterais, difusos. Após início de corticoterapia sistémica e ciclofosfamida, o doente apresentou melhoria clínica significativa. Ao elaborar este caso, os autores esperam acrescentar mais alguns dados sobre esta nova entidade.Rev Port Pneumol 2006; XII (5: 615-620 Abstract: The term Acute Fibrinous and Organizing Pneumonia (AFOP has been proposed by Beasley et al for cases that not fit into the histopathologic criteria of the recognized entities described as acute or subacute clinical presentations. The presence of intra-alveolar fibrin in the form of fibrin ‘balls’ and organizing pneumonia with patchy distribution are the main histological features of this entity. We describe the case of a male patient with the diagnostic of AFOP made by surgical lung biopsy. He had a subacute presentation of symptoms consisting of productive cough, chest pain and fever. Bilateral infiltrates with patchy and diffuse distribution were the predominant features in his chest HRCT scan. The patient had a good clinical course after a treatment with prednisone and cyclophosphamide. Our hope in reporting this case study is to add some more data to the discussion of this new entity.Rev Port Pneumol 2006; XII (5: 615-620 Palavras

  5. [Grave's disease in 2009].

    Science.gov (United States)

    Philippe, Jacques

    2009-04-08

    Grave's disease is an autoimmune disease of the thyroid gland characterized by hyperthyroidism, a homogenous goiter and occasionally an ophtalmopathy. It occurs in less than 1% of the population with a large predominance in women (10/1). Treatment is directed to inhibit thyroid hormone synthesis with carbimazole during 12-18 months. Recurrence rates after stopping treatment is about 50%; in these patients, radioactive iodine is the preferred treatment.

  6. Síndrome coronariana aguda em paciente jovem com sintomas atípicos

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    Gustavo Daher

    2012-08-01

    Full Text Available O diagnóstico da dor torácica aguda no setor de emergência pode ser difícil e desafiador, incluindo diversos diagnósticos diferenciais, dentre eles: causas benignas a causas potencialmente fatais. O diagnóstico na maioria das vezesé estabelecido através do quadro clínico e de exames complementares como: marcadores de necrose miocárdica, eletrocardiograma e radiografia de tórax.A angiotomografia coronariana tem sido utilizada nos casos de dor torácica aguda com baixa ou intermediária probabilidade de síndrome coronariana aguda, permitindo sua exclusão e conseqüente alta precoce dos pacientes. Apresentamosrelato de caso de uma paciente jovem com dor precordial atípica e marcadores de necrose miocárdica discretamente elevados. Considerando-se a epidemiologia e o quadro clínico da paciente, foi feita hipótese diagnóstica inicial de miocardite. A angiotomografia cardíaca com pesquisa de realce tardiofoi solicitada. Apesar do escore de cálcio ter sido zero, foi diagnosticada lesão estenosante grave no terço médio da artéria coronária descendente anterior com realce tardio na parede anterior do ventrículo esquerdo, compatível comnecrose miocárdica. A paciente foi submetida a cateterismo com angioplastia da lesão.

  7. Mielopatia transversa em adulto portador de leucemia aguda linfoblástica: relato de caso

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    Brito José Correia de Farias

    2001-01-01

    Full Text Available Relatamos um caso de mielopatia transversa aguda em paciente masculino de 31 anos de idade, branco, portador de leucemia aguda linfoblástica, subtipo L3 (LLA-L3. Esta é uma forma grave de leucemia e compromete mais crianças em relação aos adultos. Menos de 1% dos pacientes leucêmicos apresentam complicações espinais. No paciente em estudo, a sintomatologia instalou-se de modo abrupto e com as seguintes características: dores nas costas, paraplegia crural flácida e perda das funções sensitivas e vegetativas abaixo do segmento afetado. O diagnóstico etiológico foi estabelecido após a realização dos seguintes exames: hemograma, mielograma, análise do líquido cefalorraqueano e ressonância magnética de coluna dorsal. Foi instituído tratamento específico, que não interferiu com a evolução fatal da doença.

  8. Resultados del tratamiento de la hemorragia digestiva alta por varices esofagogástricas

    OpenAIRE

    Ruiz Luna, David; Farran, L.; Ramos, E.; Biondo, Sebastián; Moreno Llorente, Pablo; Bettónica, C.; Jorba, R.; Borobia, F. G.; Jaurrieta Mas, Eduardo

    2001-01-01

    Introducción: el tratamiento de la hemorragia digestiva alta por rotura de varices esofágicas y/o gástricas en pacientes con cirrosis hepática debe estar dirigido al control inicial de la hemorragia sin alterar más una función hepática ya deteriorada , y a la prevención de la recidiva hemorrágica precoz. Métodos endoscópicos, farmacológicos y quirúrgicos forman el conjunto de alternativas terapéuticas. Material y métodos: estudio prospectivo de los resultados obtenidos tras el seguimiento de...

  9. VIH: Infeccion aguda, pesquisa y manejo

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    Cortés S. Esteban, Dr.

    2014-05-01

    Si bien existe una relativa facilidad para realizar el diagnóstico de un paciente con la infección crónica por VIH, existe por otro lado una relativa dificultad para realizar el diagnóstico de la infección aguda en etapas tempranas de la infección. Esta situación es de importancia desde el punto de vista de la Salud Pública por cuanto en la infección aguda es cuando se producen las viremias más elevadas y por tanto la mayor facilidad para que el sujeto sea infectante y disemine la infección viral.

  10. 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. Copyright © 2011 Elsevier Ltd. All rights reserved.

  11. Bases moleculares de las leucemias agudas

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    G. Martínez Antuña

    2006-04-01

    Full Text Available El gran desarrollo de la biología molecular en los últimos años ha contribuido a un importante avance en los conocimientos relacionados con las bases moleculares de las leucemias agudas (LA. Ademas de profundizar en la biología de estas enfermedades y conocer las bases moleculares, ha renido también gran impacto en mejorar el resultado de los tratamientos y disminuir la toxicidad de las terapias.

  12. Otomastoidite Aguda em Criança

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    João Araújo

    2017-09-01

    Full Text Available Criança de 2 anos, sexo masculino, diagnóstico de otite média aguda bilateral, medicada inicialmente com amoxicilina + clavulanato 90 mg/kg/dia desde há 7 dias, internada por agravamento do quadro à esquerda, com edema e eritema retroauricular, apagamento do sulco retroauricular [...] Recebido: 07/09/2015 · Aceite: 7/01/2016

  13. Comportamiento de la otitis media aguda

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    Gladys Fuentes Fernández

    Full Text Available Introducción: la otitis media aguda es una complicación de las infecciones respiratorias agudas altas, frecuente en los niños menores de 5 años. Objetivos: caracterizar su comportamiento, según edad y sexo, e identificar algunos factores de riesgo en este grupo de edad. Métodos: se realizó un estudio descriptivo retrospectivo de 554 niños ingresados en el hospital Pediátrico de Centro Habana con el diagnóstico de otitis media aguda, durante los años 2006-2010. Los datos se recogieron de las historias clínicas. Resultados: la otitis media aguda fue más frecuente en el sexo masculino (58,7 % y en los menores de 1 año (53,1 %. El antecedente de bajo peso (33,9 % y la prematuridad (27,5 %, la asistencia a círculos infantiles (43,5 % y el hábito de fumar de los padres (58,4 %, además del antecedente de ingresos hospitalarios por otitis media en el mes previo a la aparición del episodio actual (59,0 %, constituyeron los principales factores de riesgo en el presente estudio. Conclusiones: la otitis media es una causa frecuente de ingresos hospitalarios, y se identifican como principales factores de riesgo la asistencia a círculos infantiles y el tabaquismo de algunos de los padres.

  14. Incidência de fístulas digestivas nos ferimentos toracoabdominais

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    Mario Mantovani

    Full Text Available Os ferimentos penetrantes localizados na transição toracoabdominal (FTA, além da dificuldade diagnóstica, merecem especial atenção em relação à conduta adotada para o controle das complicações abdominais. Os autores analisaram 110 pacientes atendidos na Disciplina de Cirurgia do Trauma do Departamento de Cirurgia da UNICAMP, de 1988 a 1998, apresentando ferida penetrante toracoabdominal e submetidos à laparotomia exploradora com drenagem pleural fechada. As fístulas digestivas foram estudadas quanto à incidência, ao tratamento e à evolução pós-operatória. Do total de pacientes, 91 (82,7% eram do sexo masculino e 19 (17,3% do sexo feminino. A faixa etária situou-se entre 13 e 63 anos. Os FTA foram causados por projétil de arma de fogo (PAF em 60 (54,5% casos e por arma branca (FAB em 50 (45,5%. As fístulas digestivas ocorreram em seis (5,4% dos pacientes estudados, sendo quatro (3,6% casos de fístula pancreática, um (0,9% de fístula gástrica e um (0,9% de fístula biliar, todos tratados de maneira conservadora, apresentando evolução favorável com resolução espontânea.

  15. Current Concepts in Graves' Disease

    Science.gov (United States)

    Girgis, Christian M.; Champion, Bernard L.; Wall, Jack R.

    2011-01-01

    Graves' disease is the most common cause of hyperthyroidism in the developed world. It is caused by an immune defect in genetically susceptible individuals in whom the production of unique antibodies results in thyroid hormone excess and glandular hyperplasia. When unrecognized, Graves' disease impacts negatively on quality of life and poses serious risks of psychosis, tachyarrhythmia and cardiac failure. Beyond the thyroid, Graves' disease has diverse soft-tissue effects that reflect its systemic autoimmune nature. Thyroid eye disease is the most common of these manifestations and is important to recognise given its risk to vision and potential to deteriorate in response to radioactive iodine ablation. In this review we discuss the investigation and management of Graves' disease, the recent controversy regarding the hepatotoxicity of propylthiouracil and the emergence of novel small-molecule thyroid-stimulating hormone (TSH) receptor ligands as potential targets in the treatment of Graves' disease. PMID:23148179

  16. Graves' disease following subacute thyroiditis.

    Science.gov (United States)

    Nakano, Yoshishige; Kurihara, Hideo; Sasaki, Jun

    2011-12-01

    Subacute thyroiditis is a painful, inflammatory disease frequently accompanied with fever. It is suspected to be a viral infectious disease, while Graves' disease is an autoimmune disease. Thus, there appears to be no etiological relationship between the two diseases. A total of 25,267 thyroid disease patients made their first visits to our thyroid clinic during a period of 24 years between 1985 and 2008. Among them, subacute thyroiditis and Graves' disease accounted for 918 patients (3.6%) and 4,617 patients (18.2%), respectively. We have encountered 7 patients (one male and six female) with subacute thyroiditis followed by Graves' disease in this period (0.15% of the 4,617 patients with Graves' disease and 0.76% of the 918 patients with subacute thyroiditis). The age ranges were 40~66 years (mean 48.7 years) at the onset of subacute thyroiditis. The intervals between the onsets of subacute thyroiditis and Graves' disease were 1~8 months (mean 4.7 months). Because Graves' disease was preceded by subacute thyroiditis, the signs and symptoms of both diseases were evident together in the intervening period. The diagnosis of Graves' disease in those patients is always difficult because of atypical signs and symptoms and an unclear onset time. The causes of the Graves'disease that followed subacute thyroiditis are still unknown. However, the inflammatory nature of subacute thyroiditis may lead to the activation of the autoimmune response in susceptible subjects, resulting in the onset of Graves' disease. Graves' disease should be suspected when a high blood level of thyroid hormone persists after subacute thyroiditis.

  17. Enfermedad de Carrión grave complicada con leptospirosis aguda: reporte de un caso

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    Anderson Huerta

    Full Text Available Se reporta el caso de un adulto varón de 56 años, procedente de Sihuas (Ancash que acude al Hospital Nacional Dos de Mayo con cuadro clínico caracterizado por un síndrome ictérico febril anemizante, en cuya evolución tórpida de solo tres días de hospitalizado presenta anemia severa (Hb: 11,8 a 6,7 g/dL así como mialgias generalizadas asociadas a un empeoramiento brusco de la ictericia correlacionada con elevación de bilirrubinas (BT: 3,2 a 19,6 mg/dL a predominio directo y deterioro general del paciente; por ello, se realizó la investigación microbiológica donde se encontró frotis y cultivo positivo para Bartonella bacilliformis, posteriormente, la serología (microaglutinación resultó positiva para Lesptospira serovar Pomona. El paciente recibe tratamiento antibiótico específico (ceftriaxona y ciprofloxacino, se le transfunde dos paquetes globulares, mejora clínicamente y es dado de alta

  18. Hashimoto's thyroiditis following Graves' disease.

    Science.gov (United States)

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

    2010-01-01

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

  19. Suscetibilidade genética na lesão pulmonar aguda e síndrome da angústia respiratória aguda Genetic susceptibility in acute lung injury and acute respiratory distress syndrome

    Directory of Open Access Journals (Sweden)

    Fernando Suparregui Dias

    2009-12-01

    Full Text Available A lesão pulmonar aguda e sua forma mais grave, a síndrome da angústia respiratória aguda, são o denominador comum de várias doenças que podem provocar uma inflamação exagerada nos pulmões. Nos últimos anos, essa variabilidade tem sido atribuída, pelo menos em parte, a fatores genéticos. O presente estudo tem por objetivos revisar o papel dos principais genes envolvidos na suscetibilidade, morbidade e mortalidade na lesão pulmonar aguda e na síndrome da angústia respiratória aguda. Através de pesquisa nas bases de dados PubMed e LiLACS, empregando-se os unitermos lesão pulmonar aguda, síndrome da angústia respiratória aguda e síndrome da angústia respiratória do adulto em combinação com polimorfismos genéticos, foram selecionados 69 artigos, dos quais 38 foram incluídos nesta revisão. Foram também considerados artigos relevantes extraídos das referências bibliográficas nos artigos selecionados das bases de dados. Os polimorfismos genéticos são variantes gênicas presentes em pelo menos 1% da população. A presença destas variantes genéticas pode influenciar a expressão de mediadores da resposta inflamatória, afetando diretamente a suscetibilidade à lesão pulmonar aguda, a intensidade da inflamação no parênquima pulmonar, a evolução e o desfecho destes pacientes. Estudos de associação com grandes populações e passíveis de reprodução permitirão de modo definitivo a inclusão da genômica no arsenal diagnóstico, prognóstico e terapêutico de pacientes com lesão pulmonar aguda/síndrome da angústia respiratória agudaAcute lung injury and its most severe presentation, acute respiratory distress syndrome, are a common denominator for several diseases which can lead to exaggerated lung inflammation. In the last years this variability has been ascribed, at least partially, to genetic issues. This study aims to review the role of the main genes involved in acute lung injury and acute respiratory

  20. Soporte nutricional en la insuficiencia renal aguda

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    O. Cristina Olivos, Dra.

    2010-07-01

    Full Text Available La insuficiencia renal aguda (IRA se presenta frecuentemente en distintas condiciones clínicas y es especialmente frecuente en unidades de cuidados intensivos. La presencia de IRA se considera como un factor de riesgo independiente de morbilidad y mortalidad hospitalaria. De ahí la importancia de evaluar los diversos factores determinantes de su evolución, entre los que cuenta la desnutrición calórico-proteica. El propósito de esta revisión es analizar la literatura más relevante hasta la actualidad en este tema.

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

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    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

  2. Mouse Models of Graves' Disease

    OpenAIRE

    Nagayama, Yuji

    2005-01-01

    Graves' disease is characterized by overstimulation of the thyroid gland with agonistic autoantibodies against the thyrotropin (TSH) receptor, leading to hyperthyroidism and diffuse hyperplasia of the thyroid gland. Our and other laboratories have recently established several animal models of Graves' hyperthyroidism with novel immunization approaches, i.e., in vivo expression of the TSH receptor by injection of syngeneic living cells co-expressing the TSH receptor and major histocompatibility...

  3. Comportamento da síndrome coronariana aguda: resultados de um registro brasileiro

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    Leopoldo Soares Piegas

    2013-06-01

    Full Text Available FUNDAMENTO: O Brasil carece de registros multicêntricos publicados de síndrome coronariana aguda. OBJETIVO: O Registro Brasileiro de Síndrome Coronariana Aguda é um estudo multicêntrico nacional com objetivo de apresentar dados representativos das características clínicas, e manejo e evolução hospitalares dessa síndrome. MÉTODOS: Participaram 23 hospitais de 14 cidades. Foram elegíveis pacientes que se apresentaram com suspeita de síndrome coronariana aguda nas primeiras 24 horas, com quadro clínico sugestivo, associado a alterações eletrocardiográficas compatíveis e/ou marcadores de necrose. O seguimento foi realizado até o óbito ou a alta hospitalar. RESULTADOS: Entre os anos de 2003 e 2008, foram incluídos 2.693 pacientes com diagnóstico de síndrome coronariana aguda, sendo 864 (32,1% mulheres. O diagnóstico final foi de angina instável para 1.141 (42,4% pacientes, com mortalidade de 3,06% deles; de infarto agudo do miocárdio sem supradesnível de ST para 529 (19,6% pacientes, com mortalidade de 6,8% deles; e de infarto agudo do miocárdio com supradesnível de ST para 950 (35,3% pacientes, com mortalidade de 8,1% deles; tiveram diagnóstico não confirmado 73 (2,7% pacientes, com mortalidade de 1,36% deles. A mortalidade global foi de 5,53%. O modelo de regressão logística múltipla identificou o gênero feminino (OR=1,45, o diabetes melito (OR=1,59, o índice de massa corporal (OR=1,27 e a intervenção coronariana percutânea (OR=0,70 como fatores de risco de óbito, para demografia e intervenções. Um modelo para óbito por complicações maiores identificou choque cardiogênico/Edema Agudo de Pulmão (OR=4,57, reinfarto (OR=3,48, acidente vascular cerebral (OR=21,56, sangramento grave (OR=3,33, parada cardiorrespiratória (OR=40,27 e classe funcional de Killip (OR=3,37. CONCLUSÃO: Os dados do Registro Brasileiro de Síndrome Coronariana Aguda não diferem de outros coletados fora do país. Seus achados poder

  4. Intoxicaciones agudas en pediatría

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    Yalena Prado Vizcaíno

    2011-12-01

    Full Text Available Introducción: las intoxicaciones han sido en los últimos años una importante causa de aumento de la morbilidad y mortalidad en edades pediátricas. Objetivo: determinar el comportamiento clínico de las intoxicaciones agudas en la etapa de enero de 2005 a diciembre de 2009 en el Hospital Pediátrico "William Soler". Métodos: el estudio se realizó en el Hospital "William Soler". Se revisaron las historias clínicas, los registros de intoxicaciones agudas y las tarjetas de codificación de egresos hospitalarios por intoxicaciones de los pacientes llegados al hospital en esta etapa. Resultados: se recibieron en el hospital 886 pacientes. El grupo de mayor frecuencia de intoxicaciones fue el de 1 a 5 años, con predominio del sexo masculino, aunque sin diferencias significativas con respecto al sexo femenino. Las intoxicaciones más frecuentes fueron por medicamentos, fundamentalmente psicofármacos y antibióticos, seguido por alimentos y por productos químicos del hogar. El 30,2 % de los casos fueron ingresados. Conclusiones: estos resultados nos hacen pensar en la necesidad de estar alertas y crear acciones encaminadas a proteger o evitar las intoxicaciones en edades tan vulnerables.

  5. INSUFICIENCIA RENAL AGUDA CON UREMIA NORMAL EN PACIENTE MONO-RENO SECUNDARIA A PIELONEFRITIS AGUDA

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    Musso CG

    2006-03-01

    Full Text Available RESUMEN:La insuficiencia renal aguda es un sindrome que característicamente cursa con niveles plasmáticos elevados de urea y creatinina. Sin embargo, hay situaciones clínicas en las cuales este sindrome puede cursar con un incremento de la creatininemia sin presentar elevación de la uremia.En este reporte presentamos un caso clínico de una insuficiencia renal aguda con uremia normal secundaria a una pielonefritis aguda en un paciente con riñón único. El paciente presentaba una elevada excreción fraccional de urea lo cual podía explicar su uremia normal pese a estar cursando una caída del filtrado gomerular. Dicha excreción de urea elevada fue interpretada como secundaria a una diabetes insipida nefrogénica y una alteración en el recirculado intra-renal de la urea ambos producto de la pielonefritis aguda. Concluimos que la pielonefritis aguda en un paciente mono-reno puede presentarse con un patrón de insuficiencia renal aguda con uremia normal. SUMMARYAcute renal failure is a syndrome that usually runs with an increase in creatinine and urea plasma levels. However, there are clinical situations in which this syndrome may run with an increase in plasma creatinine keeping normal the urea one.In this report we present a case of acute renal failure with normal plasma urea level secondary to an acute pyelonephritis in a single kidney patient. The patient had an increased fractional excretion of urea which could explain the normal plasma urea levels found despite of his reduced glomerular filtration. This increased urea excretion state was interpreted as a consequence of the nephrogenic diabetes insipidus and alteration of the intra-renal urea reciclying process that the acute pyelonephritis induced. In conclusion: Acute pyelonephritis in a single kidney patient can appear as a pattern of acute renal failure with normal plasma urea levels.

  6. INSUFICIENCIA RENAL AGUDA CON UREMIA NORMAL EN PACIENTE MONO-RENO SECUNDARIA A PIELONEFRITIS AGUDA

    Directory of Open Access Journals (Sweden)

    Musso CG

    2007-04-01

    Full Text Available RESUMENLa insuficiencia renal aguda es un sindrome que característicamente cursa con niveles plasmáticos elevados de urea y creatinina. Sin embargo, hay situaciones clínicas en las cuales este sindrome puede cursar con un incremento de la creatininemia sin presentar elevación de la uremia. En este reporte presentamos un caso clínico de una insuficiencia renal aguda con uremia normal secundaria a una pielonefritis aguda en un paciente con riñón único. El paciente presentaba una elevada excreción fraccional de urea lo cual podía explicar su uremia normal pese a estar cursando una caída del filtrado gomerular. Dicha excreción de urea elevada fue interpretada como secundaria a una diabetes insipida nefrogénica y una alteración en el recirculado intra-renal de la urea ambos producto de la pielonefritis aguda. Concluimos que la pielonefritis aguda en un paciente mono-reno puede presentarse con un patrón de insuficiencia renal aguda con uremia normal.SUMMARYAcute renal failure is a syndrome that usually runs with an increase in creatinine and urea plasma levels. However, there are clinical situations in which this syndrome may run with an increase in plasma creatinine keeping normal the urea one. In this report we present a case of acute renal failure with normal plasma urea level secondary to an acute pyelonephritis in a single kidney patient. The patient had an increased fractional excretion of urea which could explain the normal plasma urea levels found despite of his reduced glomerular filtration. This increased urea excretion state was interpreted as a consequence of the nephrogenic diabetes insipidus and alteration of the intra-renal urea reciclying process that the acute pyelonephritis induced. In conclusion: Acute pyelonephritis in a single kidney patient can appear as a pattern of acute renal failure with normal plasma urea levels.

  7. Escleroterapia versus somatostatina na hemorragia digestiva alta por ruptura de varizes esofágicas

    Directory of Open Access Journals (Sweden)

    RAMIRES Renata Pereira

    2000-01-01

    Full Text Available Comparação da eficácia da somatostatina e da escleroterapia no sangramento digestivo proveniente da ruptura de varizes do esôfago. Foram avaliados prospectivamente 40 pacientes com hemorragia digestiva. Vinte e um pacientes foram randomizados a receber somatostatina (dose inicial de 250 mig seguida de infusão contínua de 250 µg/h por 48 h com reforços de 250 µg de 6/6 h nas primeiras 24 h e 19 realizaram escleroterapia com oleato de etanolamina a 5%, sendo avaliados em 48 horas e no sétimo dia após o tratamento. Os grupos eram semelhantes quanto a sexo, idade, gravidade do sangramento e grau de falência hepatocelular. Falha terapêutica ocorreu em 48 h e 7 dias, respectivamente, em 26,3% e 35,7% no grupo da escleroterapia e em 23,8% e 21,4% no da somatostatina. A necessidade de transfusão (3,38 U no grupo da escleroterapia e 2,42 U no da somatostatina e a mortalidade (31,6% no grupo da escleroterapia e 28,6% no grupo da somatostatina também foram semelhantes (P >0,05. Conclui-se que a somatostatina é tão efetiva quanto a escleroterapia, devendo ser considerada no tratamento do sangramento agudo decorrente de ruptura de varizes do esôfago.

  8. [Grave's disease and stress].

    Science.gov (United States)

    Santos, A Matos; Nobre, E Lacerda; Garcia e Costa, J; Nogueira, P J; Macedo, Ana; De Castro, J Jácome; Teles, A Galvão

    2002-01-01

    In recent years, there have been many reports about a possible association between Stressful Life Events (SLE) and the onset of Graves' Disease (GD). Nevertheless, most papers have been criticised and no such association has yet been proven. To assess the possible associations between SLE and the onset of GD. Retrospective study of 62 subjects, divided into 2 groups of 31 each, GD (Gp1) and controls (Gp2). The patients in Gp1 had thyroid disease diagnosed within the last 12 months, with clinical and biochemical confirmation. In Gp2, psychopathological and endocrine disturbances had been ruled out. Each 2 group consisted of 9 males (29%) and 22 females (71%). The mean age was 38.48 + 10.9 in Gp1 and 41.1 + 11.8 in Gp2. SLE evaluation (number and impact) was reported for the 12 months preceding the onset of symptoms of thyroid disease. To assess SLE, we used the Life Experiences Survey-LES from Saranson, Johnson and Siegel (1978; 1985). Statistical analysis was done using Mann-Whitney and Kruskal-Wallis tests. Patients with GD had a significantly greater number of SLEs compared to Controls (p < .001). The number and impact of negative SLEs was significantly higher in Gp1 compared to Gp2 (p < .001). There were no significant differences between the groups in terms of the number and impact of both positive and neutral SLEs. The findings of this study support that SLEs may contribute to the precipitation of GD. We observed that patients with GD had significantly more negative events and experienced a greater negative impact from them prior to the onset of GD. The association of SLEs with GD is probably related to the association of stress with changes in the immune system, which can play an important role in the aetiology of thyrotoxicosis.

  9. Immunosuppression in Graves' ophthalmopathy

    International Nuclear Information System (INIS)

    Tian Rong; Kuang Anren; Qin Weishi; Zhang Huimin

    2000-01-01

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

  10. Avances en el tratamiento farmacológico de la hemorragia digestiva de origen oscuro Update on medical therapy for obscure gastrointestinal hemorrhage

    Directory of Open Access Journals (Sweden)

    J. Molina Infante

    2007-08-01

    Full Text Available El desarrollo de la cápsula endoscópica y la enteroscopia de doble balón ha aumentado las tasas de diagnóstico y tratamiento en la hemorragia digestiva de origen oscuro, en la que las angiodisplasias del intestino delgado son la causa más frecuente. Sin embargo, el 25-40% de los pacientes, no subsidiarios o no respondedores a la terapéutica endoscópica, angiográfica o quirúrgica, pueden tener alto riesgo de resangrado y carecen de tratamiento médico claramente eficaz. La utilidad de la terapia hormonal está cuestionada actualmente, sin olvidar los frecuentes y limitantes efectos secundarios. El octreótido suele ser eficaz en el control de la hemorragia pero no parece la terapia de mantenimiento más óptima. Los beta-bloqueantes no selectivos, de igual manera que en la profilaxis de la hemorragia por hipertensión portal, pueden ser útiles en combinación con otros fármacos. Recientemente, el octreotido LAR, una formulación de liberación retardada que se administra una vez al mes por vía intramuscular, y la talidomida oral, un potente inhibidor de la angiogénesis, han demostrado su eficacia y seguridad a largo plazo en casos graves aislados.The development of capsule endoscopy and double-balloon enteroscopy has increased diagnostic and therapeutic rates in obscure gastrointestinal hemorrhage, where angiodysplasia of the small bowel is the most frequent cause. Nevertheless, almost 25-40% of patients who are not candidates or do not respond to endoscopic, angiographic, or surgical management may be at high risk of rebleeding, and therefore lack a clearly effective medical therapy. The utility of hormonal therapy remains unclear and is burdened by adverse effects. Subcutaneous octreotide usually controls bleeding but does not seem adequate for mainteinance therapy. Non-selective beta-blockers alone or in combination with other treatments, as in the prophylaxis of portal hypertension variceal bleeding, may be helpful. Recently

  11. Insuficiencia renal aguda con necrosis tubular aguda secundaria a picadura masiva de abejas

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    Gustavo A. Aroca - Martínez

    2006-01-01

    Full Text Available Leñador de 46 años consulta al servicio de nefrología, de la Clínica Renal de la Costa en Barranquilla, con episodio de insuficiencia renal aguda 48 horas después de haber sufrido múltiples picaduras por abejas africanizadas. Durante su estancia hospitalaria presentó incremento de enzimas musculares (AST LDH, y de pruebas de función renal, motivo por el cual fue dializado en varias ocasiones. Con mejoría total, se decide egresar y manejar ambulatoriamente. Se concluye que el caso se trata de una insuficiencia renal por necrosis tubular aguda por rabdomiolisis debida a la picadura múltiple de abejas africanizadas.

  12. Grave's disease 1835-2002.

    Science.gov (United States)

    Weetman, A P

    2003-01-01

    This brief review describes the history of Graves' disease, starting with the original descriptions by Parry, Graves and von Basedow. The true aetiology of the disorder was uncovered in the 1950s and 1960s, based on the search for a novel thyroid stimulator which turned out to be an immunoglobulin G autoantibody. Assays for these thyroid stimulatory antibodies have been continually refined and their epitopes on the thyroid stimulating hormone receptor are increasingly well characterized. We also understand far more about the genetic and environmental susceptibility factors that predispose to disease, and even thyroid-associated ophthalmopathy has now been better defined as primarily a T-cell-mediated disease resulting from cytokine stimulation of orbital fibroblasts. These advances should improve treatment options for Graves' disease in the foreseeable future.

  13. Falla cardíaca aguda

    OpenAIRE

    Sénior Sánchez, Juan Manuel; Gándara Ricardo, Jairo Alfonso

    2015-01-01

    Se presenta el caso clínico de una mujer de 26 años de edad, que acudió al Hospital Universitario San Vicente Fundación (Medellín) con síntomas y signos de falla cardíaca aguda y diagnóstico previo de falla cardíaca crónica con fracción de expulsión disminuida, de origen no claro, tromboembolismo pulmonar y ataque cerebrovascular isquémico, sin modulación neurohormonal óptima. Ingresó a la institución con hallazgos clínicos de sobrecarga hídrica y baja perfusión tisular, con requerimiento de ...

  14. Coréia aguda na gravidez

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    Walter C. Pereira

    1967-12-01

    Full Text Available São apresentados doze casos de coréia aguda observados entre 150.000 gestantes (1/12.500. A maioria dos surtos ocorreu no segundo trimestre da primeira gravidez. A duração média dos sintomas foi de três meses, não tendo sido registrado caso algum de óbito materno. Todos os partos foram espontâneos e normais. Houve apenas um óbito fetal conseqüente a choque hemorrágico. São tecidas considerações a propósito dos aspectos clínico, laboratorial e prognóstico da coréia gravídica, sendo focalizado mais pormenorizadamente o problema fisiopatogênico dessa afecção.

  15. Optimal management of Graves orbitopathy: a multidisciplinary approach

    NARCIS (Netherlands)

    Soeters, M. R.; van Zeijl, C. J. J.; Boelen, A.; Kloos, R.; Saeed, P.; Vriesendorp, T. M.; Mourits, M. P.

    2011-01-01

    Graves' thyroid disease is a relatively common disorder in endocrinology and general internal medicine practice. Graves' hyperthyroidism is mediated by circulating stimulating autoantibodies. Up to 60% of patients with Graves' hyperthyroidism develop some form of Graves' orbitopathy. Immune

  16. Graves disease hyperthyroidism and glycometabolism

    International Nuclear Information System (INIS)

    Sun Qiting; Zhao Deshan

    2010-01-01

    The Patients with Graves disease hyperthyroidism are often accompanied by disorder of glycometabolism. β-cell dysfunction and insulin resistance play a main role in this disease, while the immune and genetic factors are also relevant with the disease. The blood glycose level can become normal gradually with the recovery of thyroid hormone after 131 I and antithyroid drug treatment. Therefore, the blood glycose level could be improved and complications could be prevented by early treatment in the patients with Graves disease hyperthyroidism accompanied with glycometabolism disorder is helpful for improving the blood glycose level. (authors)

  17. Hemorragia digestiva alta no varicosa: comportamiento e índice de Rockall

    Directory of Open Access Journals (Sweden)

    John Karol Ramírez

    Full Text Available Introducción: la hemorragia digestiva alta no varicosa es actualmente una emergencia quirúrgica de difícil manejo, hecho que motivó el conocer su comportamiento y, usando el índice de Rockall, el riesgo de los afectados de sufrir resultados adversos durante su evolución, aquellos de posible alta precoz y las causas que la impiden. Métodos: estudio descriptivo de corte transversal realizado en el Hospital General Docente "Ernesto Guevara de la Serna" con 182 pacientes atendidos entre 2009 y 2010. Resultados: los hombres fueron los más afectados (54,4 % y el grupo de 60-80 años tuvo el mayor número de casos. La úlcera gastroduodenal fue la primera causa (52,7 %. La melena se presentó como manifestación inicial en el 60,4 % de los pacientes. La hipertensión arterial fue la comorbilidad más frecuente (60,7 %. El 44,5 % de los pacientes necesitó transfusión sanguínea. La mortalidad fue del 8,2 %. La mayor parte de la muestra se ubicó en el grupo de riesgo intermedio de Rockall (40,1 %. Recibió alta precoz solo el 11,5 % de los pacientes, y la inestabilidad hemodinámica (38 % fue la mayor responsable de este bajo número. El Rockall tuvo sensibilidad del 98,3 %, especificidad del 56,9 %, valor predictivo positivo del 52,3 %, valor predictivo negativo del 98,6 % y una exactitud del 70,9 %. En los pacientes clasificados de bajo riesgo la única complicación fue la recidiva (1,4 %. Conclusiones: el alta precoz puede ser dada a pacientes con Rockall bajo, siempre que se preste especial atención a la estabilidad hemodinámica.

  18. Graves' disease and Thyroid anaplasic carcinoma

    International Nuclear Information System (INIS)

    Guerrero E, Helena; Quintero A, Flor Maria; Carmona C, Antonio

    1992-01-01

    A case of a 34 year-old patient is presented, who was diagnosed with Graves' disease and developed a thyroid anaplastic carcinoma from a clinically detected nodular mass. The incidence of thyroid cancer associated with Graves' disease is revisited

  19. Death by suicide in Graves' disease and Graves' orbitopathy

    DEFF Research Database (Denmark)

    Ferløv-Schwensen, Charlotte; Brix, Thomas Heiberg; Hegedus, Laszlo

    2017-01-01

    BACKGROUND: Graves' disease is associated with excess morbidity and mortality, but little is known about unnatural manners of death and the potential relation with Graves' orbitopathy. Here we investigate the risk of unnatural death in Graves' patients with orbitopathy (GO) and without (GD), comp...... in the pathophysiological mechanisms of suicidal behavior. Beyond independent confirmation, reasons for this need to be explored in order to introduce preventive measures....... with GD, and 3,965 with GO were identified and matched for age and gender with four subjects from the background population. Manner of death was identified and hazard ratios (HR) for mortality due to unnatural deaths (accident, suicide, violence/homicide, and unknown) were calculated using Cox regression...... analyses, adjusted for pre-existing somatic and psychiatric morbidity. RESULTS: In Graves' disease overall there was an increased risk of death from unknown unnatural manners [HR: 2.01 (95% confidence interval: 1.17-3.45); P=0.012] and of suicide, although the latter difference was not with certainty...

  20. Temporal relationship between onset of Graves' ophthalmopathy and onset of thyroidal Graves' disease

    NARCIS (Netherlands)

    Wiersinga, W. M.; Smit, T.; van der Gaag, R.; Koornneef, L.

    1988-01-01

    The temporal relationship between the onset of Graves' ophthalmopathy and the onset of thyroidal Graves' disease was evaluated in 125 consecutive patients with Graves' ophthalmopathy. Thyroidal Graves' disease--past or present--was clinically evident in 99 patients (79%): hyperthyroidism in 3 cases.

  1. Recidivas de hemorragia digestiva alta en pacientes atendidos en el Hospital General Docente Dr. Ernesto Guevara de la Serna

    OpenAIRE

    Alina Torreblanca Xiques

    2014-01-01

    Se realizó un estudio descriptivo en pacientes con hemorragia digestiva alta por úlcera péptica que hicieron resangrado, con el objetivo de caracterizarlos. Se estudiaron las variables de grupos de edades y sexo afectados, los hallazgos endoscópicos, las formas de presentación, así como factores asociados. La población de estudio estuvo constituida por los 82 pacientes, que ingresaron en el servicio de gastroenterología del Hospital Provincial Docente “Dr. Ernesto Guevara de la Serna” de la p...

  2. Relação entre polimorfismos de IL-8 e a gravidade da bronquiolite viral aguda

    OpenAIRE

    Leitão, Lidiane Alves de Azeredo

    2013-01-01

    Introdução : Até os 2 anos de idade, praticamente, todos os lactentes apresentam infecção por vírus sincicial respiratório (VSR). Entretanto, a gravidade da bronquiolite viral aguda (BVA) pode variar significativamente. Essa grande variação pode ser causada por fatores genéticos e imunológicos. Estudos prévios indicam que vias aéreas infectadas por VSR contêm níveis elevados de interleucina-8 (IL-8). O conhecimento de polimorfismos genéticos associados à BVA grave pode ter grande relevância c...

  3. Secrets of a Mass Grave

    Science.gov (United States)

    Ament, Caitlin Marie; Graham, Theodore J.

    2017-01-01

    This article presents a unit of study in which students examine skeletons and draw conclusions from the evidence they find in a simulated mass grave. The activity involves the foundation of forensic anthropology--interpreting the structure of skeletal remains to determine sex, age, height, and possible cause of death. Working through a series of…

  4. Medical management of Graves' ophthalmopathy

    NARCIS (Netherlands)

    Prummel, M. F.; Wiersinga, W. M.

    1995-01-01

    In most patients with Graves' hyperthyroidism the eye signs are self-limiting and mostly subclinical. However, about one-third of the patients have clinically relevant ophthalmopathy, which can be disabling and disfiguring. The mechanical causes of the symptoms and signs of the eye disease are

  5. Biologiske behandlingsmuligheder ved Graves' oftalmopati

    DEFF Research Database (Denmark)

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

    2008-01-01

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

  6. Recidivas de hemorragia digestiva alta en pacientes atendidos en el Hospital General Docente Dr. Ernesto Guevara de la Serna

    Directory of Open Access Journals (Sweden)

    Alina Torreblanca Xiques

    2014-11-01

    Full Text Available Se realizó un estudio descriptivo en pacientes con hemorragia digestiva alta por úlcera péptica que hicieron resangrado, con el objetivo de caracterizarlos. Se estudiaron las variables de grupos de edades y sexo afectados, los hallazgos endoscópicos, las formas de presentación, así como factores asociados. La población de estudio estuvo constituida por los 82 pacientes, que ingresaron en el servicio de gastroenterología del Hospital Provincial Docente “Dr. Ernesto Guevara de la Serna” de la provincia de Las Tunas, desde febrero 2012 a febrero del 2014. El sexo más afectado fue el masculino, predominando en la sexta década de la vida, la gastritis erosiva hemorrágica es el hallazgo endoscópico que se presentó con mayor frecuencia, siendo la cara anterior del bulbo duodenal la ubicación topográfica más afectada. La hipertensión arterial fue la enfermedad asociada a la hemorragia digestiva alta que predominó, en 45 pacientes, presentando como factor frecuente la ingestión de antiinflamatorios no estereoideos (AINES, constituyendo la melena la forma de aparición más frecuente

  7. Malondialdehyde in early phase of acute pancreatitis Malondialdehído en la fase inicial de la pancreatitis aguda

    Directory of Open Access Journals (Sweden)

    Vicent Hernández

    2011-11-01

    grave. La concentración de malondialdehído descendió desde el primer al cuarto día (0,600 vs. 0,451 vs. 0,343 μM, respectivamente, p 0,05. En los episodios graves la concentración de malondialdehído fue superior que en el grupo control en el día 2 (grave: 0,514; leve: 0,440; control: 0.347 μM, p < 0,05 grave vs. control. Conclusiones: en la pancreatitis aguda existe un estrés oxidativo precoz. En los episodios graves, el estrés oxidativo permanece elevado durante más tiempo que en los episodios leves. El desarrollo de complicaciones se asocia a una elevada concentración de malondialdehído.

  8. Thyroid surgery for Graves' disease and Graves' ophthalmopathy.

    Science.gov (United States)

    Liu, Zi Wei; Masterson, Liam; Fish, Brian; Jani, Piyush; Chatterjee, Krishna

    2015-11-25

    Graves' disease is an autoimmune disease caused by the production of auto-antibodies against the thyroid-stimulating hormone receptor, which stimulates follicular cell production of thyroid hormone. It is the commonest cause of hyperthyroidism and may cause considerable morbidity with increased risk of cardiovascular and respiratory adverse events. Five per cent of people with Graves' disease develop moderate to severe Graves' ophthalmopathy. Thyroid surgery for Graves' disease commonly falls into one of three categories: 1) total thyroidectomy, which aims to achieve complete macroscopic removal of thyroid tissue; 2) bilateral subtotal thyroidectomy, in which bilateral thyroid remnants are left; and 3) unilateral total and contralateral subtotal thyroidectomy, or the Dunhill procedure. Recent American Thyroid Association guidelines on treatment of Graves' hyperthyroidism emphasised the role of surgery as one of the first-line treatments. Total thyroidectomy removes target tissue for the thyroid-stimulating hormone receptor antibody. It controls hyperthyroidism at the cost of lifelong thyroxine replacement. Subtotal thyroidectomy leaves a thyroid remnant and may be less likely to lead to complications, however a higher rate of recurrent hyperthyroidism is expected and revision surgery would be challenging. The choice of the thyroidectomy technique is currently largely a matter of surgeon preference, and a systematic review of the evidence base is required to determine which option offers the best outcomes for patients. To assess the optimal surgical technique for Graves' disease and Graves' ophthalmopathy. We searched the Cochrane Library, MEDLINE and PubMed, EMBASE, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). The date of the last search was June 2015 for all databases. We did not apply any language restrictions. Only randomised controlled trials (RCTs) involving participants with a diagnosis

  9. Genetic susceptibility to Grave's disease.

    Science.gov (United States)

    Li, Hong; Chen, Qiuying

    2013-06-01

    The variety of clinical presentations of eye changes in patients with Graves' disease (GD) suggests that complex interactions between genetic, environmental, endogenous and local factors influence the severity of Graves' ophthalmopathy (GO). It is thought that the development of GO might be influenced by genetic factors and environmental factors, such as cigarette smoking. At present, however, the role of genetic factors in the development of GO is not known. On the basis of studies with candidate genes and other genetic approaches, several susceptibility loci in GO have been proposed, including immunological genes, human leukocyte antigen (HLA), cytotoxic T-lymphocyte antigen-4 (CTLA-4), regulatory T-cell genes and thyroid-specific genes. This review gives a brief overview of the current range of major susceptibility genes found for GD.

  10. Bruising of the esophagus as a cause of gastrointestinal bleeding in a case of heatstroke Hematomas esofágicos como causa de hemorragia digestiva en un caso de golpe de calor

    Directory of Open Access Journals (Sweden)

    A. J. Lucendo Villarín

    2005-08-01

    Full Text Available Alterations in blood clotting are a frequent complication of serious heatstroke and may result in gastrointestinal bleeding. We report the case of a 26-year-old man who was admitted to our hospital with symptoms of hyperthermia associated with encephalopathy and disseminated intravascular coagulation (DIC after prolonged exposure to sunlight. He presented hematemesis, after which he was diagnosed with having a bruising of the esophagus that took up the upper and lower thirds, there being no other lesions in the stomach or duodenum. After supportive treatment and following the resolution of the underlying pathology, the endoscopy-revealed injuries healed with a complete normalization of the esophageal mucosa. Esophageal submucosal bruising is an exceptional cause of hematemesis in serious heatstroke not previously described in the literature.Las alteraciones de la coagulación son una complicación frecuente en el golpe de calor grave, y pueden ser causa de hemorragia digestiva. Presentamos el caso de un varón de 26 años que fue admitido en nuestro hospital por un cuadro de hipertermia, asociado con encefalopatía y coagulación intravascular diseminada tras exposición solar prolongada. Presentó hematemesis por la que fue diagnosticado de múltiples hematomas esofágicos que ocupaban los tercios superior e inferior del órgano, en ausencia de otras lesiones en estómago y duodeno. Tras el tratamiento de soporte y la resolución de la patología subyacente, desaparecieron las lesiones endoscópicas, normalizándose la mucosa esofágica.

  11. Graves' disease in Albanian children.

    Science.gov (United States)

    Gjikopulli, A; Tomori, Sonila; Kollçaku, L; Hoxha, P; Grimci, Lindita; Ylli, Zamira

    2014-01-01

    Graves' disease (GD) accounts for 10-15% of thyroid disorders in patients less than 18 years of age. It is the most common cause of thyrotoxicosis in children and accounts for at least 95% of cases in children. Pediatric Treatment of Graves' disease consists of anti-thyroid drugs, radioactive iodide and thyroidectomy but the optimal treatment of GD in children is still controversial. To review treatment outcome of pediatric Graves' disease in Albania. Descriptive review of 15 children with Graves' disease, diagnosed from Jan.2007 to Dec. 2013, at the Division of Pediatric Endocrinology, Department of Pediatrics, University Hospital Centre "Mother Teresa", Albania was performed. All patients, mean age 10.56 ± 3.37 years, (range 2.02-16.09 years) were presented with goiter and increased serum FT4, mean 39.80 ± 16.02 ng/mL, (range 21.0-74.70 ng/mL), serum FT3, mean 12.98 ± 3.45 pg/mL, (range 6.90 -17.90 pg/mL) and suppressed TSH levels, mean 0.02 ± 0.01 mUI/L, (range 0.01-0.05 mUI/L). Anti TSH Receptor were positive in 100% of patients mean value 6.51 ± 3.61 UI/mL (range 1.63 - 14.10 UI/mL). Anti-thyroglobulin and Anti-TPO antibodies were positive in 60% and 46.6% respectively. Clinical course of 15 patients after treatment with anti-thyroid drugs mainly MMI for 3.19 ± 1.48 (range 0.60 - 6.20) years is as follows: seven (46.66%) underwent remission, five out of seven (71.41%) who underwent remission, relapsed. Three of them (20%) were treated with I(131), and two (13.3%) underwent to total thyroidectomy. MMI was the most common first line therapy in the presented patients with Graves' disease. Remission rate was 46.66% after an average 1.48 ± 0.71 years (range 0.60 - 2.70 years) of treatment with anti-thyroid drugs. Remission period was 2.70 ± 0.36 years (2.1 - 3.1 years) Relapse occurred in 71.41% of patient. I(131) and thyroidectomy were used as second line therapy in the present study.

  12. 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.

  13. Lesiones periapicales agudas en pacientes adultos

    Directory of Open Access Journals (Sweden)

    María Elena Fernández Collazo

    2012-06-01

    Full Text Available Se realizó un estudio analítico de corte transversal en el área de salud del Policlínico "27 de Noviembre" del municipio Marianao, La Habana, en el periodo correspondiente de enero a diciembre de 2009. Se incluyeron todos los pacientes que acudieron al servicio de urgencia y que presentaron lesiones periapicales agudas. Se recogió información de las variables edad, sexo, grupo dentario, causa de la enfermedad, características clínicas e higiene bucal. Esta última se clasificó en las categorías eficiente y deficiente según el índice simplificado de higiene bucal. Se utilizó el X² para estimar la relación entre las variables, y la comparación de proporciones para contrastar la hipótesis de que existieran diferencias entre las lesiones periapicales para las categorías de las variables grupo dentario, causa de la enfermedad y características clínicas. Se encontró un predominio del absceso periapical agudo en un 84,7 % del grupo de edad de 35 a 59 años y del sexo masculino, aunque no se encontraron diferencias significativas para estas variables, ni en los grupos dentarios con respecto a la enfermedad. La higiene bucal resultó estar relacionada con las lesiones periapicales. Se encontraron diferencias significativas en las lesiones periapicales respecto a todas las causas estudiadas, con excepción de las enfermedades periodontales. Respecto a las características clínicas hubo significación en cuanto al aumento de volumen del fondo del surco vestibular y la movilidad dentaria.

  14. Factores de Risco da Asma Grave

    Directory of Open Access Journals (Sweden)

    N. Adel

    1999-07-01

    Full Text Available RESUMO: Apesar da rápida progressão do conhecimento da fisiopatologia da asma e da larga difusão de meios terapêuticos de eficácia acrescida, observase um aumento da morbalidade e da morbildade da asma em numerosos paises, em particular nos paises industrialtzados, por razões ainda pouco conhecidas Estes factos permitem questionar o funcionamento do sistema de cuidados de saúde e a difusão dos progressos terapêuticos na população asmática. Os autores definem o concetto de asma aguda grave, salientando dois tipos: o tipo 1, de «instalação progressiva» em algumas horas ou dtas eo upo 2 de «instalação brutal» em menos de três horas Os factores de risco para cada urn deles parecem ser diferentes.Os autores fazem uma revisão dos factores de risco da asma grave, tendo em conta as caracterisucas individuais do doente, os factores ambientats e a intervenção da sociedade.Em relação aos factores individuais como a idade e o sexo, verificase que na infância, as taxas de internarmento por asma são mais elevadas no sexo masculino, sendo no total de internamentos em todas as idades, mais elevadas no sexo feminino e em doentes com internamentos anteriores por asma. O aumento da mortalidade por asma atinge em particular os doentes jovens economicamente desfavorecidos, pela dificuldade no acesso aos cuidados de saúde e na compra dos medicamentos, por utilizarem com menor frequência os tratamentos de crise e de fundo. Os factores psicológicos podem predispor à morte por asma no adolescente, sendo relevantes a subvalo-rização e a negação da doença por parte do doente ou da família Verificase por outro lado, um aumento da prevalência da depressão e do desespero nas cnanças com asma grave. As reacçõs psicológicas face a acontecimentos negauvos, como a morte de um ente próximo, a perda de emprego, conflitos familiares, provocam maior

  15. Antiphospholipid antibody syndrome complicated by Grave's disease.

    Science.gov (United States)

    Takahashi, Ayumi; Tamura, Atsushi; Ishikawa, Osamu

    2002-12-01

    The report describes a woman with primary antiphospholipid antibody syndrome complicated with Grave's disease. Developing symptoms included a small cutaneous nodule on her finger and subsequently ecchymotic purpura on the cheeks, ears, buttocks and lower legs. Histological examinations showed thrombosed vessels in the dermis without or with hemorrhage, respectively. Laboratory investigation revealed positive lupus anticoagulant and immunogenic hyperthyroidism due to Grave's disease. There is a close relationship between the cutaneous manifestation of antiphospholipid antibody syndrome and the activities of Grave's disease and a possible link of antiphospholipid antibody syndrome with Grave's disease was suggested both by the etiology of the disease as well as the disease activity.

  16. Atresia biliar: una enfermedad grave

    OpenAIRE

    Ramonet, Margarita; Ciocca, Mirta; Alvarez, Fernando

    2014-01-01

    La atresia biliar es una grave enfermedad que se manifiesta en los recién nacidos, y se desconoce su causa. La inflamación y destrucciónprogresiva de los conductos biliares conducen a la aparición de ictericia, coluria y acolia entre la segunda y sexta semana de vida. Como existen múltiples causas de colestasis neonatal en esta etapa de la vida, es necesario realizar un diagnóstico y derivación precoz para ofrecer un tratamiento quirúrgico, con el fin de restablecer el flujo biliar. Alrededor...

  17. Epidemiology and prevention of Graves' ophthalmopathy

    NARCIS (Netherlands)

    Wiersinga, Wilmar M.; Bartalena, Luigi

    2002-01-01

    Graves' ophthalmopathy is clinically relevant in approximately 50% of patients with Graves' disease, severe forms affecting 3%-5% of patients. Two age peaks of incidence are observed in the fifth and seventh decades of life, with slight differences between women and men. The disease is more frequent

  18. 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...

  19. Daño pulmonar agudo relacionado con la transfusión (Trali y Bartonelosis aguda

    Directory of Open Access Journals (Sweden)

    Douglas López de Guimaraes

    2006-07-01

    Full Text Available Se presenta el caso de un varón de 22 años procedente de la periferia de la ciudad de Huaraz, Perú, que acude al Hospital "Victor Ramos Guardia" de Huaraz con un tiempo de enfermedad de 14 días, febril, pálido e ictérico, en el frotis de sangre periférica se encuentran formas bacilares de Bartonella bacilliformis en 99% de la lámina; se inicia tratamiento antibiótico con ceftriaxona y ciprofloxacino. Al día siguiente se le indica transfusión de dos paquetes globulares (puesto que tenía 6,2 g/dL de Hb, dos horas después presenta dolor toráxico, tos seca exigente, vómitos, dificultad respiratoria y cianosis, en la auscultación se encuentran roncantes y crepitantes, la radiografía de tórax muestra infiltrado alveolar difuso a predominio derecho. Es trasladado a la UCI donde recibe oxígeno con máscara de reservorio, dopamina, corticoides y se inicia el monitoreo hemodinámico; responde en forma satisfactoria, sale de alta con frotis negativo a Bartonella bacilliformis. Es el primer caso de daño pulmonar agudo relacionado con la transfusión (TRALI asociado con Bartonelosis aguda con cuadro clínico - radiológico y evolución compatible, es importante distinguir entre la complicación pulmonar debido a la sepsis grave por Bartonelosis aguda, que puede producir un cuadro clínico similar y el TRALI.

  20. Current treatment of Graves' disease

    International Nuclear Information System (INIS)

    Harada, T.; Shimaoka, K.; Mimura, T.; Ito, K.

    1987-01-01

    In this review we have described the rationale for the appropriate treatment of patients with Graves' disease. Because the etiology of this disorder remains obscure, its management remains controversial. Since antithyroid drugs and radioiodine became readily available in the early 1950s, they have been widely used for the treatment of thyrotoxicosis, and the number of cases treated surgically has markedly decreased. However, almost four decades of experience have disclosed an unexpectedly high incidence of delayed hypothyroidism after radioiodine treatment and a low remission rate after antithyroid therapy. As a result, surgery is again being advocated as the treatment of choice. The three modalities of treatment have different advantages and disadvantages, and selection of treatment is of importance. In principle, we believe that for most patients a subtotal thyroidectomy should be performed after the patient has been rendered euthyroid by antithyroid drugs. We attempt to leave a thyroid remnant of 6 to 8 gm.36 references

  1. Radioiodine treatment of Grave's disease

    International Nuclear Information System (INIS)

    Heidenreich, P.; Vogt, H.; Dorn, R.; Graf, G.; Kopp, J.

    2001-01-01

    In Germany radioiodine therapy of Grave's disease is performed in patients older than 20 years, after at least one year of unsuccessful antithyroid therapy, intolerance against antithyroid medication, recurrences after surgical interventions and small goiters. Hyperthyroidism is eliminated with an ablative dose concept (300 Gy) in more than 90% associated with rate of hypothyroidism in the outcome of also more than 90%. Adverse prognostic factors are an insufficient dose to the thyroid and/or concomitant antithyreoid medication. Radioiodine therapy in Germany must be an inpatient single time approach due to quality assurance and radiation protection reasons. The mean hospitalization is only 3-4 days with the patient being discharged at an annual dose of less than 1 mSv at 2 m distance (dose rate at discharge [de

  2. [Orbital decompression in Grave's ophtalmopathy].

    Science.gov (United States)

    Longueville, E

    2010-01-01

    Graves disease orbitopathy is a complex progressive inflammatory disease. Medical treatment remains in all cases the proposed treatment of choice. Surgical treatment by bone decompression can be considered as an emergency mainly in cases of optic neuropathy or ocular hypertension not being controlled medically or in post-traumatic exophthalmos stage. Emergency bone decompression eliminates compression or stretching of the optic nerve allowing visual recovery. The uncontrolled ocular hypertension will benefit from decompression. The normalization of intraocular pressure may be obtained by this surgery or if needed by the use of postoperative antiglaucoma drops or even filtration surgery. In all operated cases, the IOP was normalized with an average decrease of 7.71 mmHg and a cessation of eye drops in 3/7 cases. Regarding sequelae, our therapeutic strategy involves consecutively surgery of the orbit, extraocular muscles and eyelids. The orbital expansion gives excellent results on the cosmetic level and facilitates the implementation of subsequent actions.

  3. Hypofractionated radiotherapy for Graves' orbitopathy

    International Nuclear Information System (INIS)

    Heyd, R.; Herkstroeter, M.; Martin, T.; Zamboglou, N.; Strassmann, G.

    2001-01-01

    Background: Radiotherapy (RT) has been proven effective in the management of Graves' orbitopathy in numerous studies. Most commonly is the use of conventional fractionated RT and the value of hypofractionated irradiation has not been investigated. Materials and methods: The results in 33 euthyroid cases who underwent RT with a total dose of 21.0 Gy given in three weekly fractions of 3.0 Gy are retrospectively analyzed. The duration of symptoms ranged from 1-84 months and all of the cases had treatment failure after previous administration of corticosteroids. After a mean follow-up period of 33.6 months the overall results were assessed according to the criteria by Donaldson et al. and for evaluation of the clinical outcome a classification with the main criteria being eye-lid changes, exophthalmos, myopathy and eye nerve involvement was used. Results: At follow-up, the overall response to RT was 84.8% (28/33 cases). The analysis with the clinical classification demonstrated that in 19/33 (57.6%) cases occurred a decrease of eye lid changes and exophthalmos and 12/33 (36.4%) had a relief of myopathy. 2/33 cases (6.0%) developed an eye nerve compression causing the necessity of surgical decompression. 3/33 cases (9.0%) had a progression of at least of one of the single criteria of the score and therefore they were classified as non-responders. Conclusions: Hypofractionated RT has been proven effective for treatment of severe cases of Graves' orbitopathy in cases with a prolongated duration of symptoms. The comparison with literature data demonstrate that the results after hypofractionated RT are comparable to those obtained after conventional fractionated RT. (orig.)

  4. Resolution of Graves' disease after renal transplantation.

    Science.gov (United States)

    Lee, Yvonne; Butani, Lavjay; Glaser, Nicole; Nguyen, Stephanie

    2016-06-01

    We report a case of an adolescent boy with Down's syndrome and ESRD on hemodialysis who developed mild Graves' disease that was not amenable to radioablation, surgery, or ATDs. After 14 months of observation without resolution of Graves' disease, he successfully received a DDRT with a steroid minimization protocol. Thymoglobulin and a three-day course of steroids were used for induction and he was started on tacrolimus, MMF, and pravastatin for maintenance transplant immunosuppression. One month after transplantation, all biochemical markers and antibody profiling for Graves' disease had resolved and remain normal one yr later. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  5. Nodular Graves' disease with medullary thyroid cancer.

    Science.gov (United States)

    Khan, Shoukat Hussain; Rather, Tanveer Ahmed; Makhdoomi, Rumana; Malik, Dharmender

    2015-01-01

    Co-existence of thyroid nodules with Graves' disease has been reported in various studies. 10-15% of such nodules harbor thyroid cancer with papillary thyroid cancer being the commonest. Medullary thyroid cancer (MTC) in nodules associated with Graves' disease is rare. On literature survey, we came across 11 such cases reported so far. We report a 62-year-old female with Graves' disease who also had a thyroid nodule that on fine-needle aspiration cytology and the subsequent postthyroidectomy histopathological examination was reported to be MTC.

  6. Sindrome confusional agudo por abstinencia aguda de nicotina Delirium due to acute nicotine withdrawal

    Directory of Open Access Journals (Sweden)

    Manuel Klein

    2002-08-01

    Full Text Available El síndrome confusional agudo (SCA o delirium en pacientes hospitalizados es un problema frecuente y grave. Se caracteriza por síntomas de comienzo agudo y curso fluctuante con inatención, pensamiento desorganizado, y con distintos niveles de alteración de la conciencia.En la bibliografía consultada, el SCA como manifestación de un síndrome de abstinencia aguda nicotínica fue descripto en solo ocho casos. Presentamos el caso de un tabaquista grave que, internado por una reagudización de su enfermedad pulmonar obstructiva crónica (EPOC, presentó un cuadro de SCA al tercer día de abstinencia tabacal, cediendo los síntomas tras la administración de un parche de nicotina. Lo descripto sugiere que en pacientes internados que presentan SCA y agitación, con fuertes antecedentes de tabaquismo, un simple ensayo con un parche de nicotina puede ofrecer en pocas horas una notable respuesta terapéutica y a su vez un test confirmatorio. El reconocimiento del SCA como forma de presentación de la abstinencia nicotínica permitirá identificar casos habitualmente complejos en los que se podrá implementar una sencilla y eficaz alternativa terapéutica.Delirium or acute confusional state among hospitalized patients is a frequent and serious problem. It is characterized by acute onset symptoms, fluctuating course, impaired attention, unorganized thinking, and altered level of conciousness. Delirium, as a manifestation of acute nicotine withdrawal syndrome has been reported in the reviewed literature only in eight cases. We report the case of a heavy smoker admitted because of a reagudization of his chronic obstructive pulmonary disease. At the third day of nicotine abstinence, he developed delirium with a rapid improvement of his symptoms after treatment with a transdermal nicotine patch. This description suggests that in hospitalized heavy smokers who develop delirium with agitation, a simple trial with a nicotine patch can offer a dramatic

  7. Citarabina y reacciones cutáneas en leucemia aguda mieloide

    Directory of Open Access Journals (Sweden)

    Sofía Grille

    2013-12-01

    Full Text Available La citarabina es un antimetabolito utilizado en el tratamiento de las leucemias agudas mieloides (LAM. Esta droga presenta numerosos efectos adversos (mielosupresión, toxicidad en sistema nervioso central, hepática, gastrointestinal, ocular y cutánea. La toxicidad dermatológica es habitualmente descrita como rara, sin embargo existen diferencias en la incidencia comunicada. Se realizó un estudio retrospectivo donde se incluyeron todas las LAM tratadas con quimioterapia que incluía citarabina, entre el 1º de julio 2006 y el 1° de julio 2012. Se incluyeron 46 pacientes con una mediana de edad de 55 años. La incidencia global de reacciones cutáneas fue de 39% (n = 18. La presencia de lesiones cutáneas no se asoció con sexo, edad, antecedentes de atopía, de reacciones medicamentosas, tipo de LAM ni dosis de citarabina utilizada. Las lesiones se observaron entre 2 a 8 días de iniciado el tratamiento. En cuanto al grado lesional, 27.8% presentaron grado 1, 38.9% grado 2 y 33.3% grado 3. No existieron lesiones grado 4 ni muerte vinculada a toxicidad cutánea. En cuanto al tipo de lesiones, 55.6% se presentaban con máculas, 22.2% con pápulas y 22.2% con eritema. Con respecto a la distribución de las lesiones, 52% de los pacientes presentaron una distribución difusa, 39.3% acral y 8.7% a nivel flexural. Las reacciones adversas cutáneas con la administración de citarabina son frecuentes en nuestro medio, en algunos casos con afectación grave. Si bien suelen resolverse espontáneamente, pueden determinar mayor riesgo de infección, así como comprometer la calidad de vida.

  8. Miopia aguda induzida por topiramato: relato de dois casos

    Directory of Open Access Journals (Sweden)

    Kathy Dadam Sgrott

    2011-06-01

    Full Text Available RESUMO A miopia aguda pode ser desencadeada pelo uso de medicações sistêmicas, dentre elas, o anticonvulsivante topiramato. Este trabalho descreve dois casos de pacientes jovens com quadro agudo bilateral de miopia induzida por terapia com topiramato para controle de síndrome depressiva, fazendo relação com casos semelhantes descritos na literatura e revisão bibliográfica pertinente.

  9. Serie de 8 casos de parotiditis supurada aguda neonatal

    Directory of Open Access Journals (Sweden)

    Manuel Díaz Álvarez

    Full Text Available La parotiditis supurada aguda es una infección poco frecuente en la práctica del pediatra y neonatólogo. El objetivo es mostrar nuestra experiencia en la atención de serie de casos con parotiditis supurada aguda en el período neonatal, y describir sus características de presentación. Se presentan los hallazgos clínicos en 8 pacientes con parotiditis supurativa neonatal, quienes estuvieron ingresados en el Servicio de Neonatología del Hospital Pediátrico Universitario "Juan Manuel Márquez", durante el período de 22 años (desde el año 1992 hasta el año 2013, y se contrasta con los reportes publicados en la literatura internacional. Las características de presentación de la parotiditis aguda supurada de nuestros casos concuerdan con la literatura revisada en muchos aspectos, y se demuestra que es, además, una infección poco frecuente en el período neonatal. Es la primera publicación sobre esta entidad en neonatos en Cuba, y la mayor serie de casos en el ámbito latinoamericano.

  10. Infusión de antibióticos continua versus intermitente para el tratamiento de las infecciones agudas graves

    Directory of Open Access Journals (Sweden)

    2014-05-01

    Conclusiones de los autores: No hubo diferencias de la mortalidad, la recurrencia de la infección, la curación clínica, la sobreinfección posterior al tratamiento ni en los resultados de seguridad al comparar las infusiones de antibióticos intravenosos continuas con las infusiones tradicionales de antibióticos intermitentes. Sin embargo, los intervalos de confianza amplios indican que no es posible descartar los efectos beneficiosos o perjudiciales de todos los resultados. Por lo tanto, las pruebas actuales no son suficientes para recomendar la adopción generalizada de la infusión de antibióticos continua en lugar de las infusiones de antibióticos intermitentes. Se necesitan ensayos aleatorios prospectivos grandes adicionales, con un informe consistente y completo de medidas de resultado clínicas, realizados con estudios simultáneos farmacocinéticos y farmacodinámicos en poblaciones especiales para determinar si la adopción de las infusiones de antibióticos continuas se justifica en circunstancias específicas.

  11. Graves' disease: thyroid function and immunologic activity

    International Nuclear Information System (INIS)

    Gossage, A.A.R.; Crawley, J.C.W.; Copping, S.; Hinge, D.; Himsworth, R.L.

    1982-01-01

    Patients with Graves' disease were studied for two years during and after a twelve-month course of treatment. Disease activity was determined by repeated measurements of thyroidal uptake of [ 9 -9μTc]pertechnetate during tri-iodothyronine administration. These in-vivo measurements of thyroid stimulation were compared with the results of in-vitro assays of Graves, immunoglobulin (TSH binding inhibitory activity - TBIA). There was no correlation between the thyroid uptake and TBIA on diagnosis. Pertechnetate uptake and TBIA both declined during the twelve months of antithyroid therapy. TBIA was detectable in sera from 19 of the 27 patients at diagnosis; in 11 of these 19 patients there was a good correlation (p<0.05) throughout the course of their disease between the laboratory assay of the Graves, immunoglobulin and the thyroid uptake. Probability of recurrence can be assessed but sustained remission of Graves' disease after treatment cannot be predicted from either measurement alone or in combination

  12. Postoperative hypocalcemia after thyroidectomy for Graves' disease.

    Science.gov (United States)

    Pesce, Catherine E; Shiue, Zita; Tsai, Hua-Ling; Umbricht, Christopher B; Tufano, Ralph P; Dackiw, Alan P B; Kowalski, Jeanne; Zeiger, Martha A

    2010-11-01

    It is believed that patients who undergo thyroidectomy for Graves' disease are more likely to experience postoperative hypocalcemia than patients undergoing total thyroidectomy for other indications. However, no study has directly compared these two groups of patients. The aim of this study was to determine whether there was an increased incidence or severity of postoperative hypocalcemia in patients who underwent thyroidectomy for Graves' disease. An institutional review board-approved database was created of all patients who underwent thyroidectomy from 1998 to 2009 at the Johns Hopkins Hospital. There were a total of 68 patients with Graves' disease who underwent surgery. Fifty-five patients who underwent total thyroidectomy were randomly selected and served as control subjects. An analysis was conducted that examined potential covariates for postoperative hypocalcemia, including age, gender, ethnicity, preoperative alkaline phosphatase level, size of goiter, whether parathyroid tissue or glands were present in the specimen, and the reason the patient underwent surgery. Specific outcomes examined were calcium levels on postoperative day 1, whether or not patients experienced symptoms of hypocalcemia, whether or not Rocaltrol was required, the number of calcium tablets prescribed upon discharge, whether or not postoperative tetany occurred, and calcium levels 1 month after discharge. Each outcome was analyzed using a logistic regression. Graves' disease patients had a significantly (p-value Graves' disease and no patient in the control group were readmitted with tetany (p = 0.033). There was a trend, though not significant, toward patients with Graves' disease having a higher prevalence of hypocalcemia the day after thyroidectomy and 1 month later. Patients with Graves' disease are more likely to require increased dosages of calcium as well as experience tetany postoperatively than patients undergoing total thyroidectomy for other indications. This suggests that

  13. [Thyroid cancer in patients with Grave's Disease].

    Science.gov (United States)

    Mssrouri, R; Benamr, S; Essadel, A; Mdaghri, J; Mohammadine, El H; Lahlou, M-K; Taghy, A; Belmahi, A; Chad, B

    2008-01-01

    To evaluate the incidence of thyroid carcinoma in patients operated on for Graves' disease, to identify criteria which may predict malignancy, and to develop a practical approach to determine the extensiveness of thyroidectomy. Retrospective study of all patients who underwent thyroidectomy for Graves' disease between 1995 and 2005. 547 patients underwent subtotal thyroidectomy for Graves' disease during this period. Post-operative pathology examination revealed six cases of thyroid cancer (1.1%). All six cases had differentiated thyroid carcinoma (papillary carcinoma in 3 cases, follicular carcinoma in 2 cases and papillo-follicular carcinoma in 1 case). The indication for initial thyroidectomy was a palpable thyroid nodule in 3 cases (50%), failure of medical treatment for Grave's disease in 2 cases (33%), and signs of goiter compression in 1 case (17%). Five patients underwent re-operative total thyroidectomy. This study shows that while malignancy in Grave's disease is uncommon, the presence of thyroid nodule(s) in patients with Grave's disease may be considered as an indication for radical surgery. The most adequate radical surgery in this situation is to perform a total thyroidectomy.

  14. 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

  15. O papel da avaliação inicial simplificada no prognóstico da pancreatite aguda

    Directory of Open Access Journals (Sweden)

    Márcio Cavalcante Carneiro

    Full Text Available OBJETIVO: Correlacionar a avaliação clínico-laboratorial inicial simplificada com a gravidade da pancreatite aguda e a presença de necrose. MÉTODO: Foi realizado um estudo retrospectivo dos pacientes com diagnóstico final de PA internados no Hospital Universitário Clementino Fraga Filho - UFRJ entre janeiro de 1990 e agosto de 2002. Foi considerado apenas o primeiro episódio de cada paciente. Os dados obtidos foram submetidos a análise estatística. Foram estudados 164 pacientes onde a idade média foi de 43,7 anos. RESULTADOS: A etiologia biliar foi a mais freqüente com 43,9% dos casos. A incidência de necrose foi de 21,3% e a mortalidade global de 23,2%. Observamos que a ausência de taquicardia na admissão estava associada à forma branda da doença, e que os níveis plasmáticos de uréia e creatinina elevados na admissão estão associados à forma grave da doença, e a hiperglicemia (121mg/dl à necrose pancreática. CONCLUSÕES: A avaliação inicial simplificada ainda tem espaço, embora que limitado, no acompanhamento do paciente com PA.

  16. Etnografía de la infección respiratoria aguda en una zona rural del altiplano mexicano

    Directory of Open Access Journals (Sweden)

    MARTÍNEZ HOMERO

    1997-01-01

    Full Text Available Objetivo. Identificar los términos utilizados por las madres para referirse a enfermedades, signos y síntomas relacionados con infecciones respiratorias agudas, así como los signos de alarma que las motivan a buscar atención médica; asimismo, describir prácticas comunes de manejo de la enfermedad en el hogar. Material y métodos. Se trata de un estudio etnográfico en seis comunidades rurales del altiplano mexicano. Se entrevistó a 12 informantes clave, a seis madres de niños fallecidos por infección respiratoria aguda, y a 24 madres de niños menores de cinco años, con diversas técnicas etnográficas para complementar la información obtenida ("triangulación". Resultados. Las enfermedades comúnmente identificadas incluyeron gripa, anginas, tos, bronquitis, pulmonía, neumonía y "broncomonía". Los síntomas clave para el diagnóstico fueron escurrimiento de moco nasal, dolor de garganta, tos, dolor de cabeza o de cuerpo, calentura, "hervor" de pecho, y referencias a que el niño "está molesto o llorón", se pone morado o le hace falta el aire. La taquipnea fue referida como "respira fuerte", "respira mucho", "respira rápido" y "tiene sesido"; el tiraje, "se le hunde el pecho"; el estridor, como "quejido o ronquido de pecho"; la sibilancia, como "ronquido de pecho", y para la cianosis; "se pone morado". Entre los tratamientos ofrecidos en el hogar destacan el uso de tés, aplicación de limón, jitomate, tomate o papa en la garganta, y aplicación de sebo o pomada en pecho y espalda. No fue común la autoprescripción de antibióticos pero sí la de antipiréticos. La mayoría de las madres reconoció enfermedades leves y, en menor proporción, graves. Ante un caso grave de insuficiencia respiratoria aguda, la opción más frecuentemente elegida fue acudir a la clínica del proyecto; en segundo lugar al médico particular en la cabecera municipal, y al hospital de la Secretaría de Salud en la Jurisdicción. La cercanía y el

  17. [Serum glycosaminoglycans in Graves' disease patients].

    Science.gov (United States)

    Winsz-Szczotka, Katarzyna B; Olczyk, Krystyna Z; Koźma, Ewa M; Komosińska-Vassev, Katarzyna B; Wisowski, Grzegorz R; Marcisz, Czesław

    2006-01-01

    The aim of the study was to determine the blood serum sulfated glycosaminoglycans (GAGs) and hyaluronic acid (HA) concentration of Graves' disease patients before treatment and after attainment of the euthyroid state. The study was carried out on the blood serum obtained from 17 patients with newly recognised Graves' disease and from the same patients after attainment of the euthyroid state. Graves' patients had not any clinical symptoms neither of ophthalmopathy nor pretibial myxedema. GAGs were isolated from the blood serum by the multistage extraction and purification using papaine hydrolysis, alkali elimination, as well as cetylpyridium chloride binding. Total amount of GAGs was quantified by the hexuronic acids assay. HA content in obtained GAGs sample was evaluated by the ELISA method. Increased serum concentration of sulfated GAGs in non-treated Graves' disease patients was found. Similarly, serum HA level in untreated patients was significantly elevated. The attainment of euthyroid state was accompanied by the decreased serum sulfated GAGs level and by normalization of serum HA concentration. In conclusion, the results obtained demonstrate that the alterations of GAGs metabolism connected with Graves' disease can lead to systemic changes of the extracellular matrix properties.

  18. Acute lower gastrointestinal hemorrhage originating in the small intestine Hemorragia digestiva baja severa originada en el intestino delgado

    Directory of Open Access Journals (Sweden)

    A. Ríos

    2006-03-01

    Full Text Available Introduction: lower gastrointestinal hemorrhage (LGIH is generally self-limiting, and the most frequent etiologies are located at colonic level. The objective here is to analyze the diagnostic and therapeutic handling of acute LGIH when its etiology was located in the small intestine. Patients and methods: between 1975 and March 2002, 12 acute cases of LGIH originating in the small intestine were admitted to our service. All consulted the hospital with acute rectorrhage, requiring a transfusion of at least 3 units of concentrated red blood cells. The mean age was 54 ± 21 years, 58% were women, and 83% had experienced previous episodes of LGIH. Results: in eleven cases (92% an urgent lower and upper endoscopy was performed without locating the source of bleeding. An arteriography was indicated in 7 patients (58%, which located the bleeding origin in 5 of them. In two cases a scintigraphy was performed, showing a Meckel's diverticulum in one patient and a normal image in another. All were operated on; in 8 cases (67%, surgery was urgent; in 9 cases, a tumor was found, and in three additional patients, a case of Meckel's diverticulum was found, with a resection being carried out for all lesions. Histology showed a leiomyoma in 7 cases, a Meckel's diverticulum in 3 cases, a leiomyoblastoma in 1, and an angioma in the remaining case. After a mean follow-up of 132 ± 75 months, the leiomyoblastoma resulted in death, and there was a relapse in the case of angioma, which was successfully embolized with interventional radiology. Conclusions: acute LGIH originating in the small intestine should be considered a possible etiology when digestive endoscopy does not locate the source of bleeding, with arteriography being a useful diagnostic technique for bleeding localization. Surgery is the definitive treatment - it confirms the etiology and rules out the presence of malignancy.Introducción: la hemorragia digestiva baja (HDB es generalmente autolimitada y

  19. Leucemia congénita aguda Acute congenital leukemia

    Directory of Open Access Journals (Sweden)

    Nilvia Esther González García

    2011-06-01

    Full Text Available La leucemia aguda durante el período neonatal es poco frecuente de evolución rápida y pronóstico sombrío. Sus características clínicas y biológicas difieren de las encontradas en niños de mayor edad, y su inicio se caracteriza por afectación cutánea, hepatoesplenomegalia, hiperleucocitosis e infiltración del sistema nervioso central. Se han observado pacientes con formas tanto mieloides como linfoides, pero la leucemia mieloide aguda parece predominar en esta etapa de la vida. Se presenta el caso de un paciente con leucemia congénita clasificada morfológicamente, con aparición de manifestaciones clínicas de enfermedad hematológica desde el nacimiento y diagnóstico de leucemia linfoblástica aguda congénita.Acute leukemia during neonatal period is not frequent, of a fast course and gloomy prognosis. Its clinical and biological features differ of that present in older children and it onset is characterized by cutaneous affection, hepatosplenomegaly, hyperleukocytosis and infiltration of central nervous system (CNS. There are patients presenting with myeloid and lymphoid types, but the acute leukemia seems to predominate in this stage of life. This is the case of a patient with acute leukemia morphologically classified, with appearance of clinical manifestations of hematologic disease from birth and a diagnosis of congenital acute lymphoblastic leukemia.

  20. Factores de riesgo asociados a la mortalidad por hemorragia digestiva alta en pacientes de un hospital público: Estudio caso control

    OpenAIRE

    Corzo Maldonado, Manuel Alejandro; Guzmán Rojas, Patricia; Bravo Paredes, Eduar Alban; Gallegos López, Roxana Consuelo; Huerta Mercado-Tenorio, Jorge; Surco Ochoa, Yolanda; Prochazka Zárate, Ricardo; Piscoya Rivera, Alejandro; Pinto Valdivia, José; De los Ríos Senmache, Raúl

    2013-01-01

    Objetivo: Determinar y establecer los factores de riesgo asociados a la mortalidad por hemorragia digestiva alta (HDA) a los 30 días posteriores al episodio en el Hospital Nacional Cayetano Heredia, Lima, Perú. Materiales y métodos: Se realizó un estudio observacional analítico caso-control retrospectivo con una proporción caso: control de 1:3, analizando 180 pacientes, siendo 135 los controles y 45 los casos. Se determinó por plausibilidad biológica como posibles factores de riesgo a 14 vari...

  1. Ataxia cerebelar aguda na criança

    Directory of Open Access Journals (Sweden)

    Valeriana Moura Ribeiro

    1968-03-01

    Full Text Available São relatados os casos de 6 crianças com ataxia cerebelar aguda. Admitem os autores a presença de um fator etiológico de caráter viral comum a todos êles, discutindo os mecanismos patogênicos com base nos casos da literatura. A evolução foi favorável em todos os pacientes, com regressão completa da sintomatologia, dentro do período de 6 a 60 dias.

  2. Insuficiencia renal aguda inducida por mordedura de serpiente Bothrops

    Directory of Open Access Journals (Sweden)

    Gustavo A. Aroca Martínez

    2014-01-01

    Full Text Available Mujer de 58 años de edad, remitida a urgencias por presentar cuadro clínico de insuficiencia renal aguda (IRA secundaria a mordedura de serpiente (Bothrops Atrox. Ingresa hipotensa con elevación de azoados e hiperkalemia, ecografía renal dentro de parámetros normales. Se maneja terapia dialítica con lo cual presenta mejoría clínica. En este reporte se detallan aspectos del diagnóstico, manejo clínico y posibles mecanismos fisiopatológicos que explican el daño renal.

  3. Sistema Progetto Nazionale Emorragia Digestiva (PNED) vs. escala de Rockall como predictores de mortalidad en pacientes con hemorragia de tubo digestivo alto no variceal: un estudio multicéntrico prospectivo

    OpenAIRE

    R. Contreras-Omaña; J.A. Alfaro-Reynoso; C.E. Cruz-Chávez; A. Velarde-Ruiz Velasco; D.I. Flores-Ramírez; I. Romero-Hernández; I. Donato-Olguín; X. García-Samper; A. Bautista-Santos; M. Reyes-Bastidas; E. Millán-Marín

    2017-01-01

    Antecedentes: El grupo Progetto Nazionale Emorragia Digestiva (PNED) de Italia publicó su propuesta de escala predictora de riesgo de mortalidad en pacientes con hemorragia digestiva alta no variceal (HTDANV), que desde su publicación no ha sido validada en Latinoamérica. Objetivo: Comparar el sistema PNED contra la escala de Rockall en la predicción de mortalidad de pacientes hospitalizados por HTDANV. Material y métodos: Estudio multicéntrico prospectivo, transversal, analítico, en el...

  4. [Neonatal hyperthyroidism and maternal Graves disease].

    Science.gov (United States)

    Ben Ameur, K; Chioukh, F Z; Marmouch, H; Ben Hamida, H; Bizid, M; Monastiri, K

    2015-04-01

    The onset of Graves disease during pregnancy exposes the neonate to the risk of hyperthyroidism. The newborn must be monitored and treatment modalities known to ensure early treatment of the newborn. We report on the case of an infant born at term of a mother with Graves disease discovered during pregnancy. He was asymptomatic during the first days of life, before declaring the disease. Neonatal hyperthyroidism was confirmed by hormonal assays. Hyperthyroidism was treated with antithyroid drugs and propranolol with a satisfactory clinical and biological course. Neonatal hyperthyroidism should be systematically sought in infants born to a mother with Graves disease. The absence of clinical signs during the first days of life does not exclude the diagnosis. The duration of monitoring should be decided according to the results of the first hormonal balance tests. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  5. Neonatal Graves' Disease with Maternal Hypothyroidism.

    Science.gov (United States)

    Akangire, Gangaram; Cuna, Alain; Lachica, Charisse; Fischer, Ryan; Raman, Sripriya; Sampath, Venkatesh

    2017-07-01

    Neonatal Graves' disease presenting as conjugated hyperbilirubinemia is a diagnostic challenge because the differential includes a gamut of liver and systemic diseases. We present a unique case of neonatal Graves' disease in a premature infant with conjugated hyperbilirubinemia born to a mother with hypothyroidism during pregnancy and remote history of Graves' disease. Infant was treated with a combination of methimazole, propranolol, and potassium iodide for 4 weeks. Thyroid function improved after 8 weeks of treatment with full recovery of thyroid function, disappearance of thyroid-stimulating antibodies, and resolution of failure to thrive and conjugated hyperbilirubinemia. This case provides several clinical vignettes as it is a rare, severe, presentation of an uncommon neonatal disease, signs, symptoms, and clinical history presented a diagnostic challenge for neonatologists and endocrinologists, normal newborn screen was misleading, and yet timely treatment led to a full recovery.

  6. Changes of hepatofibrosis markers in Graves' disease

    International Nuclear Information System (INIS)

    Zhou Feihua; Xu Haifeng; Zhou Runsuo; Gao Feng; Wang Lei

    2006-01-01

    Objective: To study the changes of hepatofibrosis markers (IV-C, PC III, HA, LN) in Graves' disease. Methods: Serum levels of hepatofibrosis were measured with RIA in 40 patients with Graves' disease (CD) before any treatment and 35 patients with Graves' disease after successful anti-thyroid drug therapy as well as in 30 controls. Results: The serum IV-C and PC III levels in GD patients were significant higher than those in controls before treatment (P<0.01). After successful treatment, the IV-C, PC III levels dropped markedly (vs before treatment, P<0.01). However, there were no significant differences among the serum HA, LN levels in all the subjects tested. Conclusion: Serum levels of IV-C and PC III increased markedly with hyperthyroidim. When IV-C and PC III levels were taken for assessment of degree of hepatofibeosis, GD must be ruled out first. (authors)

  7. Pancytopenia in a Patient with Grave's Disease.

    Science.gov (United States)

    Loh, Huai Heng; Tan, Florence

    2013-08-01

    Pancytopenia can rarely complicate Grave's disease. It can be due to uncontrolled thyrotoxicosis or as a result of rare side effect of antithyroid medication. Pernicious anemia leading to Vitamin B12 deficiency is another rare associated cause. We report a case of a patient with Grave's disease and undiagnosed pernicious anemia whom was assumed to have antithyroid drug induced pancytopenia. Failure to recognize this rare association of pernicious anemia as a cause of pancytopenia had resulted in delay in treatment and neurological complication in our patient.

  8. Comparacao dos criterios RIFLE, AKIN e KDIGO quanto a capacidade de predicao de mortalidade em pacientes graves

    Directory of Open Access Journals (Sweden)

    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.

  9. Rituximab in relapsing Graves' disease, a phase II study

    NARCIS (Netherlands)

    Heemstra, Karen A.; Toes, Rene E.; Sepers, Jan; Pereira, Alberto M.; Corssmit, Eleonora P.; Huizinga, Tom W. J.; Romijn, Johannes A.; Smit, Johannes W.

    2008-01-01

    Conventional therapies for Graves' disease, consisting of medical therapy or radioiodine are unsatisfactory, because of limited efficacy and adverse events. Interventions aimed at the underlying autoimmune pathogenesis of Graves' disease may be worthwhile to explore. We therefore performed a

  10. Carambola como causa de lesão renal aguda

    Directory of Open Access Journals (Sweden)

    Karilla Lany Scaranello

    2014-04-01

    Full Text Available A carambola pertence à família das Oxalidáceas, espécie Averrhoa carambola. É rica em sais minerais, vitaminas A, C, complexo B e ácido oxálico. Estudos recentes demonstram que a toxicidade da fruta difere entre os indivíduos e pode ser explicada pelas respostas biológicas individuais como idade, quantidade da ingestão, neurotoxinas em cada tipo de fruta. Adicionalmente, a nefrotoxicidade causada pela fruta é dose dependente, podendo levar ao desenvolvimento de lesão renal aguda pela deposição de cristais de oxalato de cálcio intratubular, assim como por lesão direta das células epiteliais tubulares, levando à apoptose das mesmas. Relatamos o caso de uma paciente que, após a ingestão do suco da fruta e fruta in natura, desenvolveu lesão renal aguda, necessitando de terapia dialítica, evoluindo com desfecho favorável e recuperação da função renal.

  11. Respostas cardiovasculares agudas em ambiente virtualmente simulado pelo Nintendo Wii

    Directory of Open Access Journals (Sweden)

    Renato Aparecido de Souza

    2013-01-01

    Full Text Available DOI: http://dx.doi.org/10.5007/1980-0037.2013v15n1p60 Recentemente, tem sido verificada a utilização do Nintendo Wii no contexto da saúde. O objetivo do presente estudo foi analisar as respostas cardiovasculares agudas monitoradas por meio do comportamento da frequência cardíaca, pressão arterial sistólica, pressão arterial diastólica e duplo produto, em ambiente virtualmente simulado pelo console Nintendo Wii. A amostra foi composta por 18 universitários saudáveis, com média de idade de 22,07 ± 1,34 anos. As variáveis foram observadas com uso de deltas (valor final - inicial após 25 arremessos de basquetebol em duas situações experimentais: (I com o voluntário sentado e, (II com o voluntário saltando verticalmente. Os resultados sugerem que a prática de atividade física em ambiente virtual emulado pelo Nintendo Wii é capaz de alterar as respostas cardiovasculares agudas, especialmente, quando realizada em associação a saltos verticais. Assim, os resultados sustentam a viabilidade do uso do Nintendo Wii em programas de treinamento e favorecem sua indicação de forma mais segura.

  12. Escala de Alvarado como herramienta diagnóstica para apendicitis aguda

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    Iván Pimienta Concepción

    2017-06-01

    Full Text Available Introducción: La apendicitis aguda es la enfermedad intrabdominal más frecuente tratada de urgencia. Resulta de interés la utilización de la Escala de Alvarado en el diagnóstico de esta patología por su contribución a la disminución de apendicectomías negativas. Objetivo: Determinar la validez de la Escala de Alvarado como herramienta diagnóstica para apendicitis aguda en pacientes atendidos en el Servicio de Cirugía General del Hospital IESS Ambato. Métodos: Se realizó una investigación observacional, descriptiva y transversal en pacientes hospitalizados con cuadro de dolor abdominal y sospecha de apendicitis aguda, valorados en el Servicio de Cirugía General en el Hospital General IESS Ambato en el período junio 2015 a noviembre del año 2015. Resultados: De acuerdo al resultado histopatológico predominó la apendicitis aguda supurada con (n=83, 54.9%; seguida de apendicitis aguda gangrenosa (n=35, 23.2%; apendicitis aguda precoz (n=15, 9.9%; mientras que el resultado normal y apendicitis aguda gangrenosa perforada se encontraron con los mismos valores (n=9, 5.9%. Conclusiones: Existió un puntaje elevado de la Escala de Alvarado para el diagnóstico de apendicitis aguda según la severidad de los hallazgos descritos en el resultado histopatológico posterior a la apendicectomía. El resultado histopatológico de mayor frecuencia fue la apendicitis aguda supurada, con un riesgo medio en la Escala de Alvarado, la cual es más sensible en periodos de gravedad.

  13. Sjiele sacrifices, Odin treasures and Saami graves?

    Directory of Open Access Journals (Sweden)

    Inger Zachrisson

    1987-01-01

    Full Text Available This paper presents archaeological findings described as Saami metal deposits. These well-known "Finds from Lapp Places of Sacrifice", objects from the Viking Age and Early Middle Ages, were mostly found in northern Sweden. The author also presents a research project dealing with prehistoric and medieval Saami graves from the south Saami area.

  14. Graves' orbitopathy: Management of difficult cases

    NARCIS (Netherlands)

    Wiersinga, Wilmar M.

    2012-01-01

    Management of Graves' ophthalmopathy (GO) is based on three pillars: to stop smoking, to restore and maintain euthyroidism, and to treat the eye changes according to severity and activity of GO. Difficulties are frequently encountered in each of these three management issues. The advice to

  15. Graves' disease: thyroid function and immunologic activity

    International Nuclear Information System (INIS)

    Gossage, A.A.; Crawley, J.C.; Copping, S.; Hinge, D.; Himsworth, R.L.

    1982-01-01

    Patients with Graves' disease were studied for two years during and after a twelve-month course of treatment. Disease activity was determined by repeated measurements of thyroidal uptake of [/sup 99m/Tc]pertechnetate during tri-iodothyronine administration. These in-vivo measurements of thyroid stimulation were compared with the results of in-vitro assays of Graves, immunoglobulin (TSH binding inhibitory activity--TBIA). There was no correlation between the thyroid uptake and TBIA on diagnosis. Pertechnetate uptake and TBIA both declined during the twelve months of antithyroid therapy. TBIA was detectable in sera from 19 of the 27 patients at diagnosis; in 11 of these 19 patients there was a good correlation (p less than 0.05) throughout the course of their disease between the laboratory assay of the Graves, immunoglobulin and the thyroid uptake. Probability of recurrence can be assessed but sustained remission of Graves' disease after treatment cannot be predicted from either measurement alone or in combination

  16. Caracterización del paciente anciano con hemorragia digestiva alta Characterization of the elderly patient with upper digestive hemorrhage

    Directory of Open Access Journals (Sweden)

    Daniel Acosta González

    2009-04-01

    Full Text Available Se realizó un estudio descriptivo, observacional y transversal de 40 ancianos con hemorragia digestiva alta, ingresados en el Servicio de Cirugía General del Hospital Clinicoquirúrgico Docente “Dr. Ambrosio Grillo Portuondo” de Santiago de Cuba durante el 2007, a fin de caracterizarles mediante una serie de variables relacionadas con este diagnóstico. Los datos primarios se extrajeron de las historias clínicas correspondientes. Entre los principales resultados sobresalieron: el sexo masculino, el grupo etario de 60 a 69 años, las enfermedades cardiovasculares asociadas, el consumo de alcohol y café como hábitos tóxicos y la ingestión de medicamentos antiinflamatorios no esteroideos y aspirina como fármacos ulcerogénicos. El diagnóstico se estableció mediante la radiografía con contraste baritado y la úlcera gastroduodenal fue la causa más frecuente; el tratamiento médico resultó ser el más utilizado y la mayoría de los pacientes egresaron entre 1 y 7 días luego de su hospitalización.A descriptive, observational and cross-sectional study of 40 elderly patients with upper digestive hemorrhage, admitted at the Service of General Surgery of "Dr. Ambrosio Grillo Portuondo" Teaching Clinical-Surgical Hospital from Santiago de Cuba during the 2007 was carried out, in order to characterize them by means of a series of variables related to this diagnosis. The primary data were obtained from the corresponding medical records. Among the main results there were: the male sex, the age group from 60 to 69 years, the associated cardiovascular diseases, the alcohol and coffee intake as toxic habits and the use of anti-inflammatory and non-steroid medications and aspirin as ulcerogenic drug. The diagnosis was reached by means of the barium contrast x-ray and the gastroduodenal ulcer was the most frequent cause; the medical treatment was the most used and most of the patients were discharged between 1 and 7 days after their

  17. Interleucina-18 (IL-18 y otros parámetros inmunológicos como marcadores de gravedad en la pancreatitis aguda Interleukin 18 (IL-18 and other immunological parameters as markers of severity in acute pancreatitis

    Directory of Open Access Journals (Sweden)

    M. A. Martín

    2008-12-01

    Full Text Available Objetivo: se trata de comparar prospectivamente el comportamiento durante la primera semana del ingreso de los niveles de interleucina-18 (IL-18, y otros parámetros inmunológicos entre pacientes con pancreatitis aguda con y sin criterios de gravedad, así como entre pacientes con y sin desarrollo ulterior de seudoquiste. Pacientes y métodos: se compararon en 36 pacientes con pancreatitis aguda los resultados de sTNF-RI, IL-1Ra, IL-6 e IL-18 los días 1, 2, 3 y 7 desde el ingreso entre pancretitis leve, grave y un grupo control (13 pacientes con cólico biliar simple, así como entre pacientes con o sin seudoquiste. Resultados: al comparar pancreatitis leve con grave, IL-18 fue significativamente superior sólo el primer día en las pancreatitis graves y los otros parámetros a partir del segundo día de forma mantenida. También en pacientes que desarrollaron seudoquiste, IL-18 estuvo significativamente elevada el primer día. Conclusiones: IL-18 resultó el marcador más precoz de complicaciones y gravedad de la pancreatitis aguda a nivel sistémico y local (seudoquiste.Objective: our aim was to prospectively compare the behavior of interleukin 18 (IL-18 levels and other immunological parameters during the first week of hospitalization between acute pancreatitis patients with and without severity criteria, as well as between patients with and without late pseudocyst development. Patients and methods: in 36 patients with acute pancreatitis we compared sTNF-RI, IL-1Ra, IL-6, and IL-18 levels at days 1, 2, 3 and 7 after hospitalization between mild pancreatitis, severe pancreatitis, and a "control" group (13 patients with uncomplicated biliary colic, as well as between patients with and without pseudocyst. Results: on comparing mild to severe pancreatitis, IL-18 was significantly higher only the first day in severe pancreatitis, while the other parameters were steadily higher after the second day. In patients developing pseudocyst, IL-18 was

  18. Lesão pulmonar aguda associada à transfusão Transfusion-related acute lung injury

    Directory of Open Access Journals (Sweden)

    Antonio Fabron Junior

    2007-04-01

    Full Text Available Lesão pulmonar aguda associada à transfusão (transfusion-related acute lung injury, TRALI é uma complicação clínica grave relacionada à transfusão de hemocomponentes que contêm plasma. Recentemente, TRALI foi considerada a principal causa de morte associada à transfusão nos Estados Unidos e Reino Unido. É manifestada tipicamente por dispnéia, hipoxemia, hipotensão, febre e edema pulmonar não cardiogênico, que ocorre durante ou dentro de 6 h, após completada a transfusão. Embora o exato mecanismo não tenha sido totalmente elucidado, postula-se que TRALI esteja associada à infusão de anticorpos contra antígenos leucocitários (classes I ou II ou aloantígenos específicos de neutrófilos e a mediadores biologicamente ativos presentes em componentes celulares estocados. A maioria dos doadores implicados em casos da TRALI são mulheres multíparas. TRALI, além de ser pouco diagnosticada, pode ainda ser confundida com outras situações de insuficiência respiratória aguda. Um melhor conhecimento sobre TRALI pode ser crucial na prevenção e tratamento desta severa complicação transfusional.Transfusion-related acute lung injury (TRALI is a serious clinical syndrome associated with the transfusion of plasma-containing blood components. Recently, TRALI has come to be recognized as the leading cause of transfusion-related death in the United States and United Kingdom. This complication typically presents as shortness of breath, hypoxemia, hypotension, fever and noncardiogeneic pulmonary edema, all occurring during or within 6 h after transfusion. Although the mechanism of TRALI has not been fully elucidated, it has been associated with human leukocyte antigen antibodies (class I, class II or neutrophil alloantigens and with biologically active mediators in stored cellular blood components. Most of the donors implicated in cases of TRALI are multiparous women. Rarely diagnosed, TRALI can be confused with other causes of acute

  19. Effect of 131I therapy on outcomes of Graves' ophthalmopathy

    International Nuclear Information System (INIS)

    Wang Renfei; Tan Jian; Zhang Guizhi; Yin Liang

    2011-01-01

    Objective: To analyze the correlation between the therapeutic effect of Graves' hyperthyroidism and the outcomes of Graves' ophthalmopathy after 131 I therapy, and to explore the effect of 131 I treatment on turnout of Graves' ophthalmopathy. Methods: Six hundreds and fifty-two patients of Graves' disease accompanied with Graves' ophthalmopathy, received one-time 131 I 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 131 I therapy, the effective rate of Graves' hyperthyroidism and Graves' ophthalmopathy were 94.3% and 73.3% respectively. The total effective rate of hyperthyroidism with ophthalmopathy was 71.2%. There was a significant correlation between the prognosis of Graves' ophthalmopathy and therapeutic efficacy of hyperthyroidism (r=0.302, P 131 I therapy (χ 2 =0.296, P>0.05). Conclusions: The key to treat Graves' ophthalmopathy is the cure of Graves' hyperthyroidism through 131 I therapy. The timely diagnosis and replacement treatment of hypothyroidism can effectively avoid the aggravation of Graves' ophthalmopathy after 131 I therapy. (authors)

  20. Follow up of Graves' Opthalmopathy after radioiodine therapy

    International Nuclear Information System (INIS)

    Miah, M.S.R.; Paul, A. K.; Rahman, H.A.

    2002-01-01

    Graves' ophthalmopathy may first appear or worsen during or after treatment for hyperthyroidism. We followed up 158 Graves' hyperthyroid patients treated with radioiodine of which 49 had Grave's' ophthalmopathy during presentation in Nuclear Medicine Centre, Khulna during the period from 1995 to 2000. The aim of our study is to see the effect of radioiodine in Graves' ophthalmopathy. All the patients received radioiodine at fixed dose regime ranged from 7 mCi to 12 mCi. The duration of follow up was at least 12 months Graves' ophthalmopathy patients, 4 (4/49 i.e., 8.2%) showed exaggeration of ophthalmopathy and the rest (45/49 i.e., 91.8%) remained unchanged. None of ophthalmopathy developed among any of Graves' hyperthyroid or disappeared after radioiodine treatment during follow up period. From the study we concluded that eye changes in Graves' hyperthyroidism remain unchanged or exaggerated after radioiodine therapy and needs ophthalmologist care.(author)

  1. Nefrite Intersticial Aguda Após Exposição a Losartan

    Directory of Open Access Journals (Sweden)

    Letícia Schwerz Weinert

    2007-07-01

    Full Text Available Nefrite intersticial aguda é uma causa comum de perda aguda de função renal. Exposição a drogas é o fator desencadeante mais freqüentemente relatado, porém auto-imunidade e infecções também estão associadas. Os inibidores da enzima de conversão da angiotensina têm sido relatados como possíveis agentes, porém não há relato na literatura de nefrite intersticial com uso de losartan. Descrevemos então, o caso de perda aguda de função renal após exposição a losartan, em paciente com dano renal prévio por nefropatia diabética, cuja biópsia renal diagnosticou nefrite intersticial aguda.

  2. Calcio sérico total y calcio corregido como predictores de severidad en pancreatitis aguda

    Directory of Open Access Journals (Sweden)

    A.A. Gutiérrez-Jiménez

    2014-01-01

    Conclusiones: El CT y CCA tomados en las primeras 24 h son útiles como predictores de severidad en pancreatitis aguda, con valores de S y predictivos comparables o superiores a los de las escalas pronósticas tradicionales.

  3. Embolectomía en una embolia pulmonar aguda masiva

    Directory of Open Access Journals (Sweden)

    Manuel Carnero Alcázar

    2007-07-01

    Full Text Available Presentamos el caso de un varón de 57 años que, en el seno de un meningioma microcítico, padece una tromboembolia pulmonar masiva aguda con inestabilidad hemodinámica. Dado el riesgo de hemorragia por el tumor craneal, se contraindica la terapia fibrinolítica y se procede a practicar embolectomía pulmonar. Ésta se realiza bajo anestesia general, con canulación convencional y bajo hipotermia moderada. Se extrae émbolo en el tronco de la arteria pulmonar y con catéter de Fogarty se extraen émbolos en ramas lobares y segmentarias. Discutimos la asociación de enfermedad tromboembólica con determinadas neoplasias y el tratamiento de la tromboembolia pulmonar

  4. Epidemia de infección respiratoria aguda observaciones hospitalarias

    OpenAIRE

    Chavarría Milanés, José Fernando; Mata, Leonardo; Mohs Villalta, Edgar; Ramírez, Giselle; Lizano, Lucía

    1985-01-01

    artículo -- Universidad de Costa Rica. Instituto de Investigaciones en Salud, 1985 Se describe la clínica, tratamiento y complicaciones de 81 niños lactantes con infección respiratoria aguda. Los niños provenían del cantón central de San José y fueron admitidos en el Hospital Nacional de Niños del 10 de noviembre al 15 de diciembre de 1983. Se encontró un 57% de varones y un 43% de mujeres; los más afectados fueron los niños menores de 3 meses. Más de la mitad de los niños egresó con el di...

  5. Acidosis láctica severa y leucemia aguda

    Directory of Open Access Journals (Sweden)

    David Loja

    2004-03-01

    Full Text Available Reportamos el caso de una paciente de 27 años de edad con leucemia linfoblástica aguda, quien presentó acidosis láctica severa como complicación metabólica. Ella acudió con desnutrición severa, anemia marcada y síndrome consuntivo. No había compromiso del sistema reticuloendotelial y un mielograma inicial fue normal. Estos factores retardaron el diagnóstico y obligaron a ampliar el diagnóstico diferencial. La sospecha de neoplasia hematológica asociada a acidosis láctica sin causa aparente permitió reevaluar el caso con un nuevo mielograma y establecer el diagnóstico.

  6. Isquemia aguda de miembros inferiores secundaria a ergortismo

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    Franco J. Vallejo, MD

    2011-11-01

    Full Text Available Paciente de género femenino, de 21 años de edad, quien ingresó por dolor progresivo e intenso en miembros inferiores, y refirió antecedente reciente de ingestión de derivados del ergot. Al examen físico se observó ausencia de pulsos en ambos miembros inferiores. Por angiotomografia se documentó disminución severa, generalizada y bilateral, del calibre de los vasos arteriales de miembros inferiores. Se diagnosticó isquemia arterial aguda secundaria a ergotismo y se inició tratamiento con vasodilatadores y calcio-antagonistas, que resolvió los síntomas en su totalidad.

  7. Factores pronósticos del éxito de la ventilación mecánica no invasiva en la insuficiencia respiratoria aguda

    Directory of Open Access Journals (Sweden)

    Zadis Navarro Rodríguez

    2014-01-01

    Full Text Available Se realizó un estudio observacional, descriptivo y analítico, de casos y controles, de 41 afectados con insuficiencia respiratoria aguda, tratados con ventilación mecánica no invasiva y egresados de las unidades de atención a pacientes en estado grave en el Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" de Santiago de Cuba, del 2012 al 2013, con vistas a describir la variabilidad de los parámetros fisiológicos y hemogasométricos, así como estimar la capacidad de pronóstico de estos en el desenlace exitoso del procedimiento. En la serie la media de edad fue de 60 años, predominó el sexo masculino (61,0 %, la técnica fue exitosa en 80,5 % y se constataron resultados significativos de éxito en pacientes con enfermedad pulmonar obstructiva crónica, asma bronquial e insuficiencia respiratoria aguda posextubación (76,9; 87,5 y 100,0 %, respectivamente. El éxito de la ventilación mecánica no invasiva trajo aparejada una mejoría considerable en los integrantes de la casuística al final de la evaluación de todos los parámetros fisiológicos y hemogasométricos, a excepción, en este último caso, de la presión arterial de dióxido de carbono y el bicarbonato sódico. Finalmente se concluyó que solo la escala de coma de Glasgow y la presión arterial de oxígeno presentaron importancia significativa para el pronóstico de éxito

  8. Thyroid cancer in Graves' disease: is surgery the best treatment for Graves' disease?

    Science.gov (United States)

    Tamatea, Jade A U; Tu'akoi, Kelson; Conaglen, John V; Elston, Marianne S; Meyer-Rochow, Goswin Y

    2014-04-01

    Graves' disease is a common cause of thyrotoxicosis. Treatment options include anti-thyroid medications or definitive therapy: thyroidectomy or radioactive iodine (I(131) ). Traditionally, I(131) has been the preferred definitive treatment for Graves' disease in New Zealand. Reports of concomitant thyroid cancer occurring in up to 17% of Graves' patients suggest surgery, if performed with low morbidity, may be the preferred option. The aim of this study was to determine the rate of thyroid cancer and surgical outcomes in a New Zealand cohort of patients undergoing thyroidectomy for Graves' disease. This study is a retrospective review of Waikato region patients undergoing thyroid surgery for Graves' disease during the 10-year period prior to 1 December 2011. A total of 833 patients underwent thyroid surgery. Of these, 117 were for Graves' disease. Total thyroidectomy was performed in 82, near-total in 33 and subtotal in 2 patients. Recurrent thyrotoxicosis developed in one subtotal patient requiring I(131) therapy. There were two cases of permanent hypoparathyroidism and one of permanent recurrent laryngeal nerve palsy. Eight patients (6.8%) had thyroid cancer detected, none of whom had overt nodal disease. Five were papillary microcarcinomas (one of which was multifocal), two were papillary carcinomas (11 mm and 15 mm) and one was a minimally invasive follicular carcinoma. Thyroid cancer was identified in approximately 7% of patients undergoing surgery for Graves' disease. A low complication rate (<2%) of permanent hypoparathyroidism and nerve injury (<1%) supports surgery being a safe alternative to I(131) especially for patients with young children, ophthalmopathy or compressive symptoms. © 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons.

  9. The microclimate within a Neolithic passage grave

    DEFF Research Database (Denmark)

    Klenz Larsen, Poul; Aasbjerg Jensen, Lars; Ryhl-Svendsen, Morten

    2017-01-01

    Microclimate measurements in a Neolithic passage grave in Denmark have shown that natural ventilation through the open entrance destabilizes the relative humidity (RH), whereas a sealed entrance gives a much more stable RH, above 90%. Episodes of condensation occur on the stone surfaces in summer...... with too much ventilation and in winter with too little ventilation. Soil moisture measurements above, below, and beside the grave mound indicate that rainfall on the mound is not a significant source of moisture to the chamber, whereas the ground below the sealed chamber is constantly moist. The chamber...... can be kept dry all year by putting a moisture barrier membrane over the floor. Apart from the more variable climate within the open chamber, there is also a significant penetration of ozone, which is absent in the sealed chamber. The ozone may have deteriorated the folds of birch bark put between...

  10. Tratamiento de la enfermedad de Graves Basedow

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    Hernando Vargas-Uricoechea

    2014-05-01

    Full Text Available Se realizó una revisión narrativa rigurosa de la literatura inglesa y en español sobre diferentes aspectos de la Enfermedad de Graves-Basedow e hipertiroidismo. Esta patología –parte de la llamada “enfermedad tiroidea autoinmune”- se produce como consecuencia de la presencia de anticuerpos circulantes que se unen y activan al receptor de tirotropina, desencadenándose generalmente el hipertiroidismo en asociación con un estrés agudo. En este artículo actualizamos tanto el manejo de hipertiroidismo como el de problemas especiales con el que puede estar asociado. La fisiopatología y el diagnóstico de la Enfermedad de Graves-Basedow son motivo de otra publicación.

  11. Hyperthyroidism: diagnosis and management of Graves' disease.

    Science.gov (United States)

    Schilling, J S

    1997-06-01

    Hyperthyroidism, or thyrotoxicosis, results when the body's tissues are exposed to excessive levels of thyroid hormone. Hyperthyroidism affects 2% of women but only one-tenth as many men. Graves' disease is the most common form of hyperthyroidism, often occurring in young adults. It is an autoimmune disorder with an important genetic component. Hyperthyroidism's hallmarks include goiter and myriad signs and symptoms related to increased metabolic activity in virtually all body tissues. Increased sensitivity to circulating catecholamines adds to the clinical picture. Diagnosed by patient history, physical examination, and laboratory tests, Graves' disease is treated with antithyroid drugs, radioactive iodine, and/or surgery, plus supportive therapy. A good treatment outcome can be expected; long-term follow-up is indicated.

  12. A mild Grave's ophthalmopathy during pregnancy.

    Science.gov (United States)

    Abbouda, Alessandro; Trimboli, Pierpaolo; Bruscolini, Alice

    2014-01-01

    Thyroid ophthalmopathy is a complication most commonly associated with Grave's disease. The disease course ranges from mild to severe, with severe cases resulting in major visual impairment. A complete ophthalmic examination in a 35-year-old secundigravida to 14 weeks of gestation presented to the hospital for a routine ophthalmological examination with eyelid retraction in the right eye was made. We studied the course of ocular disease through the gestation with orbit ecography and a 3T MRI. A diagnosis of Grave's Ophthalmopathy was made. This case presents an unusual course of the GD during pregnancy and a normal post-partum relapse, according to the Th1/Th2 balance. The frequent follow-up and the use of MRI allowed a prompt identification and complete control of the disease.

  13. Osteogenesis imperfecta in combination with Graves disease

    Directory of Open Access Journals (Sweden)

    Marina S. Sheremeta

    2017-12-01

    Full Text Available Osteogenesis imperfecta (OI – is a group of genetically disorders, which are charaterized by a disturbed bone formation. In turn, the excess of thyroid hormones in Graves' disease (GD also posses a negative effect on bone tissue, thereby aggravating OI. That requires from the endocrinologist the most careful management of patients with the combination of these pathologies. In this article, we present a unique clinical case of a combination of GD and OI.

  14. Graves hyperthyroidism and pregnancy: a clinical update.

    Science.gov (United States)

    Patil-Sisodia, Komal; Mestman, Jorge H

    2010-01-01

    To provide a clinical update on Graves' hyperthyroidism and pregnancy with a focus on treatment with antithyroid drugs. We searched the English-language literature for studies published between 1929 and 2009 related to management of hyperthyroidism in pregnancy. In this review, we discuss differential diagnosis of hyperthyroidism, management, importance of early diagnosis, and importance of achieving proper control to avoid maternal and fetal complications. Diagnosing hyperthyroidism during pregnancy can be challenging because many of the signs and symptoms are similar to normal physiologic changes that occur in pregnancy. Patients with Graves disease require prompt treatment with antithyroid drugs and should undergo frequent monitoring for signs of fetal and maternal hyperthyroidism and hypothyroidism. Rates of maternal and perinatal complications are directly related to control of hyperthyroidism in the mother. Thyroid receptor antibodies should be assessed in all women with hyperthyroidism to help predict and reduce the risk of fetal or neonatal hyperthyroidism or hypothyroidism. The maternal thyroxine level should be kept in the upper third of the reference range or just above normal, using the lowest possible antithyroid drug dosage. Hyperthyroidism may recur in the postpartum period as Graves disease or postpartum thyroiditis; thus, it is prudent to evaluate thyroid function 6 weeks after delivery. Preconception counseling, a multidisciplinary approach to care, and patient education regarding potential maternal and fetal complications that can occur with different types of treatment are important. Preconception counseling and a multifaceted approach to care by the endocrinologist and the obstetric team are imperative for a successful pregnancy in women with Graves hyperthyroidism.

  15. Thyroidectomy for Graves' disease: is hypothyroidism inevitable?

    OpenAIRE

    Davenport, M.; Talbot, C. H.

    1989-01-01

    The outcome of 234 patients with Graves' disease treated by subtotal thyroidectomy over a 12-year period is analysed with specific reference to hypothyroidism. Of definite hypothyroid cases, 98% occurred within 2 years. Failure to develop hypothyroidism was statistically related to large remnant size and a large goitre preoperatively. Histological review showed that any degree of lymphocytic infiltration was associated with the development of hypothyroidism (50% vs 22%). Late onset hypothyroi...

  16. Cirugía en la disección aórtica aguda tipo A: resultados hospitalarios y seguimiento alejado

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    Javier Celada

    2009-01-01

    Full Text Available IntroducciónLa disección aguda de la aorta tipo A (DAA-A es una emergencia que requiere cirugía inmediata, debido al mal pronóstico de su evolución natural. A pesar del avance en las técnicas quirúrgicas, el procedimiento aún tiene una morbimortalidad elevada.ObjetivosAnalizar la morbimortalidad hospitalaria y la sobrevida alejada de una serie consecutiva de pacientes operados por DAA-A.Material y métodosSe incluyeron 63 pacientes consecutivos (el 71,4% eran hombres en cuatro centros asistenciales de Buenos Aires desde julio de 1994 a mayo de 2007. El seguimiento se realizó en el 89% de los pacientes. La edad promedio fue de 63 ± 11,3 años. En 15 pacientes, el reemplazo se extendió hasta el hemiarco y en 5 se reemplazó el arco completo. La válvula aórtica se reemplazó en 12 pacientes.ResultadosDurante la estadía hospitalaria fallecieron 19 pacientes (30,1%: un caso durante la cirugía, 7 por complicaciones isquémicas o falla multiorgánica, 3 por complicaciones neurológicas, 5 por complicaciones cardíacas, 1 por hemorragia digestiva y 2 pacientes a consecuencia de múltiples complicaciones. Durante el seguimiento fallecieron 12 pacientes (32,4%: 8 casos de causa cardiovascular y 4 de causa no cardíaca. El análisis multivariado detectó que las variables asociadas con mayor mortalidad hospitalaria fueron el bajo volumen minuto y el tiempo de circulación extracorpórea (CEC prolongado, en tanto que las asociadas con mayor mortalidad alejada fueron la edad > 70 años y un tiempo menor de CEC. La sobrevida a 1, 3, 5 y 10 años fue del 89%, 79,5%, 73% y 58%, respectivamente.ConclusionesLos resultados del tratamiento quirúrgico de la DAA-A en nuestro medio pueden asimilarse a los obtenidos en series internacionales, lo que a su vez confirma la elevada morbimortalidad hospitalaria y alejada de esta entidad.REV ARGENT CARDIOL 2009;77:108-115.

  17. Grave Tending: With Mom at the Cemetery

    Directory of Open Access Journals (Sweden)

    Carolyn Ellis

    2003-05-01

    Full Text Available This autoethnographic story shows the process of tending the graves of family members. In the past, the author reluctantly accompanied her mother on her visits to the family cemetery. Once there, she took on the role of distant observer as her mother took care of the family cemetery plots. When her mother becomes disabled, the author begins to arrange the flowers on the graves. Doing so leads her to examine the meaning of visiting the cemetery, feel and connect with her losses, and consider the customs she wants to be part of her own death. When her mother dies, the next generation of women in the family—the author, her sister, and sister-in-law—take on the role of tending the graves, connected in their love and respect for their mother and their feelings of family and family responsibility. This story examines the meanings of family rituals around death and how they are passed from generation to generation. URN: urn:nbn:de:0114-fqs0302285

  18. "Estudo comparativo da função erétil em pacientes portadores da forma digestiva da Doença de Chagas"

    OpenAIRE

    Valdi Camarcio Bezerra

    2003-01-01

    O objetivo deste estudo foi correlacionar as alterações causadas pela doença de Chagas no sistema nervoso autônomo e a possibilidade destas alterações provocarem disfunção erétil. Foram incluídos 60 pacientes, do sexo masculino, entre 40 e 70 anos, sendo 30 com a forma digestiva da doença de Chagas e 30 como grupo controle negativos para tripanossomíase; foram utilizados o questionário auto-aplicável do Índice Internacional de Função Erétil (IIFE) e o algoritmo de pontuação para análise e int...

  19. Consenso intersociedades para el manejo de infecciones respiratorias: bronquitis aguda y enfermedad pulmonar obstructiva crónica

    Directory of Open Access Journals (Sweden)

    Gustavo Lopardo

    2013-04-01

    Full Text Available La Sociedad Argentina de Infectología convocó a otras sociedades científicas para elaborar una guía práctica y actualizada para el manejo del tratamiento antibiótico de las bronquitis agudas (BA y los episodios de reagudización de enfermedad pulmonar obstructiva crónica (EPOC, con el objetivo de promover el uso racional de los recursos diagnósticos y terapéuticos. La BA se caracteriza por la inflamación del árbol bronquial que afecta tanto a adultos como a niños sin enfermedades pulmonares crónicas, siendo de origen viral en la mayoría de los casos. El diagnóstico es clínico, debiéndose diferenciar de los episodios de neumonía adquirida en la comunidad. El tratamiento de los episodios de BA es fundamentalmente sintomático. En huéspedes inmunocomprometidos, con enfermedades crónicas respiratorias o cardíacas y en adultos mayores con comorbilidades debe evaluarse el requerimiento de tratamiento antibiótico caso por caso. Se define como exacerbación de la EPOC al cambio agudo en la situación clínica basal del paciente más allá de la variabilidad diaria, que cursa con aumento de la disnea, aumento de la expectoración, expectoración purulenta, o cualquier combinación de estos tres síntomas, y que precisa un cambio terapéutico. La presencia de uno de estos síntomas se define como episodio leve, dos como moderado y tres como grave. En un 50 a 75% de las exacerbaciones de EPOC se aísla en el esputo un agente infeccioso. En los episodios moderados y graves debe iniciarse tratamiento antibiótico. Amoxicilina-inhibidor de betalactamasas, macrólidos y fluoroquinolonas se encuentran entre las opciones terapéuticas.

  20. Programa de prevención y control de las enfermedades respiratorias agudas de la infancia en Santiago, Chile

    Directory of Open Access Journals (Sweden)

    Véjar M Leonardo

    1998-01-01

    Full Text Available En el presente trabajo se describen y examinan las actividades de un programa pediátrico para la prevención y el control de las infecciones respiratorias agudas (IRA en un servicio de salud estatal que atiende a la población de bajos ingresos de Santiago, Chile. En un área de salud correspondiente a una población de algo más de un millón de habitantes, con un hospital de base, 16 consultorios de atención primaria y ocho postas rurales, se desarrollaron actividades específicas de capacitación de personal, así como acciones de control en atención primaria y de hospitalización de niños con IRA grave. En los primeros 5 años de funcionamiento del programa (1990­1994 se observó entre niños menores de un año una disminución de la mortalidad anual por neumonía de 3,0 a 1,7 por 1 000, lo que ha contribuido a un descenso de la mortalidad infantil de 13,5 a 8,9 defunciones por 1 000 nacidos vivos. En 1994 los costos del programa alcanzaron los US$ 224 000. A juzgar por los resultados obtenidos, el programa de prevención y control de IRA puede haber sido un aporte valioso a la salud infantil del área.

  1. Impactos de adoecimento de longa duração: experiência de adultos jovens com Leucemia Mieloide Aguda

    Directory of Open Access Journals (Sweden)

    Reni Aparecida Barsaglini

    Full Text Available Resumo O presente artigo analisa os impactos materiais e imateriais imersos na experiência de adultos jovens com um adoecimento de longa duração – Leucemia Mieloide Aguda. Decorre de pesquisa mais ampla, inspirada na Fenomenologia de Alfred Schutz. Os dados foram obtidos por entrevistas em profundidade com quatro jovens, de 20 a 28 anos, em fase de manutenção no tratamento oncológico, entre novembro de 2013 a janeiro de 2014, em Mato Grosso. Os resultados enfocam aspectos marcantes dos impactos na experiência como o processo de descoberta da enfermidade em que o diagnóstico provocou sentimentos mobilizados por ideias sobre uma doença grave. Seguem-se os impactos na aparência devidos ao tratamento, sobressaindo a queda de cabelo e as estratégias cotidianas de enfrentamento, bem como o aumento ou a perda de peso. Por fim, é marcante o impacto da iminência da morte diante da letalidade da doença e o testemunho da ocorrência em pessoas conhecidas, colocando-a como possibilidade concreta para si, mas também como sobreviventes. Os impactos são os efeitos e as transformações na vida das pessoas e seu entorno e evocam (re ações, contudo, diluem-se na experiência compondo-a, e não sendo homogênea, sua abordagem privilegia a singularidade inscrita em biografias contextualizadas.

  2. [Association Budd Chiari syndrome, antiphospholipid syndrome and Grave's disease].

    Science.gov (United States)

    Mouelhi, Leila; Chaieb, Mouna; Debbeche, Radhouane; Salem, Mohamed; Sfar, Imene; Trabelsi, Sinda; Gorgi, Yosr; Najjar, Taoufik

    2009-02-01

    Antiphospholipid syndrome is revealed by Budd Chiari syndrome in 5% of the cases. Antiphospholipid syndrome is characterized by venous or arterial thrombosis, foetal loss and positivity of antiphospholipid antibodies, namely lupus anticoagulant, anticardiolipin antibodies and anti-beta2-glycoprotein I. Anticardiolipin antibodies was reported in auto-immune thyroid disorders, particularly in Grave's disease. Antiphospholipid syndrome associated to Grave's disease was reported in only three cases. To describe a case report of association of Grave's disease and antiphospholipid syndrome. We report the first case of Grave's disease associated with antiphospholipid syndrome, revealed by Budd Chiari syndrome. Our observation is particular by the fact that it is about a patient presenting a Grave's disease associated with antiphospholipid syndrome revealed by Budd Chiari syndrome. This triple association has never been reported in literature. Although association between antiphospholipid syndrome and Grave's disease was previously described, further studies evaluating the coexistence of these two affections in the same patient would be useful.

  3. Insuficiencia renal aguda obstructiva: Estudio de 42 pacientes

    Directory of Open Access Journals (Sweden)

    Isabel Caravia Pubillones

    1997-04-01

    Full Text Available Se revisaron las historias clínicas de 42 pacientes ingresados en el Servicio de Cuidados Intensivos del Instituto de Nefrología con el diagnóstico de insuficiencia renal aguda obstructiva (IRAO, con 1 ó 2 riñones funcionantes. Los pacientes estudiados estaban entre la 5ta y la 7ma década de la vida, con una mayor incidencia en el sexo masculino. La causa más frecuente de IRAO fue la litiasis renal (47,62 %, seguida por las enfermedades tumorales que infiltraban los uréteres (28,57 %. Se empleó tratamiento médico en 9 pacientes y el resto (33 fueron sometidos a tratamiento quirúrgico. Las principales complicaciones fueron sépticas con un franco predominio de las infecciones del tractus urinario (38,5 %. Hubo 3 fallecidos, 2 de ellos por complicaciones cardiovasculares. Del total de insuficiencias renales agudas que se atendieron en nuestro Centro, el 10,6 % correspondió a IRAO. La efectividad del tratamiento quirúrgico empleado fue del 94,4 % de curación en los pacientes atendidosMedical records of 42 patients admitted to the Intensive Care Unit of the Institute of Nephrology diagnosed as having acute obstructive renal failure with 1 or 2 kidneys functioning, were revised. Patients studied ware at the 5th and 7th decade of life with a greater incidence in males. The most frequent cause of acute obstructive renal failure was renal lithiasis (47.62 %, followed by tumor diseases which were infiltrating the ureters (28.57 %. Medical treatment was employed in 9 patients and the remaining (33 were submitted to surgical treatment. The main complications were septic with predominance of urinary tract infections (38.5 %. Three patients died, 2 of them as a result of cardiovascular complications. Of the total number of cases presenting with acute renal failure and treated in our center, 10.6 % had an acute obstructive renal failure. The effectiveness of the surgical treatment performed was 94.4 % of healing in patients treated for this

  4. Diagnosis of Grave's disease with pulmonary hypertension on chest CT.

    Science.gov (United States)

    Lee, Hwa Yeon; Yoo, Seung Min; Kim, Hye Rin; Chun, Eun Ju; White, Charles S

    To evaluate the diagnostic accuracy of chest CT findings to diagnose Grave's disease in pulmonary hypertension. We retrospectively evaluated chest CT and the medical records of 13 patients with Grave's disease with (n=6) or without pulmonary hypertension (n=7) and in 17 control patients. Presence of iso-attenuation of diffusely enlarged thyroid glands compared with adjacent neck muscle on non-enhanced CT as a diagnostic clue of Grave's disease, and assessment of pulmonary hypertension on CT has high diagnostic accuracy. Chest CT has the potential to diagnose Grave's disease with pulmonary hypertension in the absence of other information. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Necrose pancreática delimitada e outros conceitos atuais na avaliação radiológica da pancreatite aguda

    Directory of Open Access Journals (Sweden)

    Elen Freitas de Cerqueira Cunha

    2014-06-01

    Full Text Available A pancreatite aguda é uma condição inflamatória causada por ativação intracelular e extravasamento inapropriado de enzimas proteolíticas que determinam destruição do parênquima pancreático e dos tecidos peripancreáticos. Consiste em uma condição clínica bastante frequente, identificando-se duas formas principais de apresentação: a forma edematosa, menos intensa, e a forma necrosante, a forma grave da doença que acomete uma proporção significativa dos pacientes. A avaliação radiológica, sobretudo por tomografia computadorizada, tem papel fundamental na definição da conduta nos casos graves, sobretudo no que diz respeito à caracterização das complicações locais, que têm implicação prognóstica, e na determinação do tipo de abordagem terapêutica. Novos conceitos incluem a subdivisão da pancreatite necrosante nas formas de necrose do parênquima pancreático concomitante com necrose dos tecidos peripancreáticos ou necrose restrita aos tecidos peripancreáticos. Além disso, houve sistematização dos termos: acúmulos líquidos agudos peripancreáticos, pseudocisto, alterações pós-necróticas pancreáticas/peripancreáticas e necrose pancreática delimitada. Tal conhecimento é de extrema relevância no sentido de uniformizar a linguagem entre os especialistas envolvidos no diagnóstico e tratamento desses pacientes.

  6. Preoperative management in patients with Graves' disease.

    Science.gov (United States)

    Piantanida, Eliana

    2017-10-01

    Graves' disease is the most frequent cause of hyperthyroidism in iodine-sufficient geographical areas and is characterized by the presence in patients' serum of autoantibodies directed against the thyrotropin receptor (TRAb) that cause overproduction and release of thyroid hormones. Clinical presentation results from both hyperthyroidism and underlying autoimmunity. The diagnosis is based on characteristic clinical features and biochemical abnormalities. If serum thyrotropin (TSH) is low, serum free thyroxine (FT4) and free triiodothyronine (FT3) concentrations should be measured to distinguish between subclinical (with normal circulating thyroid hormones) and overt hyperthyroidism (with increased circulating thyroid hormones). Graves' disease is treated with any of three effective and relatively safe initial treatment options: antithyroid drugs (ATDs), radioactive iodine ablation (RAIU), and surgery. Total thyroidectomy is favored in several clinical situations, such as intolerance, ineffectiveness or recurrence after ATD treatment, radioiodine therapy contraindicated, documented or suspected thyroid malignancy, one or more large thyroid nodules, coexisting moderate-to-severe active Graves' orbitopathy, women planning a pregnancy within 6 months. Whenever surgery is selected as treatment, selection of an expert high-volume thyroid surgeons is fundamental and careful preoperative management is essential to optimize surgical outcomes. Pretreatment with ATDs in order to promptly achieve the euthyroid state is recommended to avoid the risk of precipitating thyroid storm during surgery. For the majority of patients, euthyroidism is achieved after few weeks of ATD treatment. Beta-blockers, such as propranolol, are often added effectively to control hyperthyroid symptoms. Saturated solution of potassium iodide (SSKI) or potassium iodine (Lugol's solution), given for a short period prior to surgery, in order to reduce both thyroid hormone release and thyroid gland

  7. 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.

  8. Tratamiento de la enfermedad de Graves Basedow

    OpenAIRE

    Hernando Vargas-Uricoechea; Carlos Hernán Sierra-Torres; Ivonne Alejandra Meza-Cabrera

    2014-01-01

    Se realizó una revisión narrativa rigurosa de la literatura inglesa y en español sobre diferentes aspectos de la Enfermedad de Graves-Basedow e hipertiroidismo. Esta patología –parte de la llamada “enfermedad tiroidea autoinmune”- se produce como consecuencia de la presencia de anticuerpos circulantes que se unen y activan al receptor de tirotropina, desencadenándose generalmente el hipertiroidismo en asociación con un estrés agudo. En este artículo actualizamos tanto el manejo de hipertiroid...

  9. Graves' disease. Manifestations and therapeutic options

    International Nuclear Information System (INIS)

    McFarland, K.F.; Saleeby, G.

    1988-01-01

    Graves' disease is the most common cause of hyperthyroidism. Clinical features include thyroid enlargement, eye signs, tachycardia, heat intolerance, emotional lability, weight loss, and hyperkinesis. Three modes of therapy are available. The preferences of the patient and physician are usually prime considerations in devising the therapeutic plan. Radioactive iodine is the most frequently used and safest method of treatment for adults. Antithyroid drugs are preferred for children and pregnant women. Surgery is usually reserved for patients in whom the other forms of treatment are not acceptable. Considerable patient education during the decision-making process enhances the success of the therapeutic plan

  10. Graves' disease and idiopathic intracranial hypertension

    Directory of Open Access Journals (Sweden)

    Manish Gutch

    2017-01-01

    Full Text Available Idiopathic intracranial hypertension (IIH is a central nervous system disorder characterized by raised intracranial pressure with normal cerebrospinal fluid composition and absence of any structural anomaly on neuroimaging. Among all endocrine disorders associated with the development of IIH, the association of hyperthyroidism and IIH is very rare with few cases reported till date. Thyroid disturbances have a unique association with IIH. Hypo- and hyper-thyroidism have been reported in association with this disorder. We present a rare case of a 25-year-old man with Graves' disease with intractable headache that was later investigated and attributed to development of IIH.

  11. Linfonodo pulmonar na paracoccidioidomicose aguda infantil (relato de um caso

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    Evanil Pires de Campos

    1992-09-01

    Full Text Available Observou-se a evolução de um linfonodo pulmonar na paracoccidioidomicose (PCM aguda infantil. Doente, masculino, 6 anos, branco, natural de Curitiba (PR, procedente de Guaratinguetá (SP, que há 3 meses desenvolveu quadro gripal, febre diária, bimodal, prolongada, precedida de calafrio, acompanhada de sudorese inodora, cefaléia frontal e anorexia. Diagnosticado e tratado como pneumonia por cinco dias, sem melhora do quadro. Há 2 meses, apresentou dor óssea nos braços e articulações do pé, com edema inflamatório e emagrecimento de 6 kg em 3 meses. Exame físico revelou: peso 20 kg; estatura 120 cm; P. A. 90/60 mmHg; facies atípica, hipoativo, palidez cutâneo-mucosa (+ +, hipotrofia muscular, adenopatiageneralizada, sopro sistólico suave em foco aórtico acessório e hepatesplenomegalia. Imunodifusão com exoantígeno glicoprotéico 43 kdpositiva (1/32. A biópsia de gânglio revelou Paracoccidioides brasiliensis. A radiologia demonstrou na primeira consulta, discreto infiltrado intersticial bilateral com linfoadenomegaliapara-hilar que desaparecu em 30 dias. Observou- se, ainda, massa tumoral mediastínica superior, hiperplasia do sistema fagocítico mononuclear e lesões osteolíticas nos 60 dias iniciais da evolução.

  12. Otitis media aguda: nuevo enfoque terapéutico

    Directory of Open Access Journals (Sweden)

    Ileana Alvarez Lam

    2004-03-01

    Full Text Available La otitis media aguda continúa siendo una de las enfermedades infecciosas más frecuentes en la infancia. Se hace una revisión del tema haciendo énfasis en la conducta terapéutica actual luego del surgimiento de complejos mecanismos de resistencia bacteriana creados por los microorganismos causantes de la enfermedad. Como toda enfermedad infecciosa las esperanzas están cifradas en el surgimiento de una vacuna que impacte de forma positiva en nuestra población infantil. En tal sentido se hace una reflexión sobre el uso de la vacuna antineumocócica de 7 valencias (Prevnar y su repercusión sobre esta enfermedad.Acute otitis media is still one of the most common infectious diseases among children. A review of the topic is made giving emphasis to the present therapeutic conduct after the appearance of complex mechanisms of bacterial resistance created by the microorganisms causing the disease. As in every infectious disease, we place our hopes on the emergence of a vaccine with a positive impact on our infantile population. In this sense, a reflection is made on the use of the heptavalent antipneumococcic vaccine (Prevnar and its repercussion on this disease.

  13. Meningoencefalite na fase aguda do sarampo : relato de seis casos

    Directory of Open Access Journals (Sweden)

    EL-FAR FABIANE

    2000-01-01

    Full Text Available Apresentamos 6 casos de meningoencefalite aguda por sarampo, diagnosticados durante epidemia na cidade de São Paulo, em 1997. Os prontuários dos 6 pacientes foram analisados retrospectivamente. O diagnóstico de meningoencefalite baseou-se nas alterações clínicas e liquóricas, e foi confirmado por sorologia específica. Dos 467 pacientes com sarampo atendidos no Instituto de Infectologia Emílio Ribas nesse período, estes 6 evoluíram com alterações neurológicas e liquóricas durante a fase exantemática, sendo a sonolência e rigidez de nuca os achados mais frequentes. Os pacientes tinham entre 2 meses e 28 anos de idade. O exame do líquor mostrou pleocitose em todos. Não houve correlação entre a severidade do quadro clínico e liquórico com a evolução. Em 4 casos foi necessária internação na unidade de terapia intensiva; destes, 2 foram intubados. Apenas 2 pacientes apresentaram alterações na tomografia computadorizada de crânio. Todos tiveram boa evolução, sem sequelas.

  14. Porfiria aguda intermitente: relato de caso e revisão da literatura Acute intermittent porphyria: case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Daniela von Ah Lopes

    2008-12-01

    Full Text Available Porfiria aguda intermitente é patologia incomum, com conseqüências potencialmente graves se não reconhecida precocemente. Dentre as possíveis causas de indução de crises de porfiria, a redução da ingestão calórica é descrita na literatura. Relatamos um caso de porfiria aguda intermitente no pós-operatório tardio de gastroplastia indicada para tratamento da obesidade, revisando aspectos do diagnóstico e tratamento da patologia na unidade de terapia intensiva. Paciente feminina, 31 anos, com história de gastroplastia há 3 semanas admitida na unidade de terapia intensiva com rebaixamento do nível de consciência e desconforto respiratório. Evoluiu com agitação psicomotora, confusão mental, dor abdominal e tetraparesia proximal. Na investigação diagnóstica foi encontrado hiponatremia grave (92 mEq/L, hipomagnesemia, hipofosfatemia e hipocalcemia, urina turva, sem hematúria. Aventou-se hipótese de porfiria aguda, realizado dosagem do ácido delta-aminolevulínico e porfobilinogênio na urina de 24h, com elevação de ambos. Iniciado tratamento com dieta rica em carboidratos, sem utilizar hematina ou arginato de heme, devido à dificuldades no fornecimento destas medicações. Evoluiu com melhora clínica gradativa e recuperação completa da força muscular após 8 meses. A porfiria aguda intermitente possui sinais e sintomas comuns a muitas patologias clínicas e neuropsiquiátricas dificultando o diagnóstico, em especial quando estes se manifestam isoladamente. Assim, deve-se incluir a porfiria aguda intermitente no diagnóstico diferencial de distúrbios neurológicos, psiquiátricos e gastroenterológicos em crises, no qual todos os demais exames estejam normais. Atenção deve ser dada a pacientes submetidos à cirurgias, em especial cirurgia bariátrica que, além do estresse cirúrgico, limita substancialmente a ingesta calórica podendo desencadear crises. Não há descrito na literatura, até o momento, nenhum

  15. Insuficiência Hepática Aguda da Gravidez Experiência Clínica com Sete Casos Acute Liver Failure of Pregnancy ¾ Clinical Experience with Seven Cases

    Directory of Open Access Journals (Sweden)

    Marcelo Perosa

    2001-04-01

    Full Text Available Objetivos: avaliar a dificuldade diagnóstica, o tratamento e seu resultado em casos de insuficiência hepática aguda da gravidez. Métodos: sete pacientes com insuficiência hepática aguda da gravidez admitidas em nosso Serviço nos últimos quatro anos foram estudadas com ênfase nos sintomas presentes, achados laboratoriais, curso clínico, complicações maternas e sobrevida fetal. Resultados: a média de idade foi de 25,8 anos (sendo duas primigestas com idade gestacional média de 30,1. Destas, quatro receberam diagnóstico final de esteatose hepática aguda da gravidez e três de colestase intra-hepática da gravidez. Os principais sinais e sintomas encontrados foram: anorexia, náusea, dor abdominal, icterícia e encefalopatia. Ocorreu morte materna em dois casos: uma paciente por falência hepática enquanto aguardava órgão para transplante e outra por falência hepática, coagulopatia grave e choque hemorrágico após biópsia hepática. Uma paciente com esteatose hepática aguda evoluiu para cronicidade e encontra-se viva um ano após transplante hepático. Nos quatro casos restantes houve completa remissão do quadro com as medidas de suporte, associadas à interrupção da gravidez. As mortalidades materna e fetal foram, respectivamente, 28,6% e 57,1%. Conclusões: concluiu-se, nesta experiência inicial, que a insuficiência hepática aguda da gravidez constitui evento clínico grave, de elevada mortalidade materno-fetal, e que seu pronto reconhecimento e encaminhamento para centros terciários especializados em fígado, além da imediata interrupção da gestação, são fatores decisivos para o sucesso do tratamento.Purpose: to evaluate the diagnostic difficulties, treatment and outcome in cases of acute liver failure of pregnancy. Methods: seven patients with acute liver failure of pregnancy, managed during the past 4 years, were studied with emphasis on presenting symptoms, laboratory findings, clinical course, maternal

  16. Dosimetry-based treatment for Graves' disease.

    Science.gov (United States)

    Hyer, Steve L; Pratt, Brenda; Gray, Matthew; Chittenden, Sarah; Du, Yong; Harmer, Clive L; Flux, Glenn D

    2018-06-01

    The aim of this retrospective study was to assess the long-term outcome of a personalized dosimetry approach in Graves' disease aiming to render patients euthyroid from a planned thyroid absorbed dose of 60 Gy. A total of 284 patients with Graves' disease were followed prospectively following administration of radioiodine calculated to deliver an absorbed dose of 60 Gy. Patients with cardiac disease were excluded. Outcomes were analysed at yearly intervals for up to 10 years with a median follow-up of 37.5 months. A single radioiodine administration was sufficient to render a patient either euthyroid or hypothyroid in 175 (62%) patients, the remainder requiring further radioiodine. The median radioactivity required to deliver 60 Gy was 77 MBq. Less than 2% patients required 400-600 MBq, the standard activity administered in many centres. In the cohort receiving a single administration, 38, 32 and 26% were euthyroid on no specific thyroid medication at 3, 5 and 10 years, respectively. Larger thyroid volumes were associated with the need for further therapy. The presence of nodules on ultrasonography did not adversely affect treatment outcome. A personalized dosimetric approach delayed the long-term onset of hypothyroidism in 26% of patients. This was achieved using much lower administered activities than currently recommended. Future studies will aim to identify those patients who would benefit most from this approach.

  17. Insuficiência respiratória aguda durante anestesia pediátrica: atelectasia e pneumotórax hipertensivo: relato de caso

    Directory of Open Access Journals (Sweden)

    Joel Massari Rezende

    2012-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A tarefa primordial do anestesiologista é garantir a adequada oxigenação do paciente. O objetivo deste relato é des crever o diagnóstico e conduta em um caso de insuficiência respiratória aguda durante anestesia, com finalidade didática. RELATO DO CASO: Criança de três anos submetida à anestesia para cirurgia urológica apresentou insuficiência respiratória por obstruções de brônquios por secreção, evoluindo com atelectasia e pneumotórax hipertensivo. Apresentamos o desenrolar do caso, e os meios de tratamento aplicado, com destaque para a urgência e técnica da drenagem no pneumotórax hipertensivo. CONCLUSÕES: A atenção do anestesiologista para o diagnóstico precoce de complicações respiratórias e o conhecimento das medidas prioritárias em cada momento pode evitar efeitos adversos graves

  18. Thymic hyperplasia in a patient with Grave's disease.

    Science.gov (United States)

    Hamzaoui, Amira A; Klii, Rim R; Salem, Randa R; Kochtali, Ines I; Golli, Mondher M; Mahjoub, Silvia S

    2012-02-09

    Hyperplastic changes of the thymus may be found in patients with Graves' disease. However, this rarely presents as an anterior mediastinal mass, particularly among adults. In this report, we describe a 46-year old woman with Graves' disease and thymic hyperplasia.

  19. Thymic hyperplasia in a patient with Grave's disease

    Directory of Open Access Journals (Sweden)

    Hamzaoui Amira A

    2012-02-01

    Full Text Available Abstract Hyperplastic changes of the thymus may be found in patients with Graves' disease. However, this rarely presents as an anterior mediastinal mass, particularly among adults. In this report, we describe a 46-year old woman with Graves' disease and thymic hyperplasia.

  20. [Diagnostic difficulties in Grave's orbitopathy--case report].

    Science.gov (United States)

    Jedrzejowski, Maciej; Grzesiuk, Wiesław; Szwejda, Elzbieta; Bar-Andziak, Ewa

    2004-03-01

    Graves' orbitopathy is caused by intraorbital inflammatory reaction due to autoimmune thyroid disease. In most cases the diagnosis is based on the coexistence of typical eye signs and hyperthyroidism symptoms. In presented case, the absence of thyroid dysfunction implicated performance of differential diagnosis. Among many available diagnostic tools nuclear magnetic resonance seems to be the most accurate in confirmation of diagnosis of Graves' orbitopathy.

  1. Notes on Glasinac: The chronology of princely graves

    Directory of Open Access Journals (Sweden)

    Vasić Rastko

    2009-01-01

    Full Text Available Princely graves of the Iron Age represent a particular phenomenon in archaeology, which is constantly the subject of interest. They are usually dated to the end of the 6th and the beginning of the 5th century. The author discusses the chronology of princely graves in the Central Balkans and analyses their appearance in each part of this territory: on the Glasinac plateau, in Serbia, Kosovo and Metohija, Montenegro, North Albania and Nordwest Bulgaria. He concludes that they date from the middle of the 7th to the middle of the 4th century, depending on the cultural and socio-economic situation in the respective area. In the middle of the 7th century princely graves in the true sense of the word were known only on the Glasinac plateau, in the Ilijak necropolis. At the end of the 7th and in the beginning of the 6th century they still appear on Glasinac, though in greater number and in various parts of the plateau. In northwest Bulgaria a grave dating to the second half of the 7th century was found, which would, according to grave goods, correspond to the Glasinac princely graves. On the other hand, there are no princely graves in Serbia and north Albania from that time but some outstanding warrior graves are known, belonging possibly to the chiefs of smaller warlike bands, whose power was limited. Princely graves from Arareva gromila on Glasinac, Pilatovići by Požega and Lisijevo Polje by Berane date to the beginning of the second half of the 6th century, and according to their characteristics represent princes, whose power and wealth were considerable and known to the neighbours. Culmination of the rise of the princes in this region was demonstrated by the graves from Novi Pazar, Atenica, and Pećka banja, which date to the end of the 6th and the first quarter of the 5th century. Some decades later there are several rich graves, e.g. the recently discovered grave from Velika Krsna, which could belong to a prince, but can not be compared with the

  2. Variceal bleeding: consensus meeting report from the Brazilian Society of Hepatology Hemorragia digestiva alta varicosa: relatório do 1º Consenso da Sociedade Brasileira de Hepatologia

    Directory of Open Access Journals (Sweden)

    Paulo Lisboa Bittencourt

    2010-06-01

    Full Text Available In the last decades, several improvements in the management of variceal bleeding have resulted in a significant decrease in morbidity and mortality of patients with cirrhosis and bleeding varices. Progress in the multidisciplinary approach to these patients has led to a better management of this disease by critical care physicians, hepatologists, gastroenterologists, endoscopists, radiologists and surgeons. In this respect, the Brazilian Society of Hepatology has, recently, sponsored a consensus meeting in order to draw evidence-based recommendations on the management of these difficult-to-treat subjects. An organizing committee comprised of four people was elected by the Governing Board and was responsible to invite 27 researchers from distinct regions of the country to make a systematic review of the subject and to present topics related to variceal bleeding, including prevention, diagnosis, management and treatment, according to evidence-based medicine. After the meeting, all participants met together for discussion of the topics and the elaboration of the aforementioned recommendations. The organizing committee was responsible for writing the final document. The meeting was held at Salvador, May 6th, 2009 and the present manuscript is the summary of the systematic review that was presented during the meeting, organized in topics, followed by the recommendations of the Brazilian Society of Hepatology.Vários avanços científicos obtidos nas últimas duas décadas foram incorporados no manejo da hemorragia digestiva alta varicosa, levando a uma redução significante da sua morbimortalidade, atribuída à abordagem multidisciplinar do sangramento varicoso por paramédicos, emergencistas, intensivistas, gastroenterologistas, hepatologistas, endoscopistas, radiologistas intervencionistas e cirurgiões. Recentemente, a Sociedade Brasileira de Hepatologia patrocinou uma reunião de consenso, visando o estabelecimento de recomendações nacionais

  3. Digestive and functional properties of a partially hydrolyzed cassava solid waste with high insoluble fiber concentration Propriedades funcionais-digestivas do concentrado de fibra alimentar obtido de mandioca

    Directory of Open Access Journals (Sweden)

    Dorivaldo da Silva Raupp

    2004-06-01

    Full Text Available Starch factories generate large amounts of cassava solid waste. A small amount is utilized for animal feed but most of it is discharged with deleterious effects to the envirounment. A edible food with a high content of insoluble dietary fiber (60.9%, named "partially hidrolyzed cassava waste" (PHCW, was prepared from industrial cassava solid waste by an enzymatic process. PHCW or wheat bran (WB were fed to model rats and both promoted digestive function effects, but PHCW produced the greatest effect. The insoluble fiber constituent from PHCW (and not the soluble fiber, promoted the greatest fecal bulking, fecal weight and defecation frequency in rats, as compared to WB. Such results indicate that the partially hydrolyzed cassava waste presents digestive function properties which allow it to be used as an adequate source of insoluble dietary fiber in the formulation of functional food for human nutrition.As fecularias e polvilheiras produzem grandes quantidades de bagaço de mandioca. A proposta dessa pesquisa consistiu determinar, em ratos modelo, a propriedade funcional-digestiva do produto alimentício bagaço de mandioca hidrolisado (BMH, um concentrado de fibra alimentar (60,9%, peso seco que foi obtido a partir do bagaço de mandioca da polvilheira e através de processo de hidrólise enzimática. O BMH produziu efeitos fisiológicos no trato digestivo dos ratos modelos mais acentuados que os efeitos produzidos pelo farelo de trigo (FT. Foram os componentes insolúveis da fibra alimentar do BMH, e não a fração solúvel, os que mais contribuíram para o maior volume e peso das fezes e, por conseguinte, para o maior número de defecações. Por isso, o BMH pode ser usado como fonte alternativa de fibra alimentar para a formulação de alimentos, principalmente os consumidos por indivíduos com a finalidade de regular ou manter normal a funcionalidade digestiva.

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

    NARCIS (Netherlands)

    Bartalena, Luigi; Baldeschi, Lelio; Boboridis, Kostas; Eckstein, Anja; Kahaly, George J.; Marcocci, Claudio; Perros, Petros; Salvi, Mario; Wiersinga, Wilmar M.; Adamidou, Fotini; Anagnostis, Panagiotis; Ayvaz, Goksun; Azzolini, Claudio; Boschi, Antonella; Bournaud, Claire; Clarke, Lucy; Currò, Nicola; Daumerie, Chantal; Dayan, Colin; Fuhrer, Dagmar; Konuk, Onur; Marinò, Michele; Morris, Daniel; Nardi, Marco; Pearce, Simon; Pitz, Susanne; Rudovsky, Gottfried; Vannucchi, Guia; Vardanian, Christine; von Arx, Georg

    2016-01-01

    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 mech anisms of the disease. Treatment should rely on a thorough assessment of the

  5. Predictive score for the development or progression of Graves' orbitopathy in patients with newly diagnosed Graves' hyperthyroidism

    DEFF Research Database (Denmark)

    Wiersinga, Wilmar; Žarković, Miloš; Bartalena, Luigi

    2018-01-01

    OBJECTIVE: To construct a predictive score for the development or progression of Graves' orbitopathy (GO) in Graves' hyperthyroidism (GH). DESIGN: Prospective observational study in patients with newly diagnosed GH, treated with antithyroid drugs (ATD) for 18 months at ten participating centers f...

  6. Outcome of very long-term treatment with antithyroid drugs in Graves' hyperthyroidism associated with Graves' orbitopathy

    NARCIS (Netherlands)

    Elbers, Laura; Mourits, Maarten; Wiersinga, Wilmar

    2011-01-01

    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 surgical

  7. Lúpus eritematoso sistêmico e pancreatite aguda: relato de dois casos

    OpenAIRE

    Azevedo, Ana Beatriz Cordeiro de; Brito, Fabiano Almeida; Santos, Flávia Patrícia Sena Teixeira; Ferreira, Gilda Aparecida; Carvalho, Marco Antônio Parreiras de

    2003-01-01

    A pancreatite aguda é uma manifestação incomum do lúpus eritematoso sistêmico (LES) e a freqüência desta associação não é conhecida. Contudo, a pancreatite aguda é um diagnóstico diferencial importante na avaliação da dor abdominal em pacientes com LES. Os pacientes, normalmente, apresentam dor de intensidade variável, algumas vezes simulando abdome agudo. Vários fatores têm sido implicados na patogênese desta condição, tais como fenômenos autoimunes, vasculite, anticorpos antifosfolípides e ...

  8. Abdomen agudo ocasionado por apendicitis aguda de probable origen tuberculoso. Informe de un caso

    OpenAIRE

    Montiel-Jarquín, Álvaro José; Alvarado-Ortega, Iván; Romero-Figueroa, María del Socorro; Rodríguez-Pérez, Fabiola; Rodríguez-Lima, Felipe; Loria-Castellanos, Jorge

    2017-01-01

    RESUMEN Antecedentes: la apendicitis aguda tuberculosa es una enfermedad rara, constituye de 0,001 % a 0,01 % de las formas clínicas de tuberculosis. Se presenta un caso de apendicitis aguda probablemente tuberculosa como causa de abdomen agudo quirúrgico. Caso clínico: hombre de 29 años con cuadro de dolor abdominal leve a moderado que se intensificó y localizó en el hemiabdomen derecho, claudicación, febrícula, vómito, mal estado general, leucocitosis de 11 300/µL y neutrofilia de 91 %....

  9. Injúria renal aguda: um alerta global

    Directory of Open Access Journals (Sweden)

    Philip Kam Tao Li

    2013-03-01

    Full Text Available A Injúria Renal Aguda (IRA é cada vez mais prevalente nos países desenvolvidos e nos em desenvolvimento, e está associada com morbidade e mortalidade severas. A maioria das causas da IRA pode ser evitada por meio de intervenções em nível individual, comunitário, regional e intra-hospitalar. Medidas efetivas devem incluir, em toda a comunidade, os esforços para aumentar a consciência dos efeitos devastadores do IRA e fornecer orientações sobre as estratégias de prevenção, bem como o reconhecimento e tratamento precoces. Os esforços devem ser focados em minimizar as causas de IRA, aumentando a consciência da importância de medidas seriadas de creatinina sérica em pacientes de alto risco para IRA, e documentar o volume de urina em pessoas gravemente doentes para obtenção de diagnóstico precoce; até o momento, não há ainda um papel definitivo para outros biomarcadores. Há a necessidade de protocolos para sistematizar a conduta em condições de IRA pré-renal e em infecções específicas. Dados mais precisos sobre a verdadeira incidência e o impacto clínico da IRA ajudarão a melhor conhecer a importância desta doença, a aumentar o conhecimento de IRA por parte dos governantes, dos médicos em geral e de outros profissionais de saúde para ajudar na prevenção da doença. A prevenção é a chave para evitar a pesado ônus de mortalidade e morbidade associada com IRA.

  10. Intoxicación aguda por hidrato de hidracina

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    Santiago Nogué Xarau

    2008-06-01

    Full Text Available Se aporta un caso de exposición aguda, debido a un vertido accidental de unos 25 litros de hidrato de hidracina, que el trabajador estuvo recogiendo sin ningún tipo de equipo de protección individual. El trabajador presentó alteraciones bucales, cutáneas y dolores abdominales difusos. De las pruebas complementarias únicamente se detectó un aumento de la bilirrubina total con predominio de la indirecta. Se le separó de la exposición, se le administró un tratamiento sintomático y en un periodo de un mes se recuperó íntegramente. Se comenta los principales casos de intoxicación por hidracina descritos en la literatura médica y se enfatiza en las medidas preventivas que se deben tomar para evitar casos como éste.We report a case of poisoning by acute exposure to hydrazine hydrate in a worker clearing up an accidental spillage of about 25 litres of the product who had no type of individual protective equipment. The patient presented buccal and cutaneous involvement and diffuse abdominal pain. Complementary tests were unremarkable except for an increase in total bilirubin with a predominance of indirect bilirubin. The patient was removed from the occupational exposure, symptomatic treatment was administered and the patient recovered completely after one month. We review the main reported cases of hydrazine poisoning and emphasize the preventive measures that should be taken to avoid this type of poisoning.

  11. Dacriocistitis aguda neonatal (1996-2005 Acute neonatal dacryocystitis

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    Zoila del S López Díaz

    2006-12-01

    Full Text Available Se realizó un estudio longitudinal y retrospectivo en diez años (1996-2005, de todos los neonatos cuyo motivo de ingreso en nuestra Unidad de Cuidados Intensivos Neonatales fue ser portadores de dacriocistitis aguda. Se obtuvo los siguientes resultados: incidencia 0,04 c/ 100 ingresos. Predominio: edades entre 7-27días (sepsis tardía, sexo femenino 66,6 %, nacidos de embarazos a término y con buen peso al nacer 100 %. Etiología no precisada 83,3 %. Tratamiento utilizado: antibioticoterapia (penicilina + gentacina, 4 pacientes, 66,6 %, (unasyn, 1 paciente, 16,6 %, (amoxicilina + unasyn + gentamicina, 1 paciente, 16,6 %; uso de inmunoglobulina humana en 2 pacientes. Complicaciones: celulitis facial y periorbitaria 66,6 %; absceso periorbitario 33,3 %; fiebre (33,3 % y obstrucción nasal 16,6 %. Evolución satisfactoria con seguimiento por Oftalmología después del egreso hospitalario, en 100 % de los casosA retrospective longitudinal study of all neonates admitted to our Intensive Care Unit because they suffered from acute dacryocystitis was performed for 10 years (1996-2005. The results were as follows: incidence rate of 0,04 per 100 admissions; prevalence: 7-27d age groups (late sepsis, females with 66,6%; neonates born to term pregnancies and with good birthweight in 100%. Inaccurate etiology in 83,3 %. Treatment: antibiotic therapy (penicilline + gentamycin in 4 paients, 66,6%, (unasyn, one patient, 16,6 %, (amoxycillin + unasyn +gentamycin, 1 patient, 16.6 %. Use of human immunoglobulin in 2 patients. Complications: facial and periorbital cellulitis, 66,6%; periorbital abscess 33,3 %; fever (33,3 % and nasal obstruction (16,6 %. Satisfactory recovery with ophtalmological follow-up after discharge from hospital in 100 % of cases

  12. Intoxicação aguda por cobre em ovinos

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    Marcele Bettim Bandinelli

    2013-10-01

    Full Text Available Descrevem-se casos de intoxicação aguda por cobre em ovinos da raça Santa Inês, numa propriedade rural, no Rio Grande do Sul. Três ovelhas recém-paridas, que consumiam ração formulada para bovinos, ingeriram, avidamente, sal mineral comercial para bovinos e apresentaram doença clínica e morte, uma semana após a introdução do sal. Os animais desenvolveram anorexia, permaneceram em decúbito lateral, o qual evoluiu para esternal e apresentaram fasciculação e rigidez muscular generalizada, antes de morrerem. À necropsia de um desses animais, as principais alterações foram hepatomegalia moderada e acentuação do padrão lobular hepático, além de erosões e ulcerações multifocais aleatórias na mucosa abomasal. Na avaliação histológica do fígado, havia necrose hepatocelular centrolobular acentuada e difusa, tumefação de hepatócitos, predominantemente, na região periportal, além de pequena quantidade de células de Kupffer com pigmento granular citoplasmático. O diagnóstico baseou-se na história clínica, nos achados de necropsia e histopatológicos e confirmou-se pelas altas concentrações de cobre detectadas no tecido hepático e nas amostras de ração e sal mineral.

  13. Uso de antimicrobianos en la enfermedad diarreica aguda

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    Enrique A. González Corona

    1996-04-01

    Full Text Available Se realizó un estudio sobre el estado actual del uso de antimicrobianos en el Servicio de Enfermedades Diarreicas Agudas del Hospital Infantil Docente Sur de Santiago de Cuba, durante el período comprendido entre marzo y agosto de 1992. El universo estuvo integrado por 427 pacientes ingresados, de los cuales sólo 13,1 % requirió el empleo de estos medicamentos: 9,4 % por infección enteral y 3,7 % por extraenteral bacteriana. Más de la tercera parte de los afectados curaron con alimentación continuada y rehidratación, en su mayoría oral, y fueron las diarreas persistentes y disentéricas las que más frecuentemente condicionaron su administración. El criterio clínico fue determinante en su indicación.A study was carried out on the current state of the use of microbicidals in the Acute Diarrhea Service of the Southern Educational Children's Hospital at Santiago de Cuba, during the period between March and August 1992. The universe was integrated by 427 inpatients, of which only the 13,1 % required the use of these drugs: 9,4 % due to enteral infection, and 3,7 % due to bacterial extraenteral infection. More than the third part of the patients healed with continuous feeding and rehydration, mostly oral, and the persistent and dysenteric diarrheas conditioned most frequently its administration. The clinical criterion was determining in its indication.

  14. Problemas identificados en el manejo de la enfermedad diarreica aguda

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    Carlos Coronel Carbajal

    2000-08-01

    Full Text Available Se realizó un estudio retrospectivo de corte transversal en el Hospital "Armando E. Cardoso", en el período de 1 año (Mayo 98-Febrero 99. Este estudio consistió en encuestar a 256 madres de niños con diarreas agudas con el objetivo de identificar las costumbres inapropiadas que aún persisten en el manejo ambulatorio de las enfermedades diarreicas. Al concluir el estudio se pudo apreciar cómo en el 56,3 % de los pacientes hubo mal manejo alimentario, además solo el 12,1 % de las madres buscaron orientación médica en las primeras 24 horas. En este estudio se pudo conocer que el 100 % de las madres saben que las soluciones de rehidratación oral (SRO forman parte del tratamiento de la EDA, pero solo el 42 % conoce que previenen la deshidratación, además solo un 25 % conoce de otros líquidos que reemplazan el uso de las soluciones de rehidratación oralA cross-sectional study was conducted at the "Armando E. Cardoso" Hospital from May, 1998, to February,1999. 256 mothers of children with acute diarrhea were surveyed in order to identify the inappropiate costums that still exist in the ambulatory management of diarrheal diseases. A poor food management was observed in 56.3% of the patients and only 12.1% of the mothers looked for medical advice during the first 24 hours. It was possible to know through this study that 100% of the mothers know that oral rehydration solutions (ORS are part of the treatment of ADD, but only 42% know that the drug also prevents dehydration. Just 25% know about other fluids that replace the use of oral rehydration solutions

  15. Graves' ophthalmopathy and 131I therapy

    International Nuclear Information System (INIS)

    Marcocci, C.; Bartalena, L.; Tanda, M.L.; Manetti, L.; Dell'Unto, E.; Mazzi, B.; Rocchi, R.; Barbesino, G.; Pinchera, A.

    1999-01-01

    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; i i) hypothyroidism, which follows thyroid tissue ablation, should be regarded as a therapeutic end point rather than as an undesirable result; iii) ablation of thyroid tissue may result in the removal of both the thyroid-orbit cross-reacting antigen(s) and the major source of thyroid-auto reactive lymphocytes. The relationship between radioiodine therapy and the course of GO is a matter of controversy, and some authors have suggested that radioiodine administration ma be associated with a worsening of preexisting ophthalmopathy. This was not observed when radioiodine treatment was associated with a 3-month oral course of prednisone. The development or progression of GO after radioiodine therapy might be due to the release of thyroid antigens following radiation injury and to subsequent exacerbations of autoimmune reactions directed towards antigens shared by the thyroid and the orbit. The view that radioiodine therapy may be associated with a progression of ophthalmopathy is not shared by some authors who claim that the apparent link between progression of

  16. Evaluación nutricional de niños con insuficiencia renal aguda que reciben diálisis Nutritional assessment of children presenting with acute renal insufficiency and underwent to dialysis

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    Jorge Silva Ferrera

    2010-03-01

    Full Text Available INTRODUCCIÓN. La insuficiencia renal aguda se produce en horas o en algunos días, y durante su evolución se produce un deterioro del estado nutricional del paciente. El objetivo de este estudio fue caracterizar el estado nutricional de niños con esta enfermedad que requirieron terapias de reemplazo renal. MÉTODOS. Se realizó un estudio retrospectivo y transversal que incluyó a los pacientes ingresados por insuficiencia renal aguda en dos hospitales pediátricos de Santiago de Cuba entre diciembre de 2006 y diciembre de 2008. Se analizó edad, sexo, etiología, terapia de reemplazo renal, causa del uso de nutrición parenteral, evaluación nutricional según tablas cubanas de percentiles y parámetros antropométricos (edad, peso, talla y aporte de nutrientes parenterales. RESULTADOS. Eventos prerrenales fueron la causa de la insuficiencia renal aguda en el 44,4 % de los casos, y renales y posrenales, en el 33,4 y 22,2 %, respectivamente. Como método de depuración renal se utilizó la diálisis peritoneal en el 66,6 % de los casos y la hemodiálisis en los restantes pacientes. Las principales causas que motivaron la nutrición parenteral fueron las afecciones quirúrgicas, los estados hipercatabólicos, la hemorragia digestiva y la pancreatitis, en orden decreciente. Cuatro pacientes fueron evaluados como de bajo peso. CONCLUSIONES. El aporte promedio de proteínas y lípidos estuvo por debajo de los aportes nutricionales establecidos, y el aporte de kilocalorías fue superior a lo recomendado. Se deben mejorar estos parámetros en el tratamiento de estos pacientes.INTRODUCTION: Acute renal insufficiency appears in hours or in a few days and during its course there is a deterioration of patient nutritional status. The aim of present study was to characterize the nutritional status of children with this disease requiring renal replacement therapies. METHODS: A crossed-sectional and retrospective study was conducted including the patients

  17. Management of Graves' hyperthyroidism

    Energy Technology Data Exchange (ETDEWEB)

    Orgiazzi, J.

    1987-06-01

    Management of Graves' disease hyperthyroidism, a life-long disease, hinges on a clear strategy and involves the patient's understanding and adherence. Antithyroid drug treatment is difficult to adapt to each patient's need; so far, the more efficient use of antithyroid drug remains on long-term courses of 18 months or more. Although a picture is evolving of patients more likely to go into remission after the medical treatment, its characteristics are not yet reliable. Radical (ablative) treatments are often necessary. In general, surgery might appear less appealing than /sup 131/I irradiation which, as compared to surgery, carries only the risk of later hypothyroidism. It is hoped that basic as well as clinical research is able to generate innovative, better adapted, and pathophysiologically oriented new therapeutic means. 124 references.

  18. Radiation therapy of Graves' ophthalmopathy

    Energy Technology Data Exchange (ETDEWEB)

    Kawamura, Toshiki; Koga, Sukehiko; Anno, Hirofumi; Komai, Satoshi (Fujita-Gakuen Health Univ., Toyoake, Aichi (Japan))

    1992-01-01

    During the decade from 1978 to 1987, 20 patients with Graves' ophthalmopathy were treated with irradiation of 2000 cGy to the orbital tissue. We examined the effects of the therapy on 17 such patients. Exophthalmos tended to decrease. When the degree of deviation of the exophthalmic eye was small, the effect of therapy tended to be better than when it was large. Two cases that showed an increase in retrobulbar fatty tissue without thickening of the extraocular muscles did not respond as well as those that had thickening of the extraocular muscles. Diplopia tended to improve both subjectively and objectively. Ocular movement improved in 11 of the 17 patients. There were no serious radiation injuries after the radiation therapy, except for some transient swelling of the eyelid. (author).

  19. Pathogenesis of Graves' disease and therapeutic implications

    International Nuclear Information System (INIS)

    Seif, F.J.

    1997-01-01

    Graves' disease presents itself clinically mainly as hyperthyroidism and infiltrative ophthalmopathy and to a minimal extent also as dermopathy and acropachy. Autoimmune processes are the basic pathogenesis. Stimulating antibodies against the TSH receptor cause hyperthyroidism. Autoantibodies and autoreactive T lymphocytes against primarily thyroidal antigens cross-react with similar antigens of the eye muscles and orbital connective tissue, thus spreading the disease from the thyroid to the eyes. The therapeutic goal comprises not only the treatment of hyperthyroidism, but also the induction of a steady immuntolerance in order to minimize the irreversible damage to the eye. The therapeutic armamentarium is formed by antithyroid drugs, glucocorticoids, retrobulbar radition and thyroid ablation, either by nearly total thyroidectomy or by radioiodine. The different indications for both ablative procedures are discussed. (orig.) [de

  20. Supervoltage orbital radiotherapy for progressive Graves' ophthalmopathy

    International Nuclear Information System (INIS)

    Kriss, J.P.; McDougall, I.R.; Petersen, I.A.; Donaldson, S.S.

    1989-01-01

    Since 1968 we have employed supervoltage orbital radiation as treatment for severe progressive Graves' ophthalmopathy. A numerical ophthalmic index was used to asess pre- and post-treatment serverity. In the past 20 years we have treated 311 patients of whom 275 have been followed for ≤ 1 year or until any eye surgery was performed. An orbital radiation dosage of 2000 rads in 2 weeks was used for the majority of patients (Series I and III). Series II patients received an orbital dose of 3000 rads in 3 weeks. Demographic differences were observed between these series, thus mandating presentation of the results of each separately. Analyses excluded any result achieved by any post-radiation surgical procedure on the eyes. Post-theraphy worsening of ophtalmopathy occurred in only 29 of 1025 observations. Improvement or complete resolution was observed within each category of eye involvement, but lack of favorable response was also recorded in significant numbers. Improvement in proptosis occurred with the lowest frequency and magnitude. About 30% of the patients required eye muscle surgery to correct residual diplopia. Analysis of the data by step-wise linear regression analysis enabled us a. to derive formulae predicting the problable response to radiation therapy according to sign and severity, and b. identify parameters which diminished the likelihood or the extent of a favorable response. The latter included male sex, never thyrotoxic, age greater than 60 years, and requirement for concomitant treatment for hyperthyroidism. No long-term adverse reactions attributable to the radiotherapy have been observed. We conclude that supervoltage orbital radiotherapy, combined with later eye muscle surgery if necessary, is an effective treatment strategy for progressive Graves' ophthalmopathy. (author)

  1. Radiotherapy in the management of Graves' ophthalmopathy

    International Nuclear Information System (INIS)

    Sakata, Koh-ichi; Hareyama, Masato; Oouchi, Atsushi; Shidou, Mitsuo; Nagakura, Hisayasu; Morita, Kazuo; Osanai, Hajime; Ohtsuka, Kenji; Hinoda, Yuji

    1998-01-01

    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)

  2. Graves' Disease that Developed Shortly after Surgery for Thyroid Cancer.

    Science.gov (United States)

    Yu, Hea Min; Park, Soon Hyun; Lee, Jae Min; Park, Kang Seo

    2013-09-01

    Graves' disease is an autoimmune disorder that may present with various clinical manifestations of hyperthyroidism. Patients with Graves' disease have a greater number of thyroid nodules and a higher incidence of thyroid cancer compared with patients with normal thyroid activity. However, cases in which patients are diagnosed with recurrence of Graves' disease shortly after partial thyroidectomy for thyroid cancer are very rare. Here we report a case of hyperthyroid Graves' disease that occurred after partial thyroidectomy for papillary thyroid cancer. In this case, the patient developed hyperthyroidism 9 months after right hemithyroidectomy, and antithyroglobulin autoantibody and thyroid stimulating hormone receptor stimulating autoantibody were positive. Therefore, we diagnosed Graves' disease on the basis of the laboratory test results and thyroid ultrasonography findings. The patient was treated with and maintained on antithyroid drugs. The mechanism of the recurrence of Graves' disease in this patient is still unclear. The mechanism may have been the improper response of the immune system after partial thyroidectomy. To precisely determine the mechanisms in Graves' disease after partial thyroidectomy, further studies based on a greater number of cases are needed.

  3. Predictive factors of thyroid cancer in patients with Graves' disease.

    Science.gov (United States)

    Ren, Meng; Wu, Mu Chao; Shang, Chang Zhen; Wang, Xiao Yi; Zhang, Jing Lu; Cheng, Hua; Xu, Ming Tong; Yan, Li

    2014-01-01

    The best preoperative examination in Graves' disease with thyroid cancer still remains uncertain. The objectives of the present study were to investigate the prevalence of thyroid cancer in Graves' disease patients, and to identify the predictive factors and ultrasonographic features of thyroid cancer that may aid the preoperative diagnosis in Graves' disease. This retrospective study included 423 patients with Graves' disease who underwent surgical treatment from 2002 to 2012 at our institution. The clinical features and ultrasonographic findings of thyroid nodules were recorded. The diagnosis of thyroid cancer was determined according to the pathological results. Thyroid cancer was discovered in 58 of the 423 (13.7 %) surgically treated Graves' disease patients; 46 of those 58 patients had thyroid nodules, and the other 12 patients were diagnosed with incidentally discovered thyroid carcinomas without thyroid nodules. Among the 58 patients with thyroid cancer, papillary microcarcinomas were discovered in 50 patients, and multifocality and lymph node involvement were detected in the other 8 patients. Multivariate regression analysis showed younger age was the only significant factor predictive of metastatic thyroid cancer. Ultrasonographic findings of calcification and intranodular blood flow in thyroid nodules indicate that they are more likely to harbor thyroid cancers. Because the influencing factor of metastatic thyroid cancers in Graves' disease is young age, every suspicious nodule in Graves' disease patients should be evaluated and treated carefully, especially in younger patients because of the potential for metastasis.

  4. Graves' Disease that Developed Shortly after Surgery for Thyroid Cancer

    Directory of Open Access Journals (Sweden)

    Hea Min Yu

    2013-09-01

    Full Text Available Graves' disease is an autoimmune disorder that may present with various clinical manifestations of hyperthyroidism. Patients with Graves' disease have a greater number of thyroid nodules and a higher incidence of thyroid cancer compared with patients with normal thyroid activity. However, cases in which patients are diagnosed with recurrence of Graves' disease shortly after partial thyroidectomy for thyroid cancer are very rare. Here we report a case of hyperthyroid Graves' disease that occurred after partial thyroidectomy for papillary thyroid cancer. In this case, the patient developed hyperthyroidism 9 months after right hemithyroidectomy, and antithyroglobulin autoantibody and thyroid stimulating hormone receptor stimulating autoantibody were positive. Therefore, we diagnosed Graves' disease on the basis of the laboratory test results and thyroid ultrasonography findings. The patient was treated with and maintained on antithyroid drugs. The mechanism of the recurrence of Graves' disease in this patient is still unclear. The mechanism may have been the improper response of the immune system after partial thyroidectomy. To precisely determine the mechanisms in Graves' disease after partial thyroidectomy, further studies based on a greater number of cases are needed.

  5. Psychiatric manifestations of Graves' hyperthyroidism: pathophysiology and treatment options.

    Science.gov (United States)

    Bunevicius, Robertas; Prange, Arthur J

    2006-01-01

    Graves' disease is an autoimmune disorder that is the most common cause of hyperthyroidism. Other symptoms associated with the disease are goitre, ophthalmopathy, and psychiatric manifestations such as mood and anxiety disorders and, sometimes, cognitive dysfunction. Graves' hyperthyroidism may result in these latter manifestations via the induction of hyperactivity of the adrenergic nervous system. This review addresses the psychiatric presentations, and their pathophysiology and treatment, in patients with hyperthyroidism, based on literature identified by a PubMed/MEDLINE database search. Although the focus is on mental symptoms associated with Graves' disease, it is not always clear from the literature whether patients had Graves' disease: in some studies, the patients were thought to have Graves' disease based on clinical findings such as diffuse goitre or ophthalmopathy or on measurements of thyroid antibodies in serum; however, in other studies, no distinction was made between Graves' hyperthyroidism and hyperthyroidism from other causes. Antithyroid drugs combined with beta-adrenoceptor antagonists are the treatments of choice for hyperthyroidism, as well as for the psychiatric disorders and mental symptoms caused by hyperthyroidism. A substantial proportion of patients have an altered mental state even after successful treatment of hyperthyroidism, suggesting that mechanisms other than hyperthyroidism, including the Graves' autoimmune process per se and ophthalmopathy, may also be involved. When psychiatric disorders remain after restoration of euthyroidism and after treatment with beta-adrenoceptor antagonists, specific treatment for the psychiatric symptoms, especially psychotropic drugs, may be needed.

  6. Consideraciones actuales sobre el diagnóstico de la apendicitis aguda: Current criteria Diagnosis of acute appendicitis:

    Directory of Open Access Journals (Sweden)

    Zenén Rodríguez Fernández

    2009-09-01

    Full Text Available INTRODUCCIÓN. El objetivo de la presente investigación fue identificar algunos aspectos relacionados con el diagnóstico preoperatorio de la apendicitis aguda, según variables seleccionadas, así como establecer comparaciones con los hallazgos de otros autores. MÉTODOS. Se realizó un estudio observacional, descriptivo y prospectivo de 560 pacientes operados y dados de alta con el diagnóstico histopatológico de apendicitis aguda. Los pacientes fueron atendidos en el Servicio de Cirugía General del Hospital Provincial Docente «Saturnino Lora» de Santiago de Cuba, durante el 2006. RESULTADOS. Entre los resultados más importantes sobresalieron el predominio de los varones jóvenes con mediana de edad de 25,5 años y la preponderancia del diagnóstico clínico. La mediana del tiempo de evolución preoperatoria fue mayor en los hombres y predominaron las variedades gangrenosa y perforada, aunque la primacía correspondió a la apendicitis supurada. En los fallecidos se detectaron las formas histopatológicas más graves, y estos fueron ancianos con manifestaciones clínicas atípicas de la enfermedad. CONCLUSIONES. El método clínico continúa teniendo una importancia capital, pues a través de él se puede diagnosticar precozmente esta urgencia tan común y reducir el tiempo de evolución preoperatoria, cuya prolongación es causa de morbilidad y mortalidad innecesarias.INTRODUCTION: The aim of present paper was to identify some features related to preoperative diagnosis of acute appendicitis, according the selected variables, as well as to establish comparisons with findings from other authors. METHODS: We made a prospective, descriptive and observational study of 560 patients operated on and discharged with the histopathology diagnosis of acute appendicitis. Patients were seen in General Surgery Service of the "Saturnino Lora" Teaching Provincial Hospital of Santiago de Cuba during year 2006. RESULTS: Among the more significant results

  7. Aplicación del método clínico para el diagnóstico de pacientes con hemorragia digestiva alta no variceal

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    Gabriel González Sosa

    Full Text Available La utilización del método clínico para lograr un diagnóstico preciso de las enfermedades en el ser humano, surge con el nacimiento de la Medicina, en la antigua Grecia y tiene como componentes fundamentales la relación médico-paciente, el interrogatorio, el examen físico y la historia clínica; esta última constituye su herramienta más importante en la recogida de datos. Se reflexiona sobre la importancia de su aplicación correcta para llegar a un diagnóstico preciso en los pacientes con hemorragia digestiva alta no variceal comenzando en la atención primaria de salud donde se puede lograr un diagnóstico precoz de esta entidad y evitar complicaciones que ocurren en estos pacientes cuando el diagnóstico es tardío, por lo que lejos pensar en la muerte del método clínico, su vigencia e importancia en la medicina contemporánea es incuestionable.

  8. The Progetto Nazionale Emorragia Digestiva (PNED) system vs. the Rockall score as mortality predictors in patients with nonvariceal upper gastrointestinal bleeding: A multicenter prospective study.

    Science.gov (United States)

    Contreras-Omaña, R; Alfaro-Reynoso, J A; Cruz-Chávez, C E; Velarde-Ruiz Velasco, A; Flores-Ramírez, D I; Romero-Hernández, I; Donato-Olguín, I; García-Samper, X; Bautista-Santos, A; Reyes-Bastidas, M; Millán-Marín, E

    The predictive scale for mortality risk in patients with nonvariceal upper gastrointestinal bleeding (NVUGIB) proposed by Italy's PNED (Progetto Nazionale Emorragia Digestiva) group has not been validated in Latin America since its original publication. To compare the PNED system and the Rockall score as mortality predictors in patients hospitalized for NVUGIB. A multicenter, prospective, cross-sectional, analytic study was conducted that recruited patients diagnosed with nonvariceal upper gastrointestinal bleeding within the time frame of 2011 to 2015. Six Mexican hospital centers participated in the study. The Rockall and PNED system scores were calculated, classifying the patients as having mild, moderate, or severe disease. The association between mortality and risk was determined through the chi-square test and relative risk (RR) calculation. Statistical significance was set at a Pbleeding. According to the Rockall score, 46 patients had severe disease (23.2%), 5 of whom died, with a RR of 5.5 (CI 1.35-22.02, P=.006). In relation to the PNED, only 8 patients had severe disease (4%), 5 of whom died, with a RR of 38.7 (CI 11.4-137.3, P=.001). The PNED system was more selective for classifying a case as severe, but it had a greater predictive capacity for mortality, compared with the Rockall score. Copyright © 2016 Asociación Mexicana de Gastroenterología. Publicado por Masson Doyma México S.A. All rights reserved.

  9. Thyroid carcinoma in Graves' disease: A meta-analysis.

    Science.gov (United States)

    Staniforth, Joy U L; Erdirimanne, Senarath; Eslick, Guy D

    2016-03-01

    The incidence of thyroid carcinoma is increasing worldwide. Graves' disease is the most common hyperthyroid disease. Studies have suggested an increased risk of thyroid malignancy in Graves' disease: there has not yet been a meta-analysis to allow quantitative comparison. The purpose of this study was to determine the risk of thyroid carcinoma in Graves' disease, and to gather information on the histological subtypes of carcinoma and the co-existence of thyroid nodules. Several databases and article reference lists were searched. Inclusion criteria included appropriate diagnostic criteria for thyroid conditions and a diagnoses of carcinoma based on histology. 33 studies were selected, all reporting on surgically-resected specimens. The event rate of thyroid carcinoma in Graves' disease was 0.07 (95% CI 0.04 to 0.12). There was no data to allow comparison with patients without hyperthyroid diseases. There was no increase in the odds of developing carcinoma in Graves' disease compared to toxic multinodular goitre and toxic uninodular goitre. 88% of thyroid carcinomas in Graves' disease were papillary, with solitary papillary micro-carcinoma (diameter 10 mm or less) comprising 23% of all detected thyroid carcinomas. Patients with Graves' disease and co-existing thyroid nodules were almost 5 times more likely to be diagnosed with thyroid carcinoma than those without nodules. Thyroid malignancy in Graves' disease requiring surgical treatment should be considered as likely as in other hyperthyroid diseases needing surgical treatment. Clinicians should consider screening selected patients with Graves' disease for nodules whilst being aware of potentially over-diagnosing papillary micro-carcinoma. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

  10. Death by Suicide in Graves' Disease and Graves' Orbitopathy: A Nationwide Danish Register Study.

    Science.gov (United States)

    Ferløv-Schwensen, Charlotte; Brix, Thomas Heiberg; Hegedüs, Laszlo

    2017-12-01

    Graves' disease (GD) is associated with excess morbidity and mortality, but little is known about unnatural manners of death and the potential relation with Graves' orbitopathy (GO). This study investigated the risk of unnatural death in Graves' patients with and without orbitopathy compared to matched control populations. This was a cohort study covering all adult Danes (≥18 years) diagnosed with GD or GO during 1995-2012. Median follow-up time was 7.9 years (range 0-17.5 years). Utilizing the Danish Register of Causes of Death and the Danish National Patient Registry, 28,461 subjects with GD and 3965 with GO were identified and matched for age and sex with four subjects from the background population. The manner of death was identified, and hazard ratios (HR) for mortality due to unnatural deaths (accident, suicide, violence/homicide, and unknown) were calculated using Cox regression analyses, adjusted for pre-existing somatic and psychiatric morbidity. In Graves' disease overall (GD + GO), there was an increased risk of death from unknown unnatural manners (HR = 2.01 [confidence interval (CI) 1.17-3.45], p = 0.012) and of suicide, although the latter difference was not with certainty statistically significant (HR = 1.43 [CI 1.00-2.04], p = 0.053). There was no significant difference in risk of death from suicide in GD subjects compared to their controls (HR = 1.27 [CI 0.85-1.89], p = 0.253). However, GO patients had a significantly higher risk of death from suicide (HR = 2.71 [CI 1.16-6.32], p = 0.022). Mortality by suicide was increased in Graves' disease overall, most significantly in patients with GO, also after adjustment for pre-existing somatic and psychiatric disease. These findings indicate that GD and GO may have a significant role in the pathophysiological mechanisms of suicidal behavior. Beyond independent confirmation, reasons for this need to be explored in order to introduce preventive measures.

  11. 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.

  12. Standardization of 131I therapy for Graves disease

    International Nuclear Information System (INIS)

    Tang Jianlin; Li Yuying; Gao Liuyan; Tang Xiuping; Hu Hongyong

    2011-01-01

    Objective: To establish the normative and standard measures, to ensure medical safety and quality of care of the patients with Graves disease treated by 131 I therapy. Methods: Formulating and strictly implementing the medical organizational and technical measures of 131 I therapy for Graves disease and regular follow-up. Results: Receiving 131 I treatment of 104 patients, follow-up 6-36 months, no adverse events, the cure rate of 59.6%, the efficient rate is 99.9%. Conclusion: It is important guarantee for the medical quality and safety to standardize the 131 I therapy of Graves disease. (authors)

  13. Graves' disease with special reference to radiation therapy

    International Nuclear Information System (INIS)

    Seegenschmidt, M. H.; Heyd, R.; Esser, J.; Mould, R.F.

    2006-01-01

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

  14. Immunoreactive 'TSH' in urinary concentrates of Graves' disease patients

    International Nuclear Information System (INIS)

    Van Herle, A.; Orgiazzi, J.; Greipel, M.A.; Slucher, J.A.; Honbo, K.S.; Hopital de l'Antiquaille, 69 - Lyon

    1978-01-01

    A double antibody radioimmunoassay was used to analyse immunoreactive thyrotrophin in urinary concentrates from fourteen patients with hyperthyroidism due to Graves' disease, in three subjects with primary hypothyroidism, and in six normal subjects. Immunoreactive thyrotrophin was detectable in eleven subjects with Graves' disease, in one subject with primary hypothyroidism, and in four normal subjects. The mean urinary thyrotrophin concentration was significantly higher in Graves' disease (492+-99.9μU/24h(SEM)(n=11)) than in normal subjects (177+-26.4μU/24h(SEM)(n=4)(P [de

  15. Persistent hyperthyroidism and de novo Graves' ophthalmopathy after total thyroidectomy.

    Science.gov (United States)

    Tay, Wei Lin; Loh, Wann Jia; Lee, Lianne Ai Ling; Chng, Chiaw Ling

    2017-01-01

    We report a patient with Graves' disease who remained persistently hyperthyroid after a total thyroidectomy and also developed de novo Graves' ophthalmopathy 5 months after surgery. She was subsequently found to have a mature cystic teratoma containing struma ovarii after undergoing a total hysterectomy and salpingo-oophorectomy for an incidental ovarian lesion. It is important to investigate for other causes of primary hyperthyroidism when thyrotoxicosis persists after total thyroidectomy.TSH receptor antibody may persist after total thyroidectomy and may potentially contribute to the development of de novo Graves' ophthalmopathy.

  16. Grave's disease associated with immunoglobulin A nephropathy: A rare association.

    Science.gov (United States)

    Khan, I; Bhat, R A; Khan, I; Hameed, I

    2015-01-01

    Immunoglobulin A (Ig A) nephropathy is the most common form of primary glomerulonephritis. The association of Ig A nephropathy with Grave's disease has not been reported so far. We report a case of 20-year-old female with Grave's disease who presented with edema, facial puffiness, and decreased urine output. She was found to be hypertensive with renal failure and nephrotic range proteinuria. Renal biopsy revealed features of Ig A nephropathy. The patient was treated with oral corticosteroids (1 mg/kg/day). To our knowledge, this is the first case showing association of Grave's disease with Ig A nephropathy.

  17. Efectividad de la magnetoterapia como tratamiento en pacientes con lumbalgia aguda

    Directory of Open Access Journals (Sweden)

    Raidel González Rodríguez

    2015-05-01

    Full Text Available Son numerosos los pacientes aquejados de algias vertebrales, tanto lumbares como dorsales y cervicales. Se realizó esta investigación con el objetivo de determinar la efectividad de la magnetoterapia como tratamiento en la lumbalgia aguda, en pacientes atendidos en el policlínico universitario “Raúl Sánchez” de la provincia de Pinar del Río, Cuba. Se realizó un estudio descriptivo, prospectivo, de corte transversal en pacientes con lumbalgia aguda, pertenecientes a dicha área de salud. La muestra quedó conformada por 68 pacientes de ambos sexos con lumbalgia aguda, diagnosticados clínicamente y mayores de 17 años de edad. En la investigación predominó el sexo femenino (67,6 % y el rango de edad estuvo entre 40 y 49 años. El esfuerzo físico fue el principal factor desencadenante (47,1 %. Con el tratamiento de la magnetoterapia aplicado a los pacientes se redujeron los estadios del dolor. La mayoría de los pacientes presentaron una respuesta clínica excelente y mejoraron los síntomas entre los siete y diez días (61,8 %. No se reportaron efectos adversos. La magnetoterapia resultó efectiva en el tratamiento de pacientes aquejados de lumbalgia aguda

  18. Fisiopatología de la diarrea aguda

    Directory of Open Access Journals (Sweden)

    Raúl L. Riverón Corteguera

    1999-06-01

    Full Text Available Es un artículo de revisión de los aspectos importantes de la fisiopatología de la diarrea. Se hace una descripción de la fisiopatología intestinal que incluye la anatomía del intestino y de su superficie de absorción y la estructura funcional de la mucosa intestinal. La fisiopatología normal de los líquidos intestinales. Mecanismo de absorción del agua y los electrólitos. Absorción de sodio por difusión electrogénica, unido al ion cloro, intercambio con el ion hidrógeno y unido a sustancias orgánicas como glucosa, aminoácidos y algunos oligopéptidos; secreción intestinal de agua y electrólitos. Control intracelular de la secreción. Mediadores y moduladores extracelulares del transporte intestinal. Factores que aumentan la absorción y reducen la secreción. Factores que estimulan la secreción y reducen la absorción Mecanismo fisiopatológico de la diarrea. Clasificación de la diarrea infecciosa aguda: acuosa secretoria y osmótica; diarrea con sangre invasiva y no invasiva.This a review of some important aspects of the physiopathology of diarrhea. A description is made of the intestinal physiopathology, including the anatomy of the intestine and of its surface of absorption, as well as the functional structure of the intestinal mucosa: the normal physiopathology of the intestinal fluids; the mechanism of absorption of water and electrolites; the absorption of sodium by electrogenic difussion, joined to the chloride ion; the interchange with the hydrogen ion and attached to organic substances, such as glucose, aminoacids and some oligopeptides; the intestinal secretion of water and electrolites; the intracellular control of secretion, the extracellular mediators and modulators of intestinal transport; the factors that increase absorption and reduce secretion; the factors that stimulate secretion and absorption; and the physiopathological mechanism of diarrhea. The classification of acute infectious diarrhea in aqueous

  19. Linfonodo pulmonar na paracoccidioidomicose aguda infantil (relato de um caso

    Directory of Open Access Journals (Sweden)

    Evanil Pires de Campos

    1992-09-01

    Full Text Available Observou-se a evolução de um linfonodo pulmonar na paracoccidioidomicose (PCM aguda infantil. Doente, masculino, 6 anos, branco, natural de Curitiba (PR, procedente de Guaratinguetá (SP, que há 3 meses desenvolveu quadro gripal, febre diária, bimodal, prolongada, precedida de calafrio, acompanhada de sudorese inodora, cefaléia frontal e anorexia. Diagnosticado e tratado como pneumonia por cinco dias, sem melhora do quadro. Há 2 meses, apresentou dor óssea nos braços e articulações do pé, com edema inflamatório e emagrecimento de 6 kg em 3 meses. Exame físico revelou: peso 20 kg; estatura 120 cm; P. A. 90/60 mmHg; facies atípica, hipoativo, palidez cutâneo-mucosa (+ +, hipotrofia muscular, adenopatiageneralizada, sopro sistólico suave em foco aórtico acessório e hepatesplenomegalia. Imunodifusão com exoantígeno glicoprotéico 43 kdpositiva (1/32. A biópsia de gânglio revelou Paracoccidioides brasiliensis. A radiologia demonstrou na primeira consulta, discreto infiltrado intersticial bilateral com linfoadenomegaliapara-hilar que desaparecu em 30 dias. Observou- se, ainda, massa tumoral mediastínica superior, hiperplasia do sistema fagocítico mononuclear e lesões osteolíticas nos 60 dias iniciais da evolução.The primary complex like Ghon was observed in a child's clinical roentgenographic study. C.S., white, male, 6 years old, was born in Curitiba (PR, Brazil and living in Guaratingueta (SP, Brazil, developed "common cold", bimodal diary fever, chills, shake and sweats. Dyspnea, cough with general fymphadenopathy. Foot and right shoulder artralgies. Six months ago visited a cave, equitation practice, dog and cat contacts and notransfusion, frontal sweats, fever (38.4°C. T.A. was 8/6, tachicardia in generalizated fymphadenopathy. Cardiopulmonary system was normal, mesogastric tumoral mass, hepatesplenomegaly and no ascitis. Bone marrow with eosinophilia; nodule demonstred presence of P. brasiliensis; hypoalbuminemia

  20. Effect of abnormal thyroid function on the severity of Graves' ophthalmopathy

    NARCIS (Netherlands)

    Prummel, M. F.; Wiersinga, W. M.; Mourits, M. P.; Koornneef, L.; Berghout, A.; van der Gaag, R.

    1990-01-01

    Many clinicians have the impression that treatment of thyroid dysfunction ameliorates ophthalmopathy in Graves' disease. The aim of our study was to relate thyroid function to the severity of Graves' ophthalmopathy. We studied 90 patients with Graves' ophthalmopathy and Graves' hyperthyroidism in

  1. Custo-efetividade de fondaparinux em pacientes com Síndrome Coronariana Aguda sem supradesnivelamento do ST

    Directory of Open Access Journals (Sweden)

    Camila Pepe

    2012-07-01

    Full Text Available FUNDAMENTO: O uso combinado de agentes antitrombínicos, antiplaquetários e estratégias invasivas na síndrome coronariana aguda sem supradesnivelamento do ST (SCAsSST reduz eventos cardiovasculares. O fondaparinux demonstrou equivalência à enoxaparina na redução de eventos cardiovasculares, porém com menor índice de sangramento nos pacientes que usaram fondaparinux. OBJETIVO: Avaliar o custo-efetividade de fondaparinux versus enoxaparina em pacientes com SCAsSST no Brasil a partir da perspectiva econômica do Sistema Único de Saúde (SUS. MÉTODOS: Um modelo de decisão analítico foi construído para calcular os custos e consequências resultantes dos tratamentos comparados. Os parâmetros do modelo foram obtidos do estudo OASIS-5 (N = 20.078 pacientes com SCAsSST randomizados para fondaparinux ou enoxaparina. O desfecho avaliado foi um composto de eventos cardiovasculares (isto é, morte, infarto agudo do miocárdio, isquemia refratária e sangramentos graves nos dias 9, 30 e 180 pós-SCAsSST. Foram avaliados todos os custos diretos de tratamento e eventos relacionados à SCAsSST. O ano da análise foi 2010 e os custos foram descritos em reais (R$. RESULTADOS: No dia 9, o custo de tratamento por paciente foi R$ 2.768 para fondaparinux e R$ 2.852 para enoxaparina. Aproximadamente 80% do custo total foram associados a tratamentos invasivos. Os custos com medicamentos representaram 10% do custo total. As taxas combinadas de eventos cardiovasculares e de sangramentos maiores foram 7,3% e 9,0% para fondaparinux e enoxaparina, respectivamente. Análises de sensibilidade confirmaram os resultados iniciais do modelo. CONCLUSÃO: O fondaparinux para tratamento de pacientes com SCAsSST é superior à enoxaparina em termos de prevenção de novos eventos cardiovasculares com menor custo. (Arq Bras Cardiol. 2012; [online].ahead print, PP.0-0

  2. Controvérsias no manejo farmacológico da asma aguda infantil Controversies in the pharmacological management of acute asthma in children

    Directory of Open Access Journals (Sweden)

    Sérgio Luís Amantéa

    2002-12-01

    Full Text Available Objetivos: apresentar uma revisão acerca de questões controversas, relativas ao manejo farmacológico utilizado nos pacientes pediátricos portadores de asma aguda. Fontes dos dados: foram utilizadas informações de artigos publicados em revistas científicas nacionais e internacionais, selecionadas das bases de dados Lilacs e Medline. Síntese dos dados: o artigo foi estruturado em tópicos, apresentando aspectos consensuais no tratamento farmacológico da asma infantil. Questões relacionadas à utilização de inaladores dosimetrados versus nebulizadores, o papel das drogas ß2-adrenérgicas utilizadas pela via endovenosa, bem como das metilxantinas e do sulfato de magnésio, são abordados de maneira crítica. Conclusões: os ß2-agonistas administrados pela via inalatória, associados aos coricosteróides, permanecem o tratamento de eleição para episódios agudos de asma na população pediátrica. Tanto os nebulizadores quanto os inaladores dosimetrados, acoplados a espaçadores, são efetivos para alívio dos sintomas agudos. Pacientes refratários ao tratamento convencional, que evoluem para quadros de asma aguda grave, devem ter considerada a utilização de drogas ß2-agonistas pela via endovenosa, desde que adequadamente monitorizados. Quanto às metilxantinas e ao sulfato de magnésio, devem ser considerados alternativas secundárias para pacientes selecionados.Objective: to present a review of controversial issues related to the pharmacological management of the treatment of acute asthma in children. Sources: articles published in national and international scientific journals. Data were selected from Lilacs and Medline databases. Summary of the findings: the article was organized into topics, presenting aspects on which there is consensus regarding the pharmacological treatment of asthma in children. Issues related to the use of metered dose inhaler versus nebulizers, the role of ß2-adrenergic drugs administered intravenously

  3. Development of Graves' disease following radiation therapy in Hodgkin's disease

    International Nuclear Information System (INIS)

    Loeffler, J.S.; Tarbell, N.J.; Garber, J.R.; Mauch, P.

    1988-01-01

    Radiation-related thyroid dysfunction is a common occurrence in patients with Hodgkin's disease treated with mantle field radiation. Although chemical and clinical hypothyroidism are most commonly seen, Graves' disease has also been described. We have examined the records of 437 surgically staged patients who received mantle field irradiation between April 1969 and December 1980 to ascertain the frequency of manifestations of Graves' disease. Within this group, seven patients developed hyperthyroidism accompanied by ophthalmic findings typical of those seen in Graves' disease. The actuarial risk of developing Graves' disease at 10 years following mantle irradiation for Hodgkin's disease was 3.3% in female patients and 1% in male patients in this study. The observed/expected ratios were 5.9 and 5.1 for female and male patients, respectively. This observed risk significantly exceeded that seen in the general population

  4. Graves disease with ophthalmopathy following radiotherapy for Hodgkin's disease

    International Nuclear Information System (INIS)

    Jacobson, D.R.; Fleming, B.J.

    1984-01-01

    The number of patients achieving long-term survival following neck irradiation for Hodgkin's disease and other malignancies is increasing. Paralleling this increase in survivors is the development of late complications of the therapy itself. Eleven patients have previously been reported who developed Graves ophthalmopathy 18 months to seven years after receiving neck radiotherapy for nonthyroidal malignancies. The seven patients who had HLA typing were all HLA-B8 negative, despite the reported association of the HLA-B8 antigen with Graves disease. A patient who is HLA-B8 positive who developed Graves ophthalmopathy and hyperthyroidism nine years after receiving mantle radiotherapy for Hodgkin's disease is reported. It is recommended that Graves disease be included among the thyroid diseases that receive consideration during follow-up of patients who have received mantle radiotherapy

  5. Graves' Disease Associated with Cerebrovascular Disease and Antiphospholipid Antibody Syndrome

    Directory of Open Access Journals (Sweden)

    Ines Khochtali

    2010-01-01

    have increased risk for developing thromboembolic accidents, which are favoured by a simultaneous presence of antiphospholipid antibodies syndrome. in this paper, we describe the case of a patient with Graves' disease, who developed strokes with antiphospholipid antibodies syndrome.

  6. Thyroid Function after Subtotal Thyroidectomy in Patients with Graves' Hyperthyroidism

    NARCIS (Netherlands)

    Limonard, E. J.; Bisschop, P. H.; Fliers, E.; Nieveen van Dijkum, E. J.

    2012-01-01

    Background. Subtotal thyroidectomy is a surgical procedure, in which the surgeon leaves a small thyroid remnant in situ to preserve thyroid function, thereby preventing lifelong thyroid hormone supplementation therapy. Aim. To evaluate thyroid function after subtotal thyroidectomy for Graves'

  7. An assessment of psychiatric disturbances in graves disease in a ...

    African Journals Online (AJOL)

    An assessment of psychiatric disturbances in graves disease in a medical college in eastern India. ... standard error of difference, the chi-square test, and paired Student's T-test. ... The common symptoms were insomnia, irritability, and anxiety.

  8. CASE REPORT : GRAVE'S DISEASE PRESENTING AS PARANOID SCHIZOPHRENIA

    OpenAIRE

    Singh, S.K.; Hatwal, A.; Agarwal, J.K.; Bajpai, H.S.; Sharma, I.

    1989-01-01

    SUMMARY The case of a 37 year old male is described who initially presented as paranoid schizophrenia unresponsive to anti-psychotic drug treatment and subsequently developed features of Grave's disease. Treatment with carbimazole alone improved his psychiatric symptoms.

  9. Study progress on free radicals and graves disease

    International Nuclear Information System (INIS)

    Zhang Ruiguo; Jin Jianhua

    2009-01-01

    Free radical-mediated oxidative injury has been closely implicated in the occurrence and development of many diseases. Graves disease was also accompanied by changes of the free radicals, especially for reactive oxygen species and reactive nitrogen, et al, and the oxidative stress can cause a certain degree of injury on the thyroid and other human important organs. Antithyroid drug and 131 I treatment of Graves disease, the oxidative and antioxidative parameters can also be changed. (authors)

  10. An evaluation of supervoltage orbital irradiation for Graves' opthalmopathy

    International Nuclear Information System (INIS)

    Teng, C.S.; Crombie, A.L.; Hall, R.; Ross, W.M.

    1980-01-01

    Twenty patients with moderately severe ophthalmopathy due to Graves' disease or ophtalmic Graves' disease were treated by supervoltage orbital radiotherapy generated by a linear accelerator. Seven patients (35%) showed some response within 3 weeks of the treatment, four patients (20%) improved minimally while nine patients (45%) were unchanged. Improvement was noted mainly in soft tissue changes while proptosis decreased in only four patients. With one exception, ophthalmoplegia did not improve after the radiotherapy. The benefit obtained with the treatment was not impressive. (author)

  11. Airway complication occurring during radioiodine treatment for Graves' disease

    International Nuclear Information System (INIS)

    Kinuya, Seigo; Yoneyama, Tatsuya; Michigishi, Takatoshi

    2007-01-01

    Airway complications rarely occur in 131 I radioiodine therapy for Graves' disease. This study presents two cases in which 131 I therapy caused this acute complication. The patients complained of the symptom 6 h and 33 h after administration of 131 I. A histamine H1 receptor antagonist and hydrocortisone rapidly resolved symptoms in both cases. These two cases remind physicians that 131 I therapy for Graves' disease may cause potentially life-threatening complications. (author)

  12. Comportamento da síndrome coronariana aguda: resultados de um registro brasileiro Acute coronary syndrome behavior: results of a Brazilian registry

    Directory of Open Access Journals (Sweden)

    Leopoldo Soares Piegas

    2013-01-01

    Full Text Available FUNDAMENTO: O Brasil carece de registros multicêntricos publicados de síndrome coronariana aguda. OBJETIVO: O Registro Brasileiro de Síndrome Coronariana Aguda é um estudo multicêntrico nacional com objetivo de apresentar dados representativos das características clínicas, e manejo e evolução hospitalares dessa síndrome. MÉTODOS: Participaram 23 hospitais de 14 cidades. Foram elegíveis pacientes que se apresentaram com suspeita de síndrome coronariana aguda nas primeiras 24 horas, com quadro clínico sugestivo, associado a alterações eletrocardiográficas compatíveis e/ou marcadores de necrose. O seguimento foi realizado até o óbito ou a alta hospitalar. RESULTADOS: Entre os anos de 2003 e 2008, foram incluídos 2.693 pacientes com diagnóstico de síndrome coronariana aguda, sendo 864 (32,1% mulheres. O diagnóstico final foi de angina instável para 1.141 (42,4% pacientes, com mortalidade de 3,06% deles; de infarto agudo do miocárdio sem supradesnível de ST para 529 (19,6% pacientes, com mortalidade de 6,8% deles; e de infarto agudo do miocárdio com supradesnível de ST para 950 (35,3% pacientes, com mortalidade de 8,1% deles; tiveram diagnóstico não confirmado 73 (2,7% pacientes, com mortalidade de 1,36% deles. A mortalidade global foi de 5,53%. O modelo de regressão logística múltipla identificou o gênero feminino (OR=1,45, o diabetes melito (OR=1,59, o índice de massa corporal (OR=1,27 e a intervenção coronariana percutânea (OR=0,70 como fatores de risco de óbito, para demografia e intervenções. Um modelo para óbito por complicações maiores identificou choque cardiogênico/Edema Agudo de Pulmão (OR=4,57, reinfarto (OR=3,48, acidente vascular cerebral (OR=21,56, sangramento grave (OR=3,33, parada cardiorrespiratória (OR=40,27 e classe funcional de Killip (OR=3,37. CONCLUSÃO: Os dados do Registro Brasileiro de Síndrome Coronariana Aguda não diferem de outros coletados fora do país. Seus achados poder

  13. Hyperparathyroidism after radioactive iodine therapy for Graves disease

    International Nuclear Information System (INIS)

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

    1982-01-01

    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

  14. 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.

  15. Lymphocyte-platelet crosstalk in Graves' disease.

    Science.gov (United States)

    Kuznik, Boris I; Vitkovsky, Yuri A; Gvozdeva, Olga V; Solpov, Alexey V; Magen, Eli

    2014-03-01

    Platelets can modulate lymphocytes' role in the pathophysiology of thyroid autoimmune diseases. The present study was performed to clarify the status of platelet-lymphocyte subpopulations aggregation in circulating blood in patients with Graves' disease (GD). One hundred and fifty patients with GD (GD group) and 45 hyperthyroid patients with toxic multinodular goiter (TMG group) were recruited in the study. Control group consisted 150 healthy subjects. Immunophenotyping of lymphocytes was performed by flow cytometry. Detection of lymphocyte-platelet aggregates (LPAs) was done using light microscope after Ficoll-gradient centrifugation. The group of GD patients exhibited reduced CD8 lymphocyte and higher CD19 cell counts compared with TMG group and healthy controls. A greater number of activated CD3, HLA-DR+ lymphocytes were observed in GD than in TMG group and control group. GD group was characterized by lower blood platelet count (232 ± 89 × 10 cells/µL) than TMG group (251 ± 97 × 10 cells/µL; P TMG group (116 ± 67/µL, P < 0.005) and control group (104 ± 58 /µL; P < 0.001). GD is associated with higher levels of activated lymphocytes and lymphocyte-platelet aggregates.

  16. Radioiodine treatment for pediatric hyperthyroid Grave's disease.

    Science.gov (United States)

    Chao, Ma; Jiawei, Xie; Guoming, Wang; Jianbin, Liu; Wanxia, Liu; Driedger, Al; Shuyao, Zuo; Qin, Zhang

    2009-10-01

    Grave's disease (GD) is an autoimmune disease in which excessive amounts of thyroid hormones circulate in the blood. Treatment for pediatric GD includes (1) antithyroid drugs (ATD), (2) radioiodine, and (3) thyroidectomy. Yet, the optimal therapy remains controversial. We collected studies from all electronically available sources as well as from conferences held in China. All studies using radioiodine and/or ATD and/or thyroidectomy were included. Information was found on 1,874 pediatric GD patients treated with radioiodine, 1,279 patients treated with ATD and 1,362 patients treated surgically. The cure rate for radioiodine was 49.8%; the incidence of hypothyroidism, 37.8%; of relapse, 6.3%; of adverse effects, 1.55%; and of drop outs, 0.6%. These data show that radioiodine treatment is safe and effective in pediatric GD with significant lower incidence of relapse and adverse effects but significantly higher incidence of hypothyroidism as compared with both ATD and thyroidectomy. For the time being, radioiodine treatment for pediatric GD remains an excellent first-line therapy and a good second-line therapy for patients with ATD failure, severe complications, or poor compliance.

  17. Concurrence of Grave's disease and Hashimoto's thyroiditis.

    Science.gov (United States)

    Sato, T; Takata, I; Taketani, T; Saida, K; Nakajima, H

    1977-01-01

    Early histological changes in the thyroid gland were examined in 30 patients with juvenile thyrotoxicosis, by means of needle biopsy. Based on the degree of lymphocytic infiltration and degenerative changes in follicular epithelium, results were classified into four groups. A: hyperplastic changes without cellular infiltration (6 patients, 20%); B: hyperplastic changes with areas of focal thyroiditis less than 30% of specimen (10 patients, 33%); C: those with 30 to 60% areas ot thyroiditis (10 patients, 33%); D: almost diffuse thyroiditis (4 patients, 13%). Moderate to severe lymphocytic thyroiditis was frequently present in the early stage of hyperplastic thyroid glands. The clinical significance of the 4 histological groups was evaluated. Neither clinical signs nor routine laboratory tests could differentiate these groups except group D, in which thyrotoxic signs were mild and transient. However, serum antithyroid antibodies tended to increase in accordance with severity of thyroiditis. The rate of remission was high in groups C and D, whereas relapse was frequent in group A. These results suggest that Grave's disease and chronic lymphocytic thyroiditis are closely related in the early stage of thyrotoxicosis in children, and that the clinical course may be considerably altered by the degree of associated thyroiditis. Images Fig. 1 Fig. 2 Fig. 3 Fig. 3 PMID:580172

  18. Proton-pump inhibitors adverse effects: a review of the evidence and position statement by the Sociedad Española de Patología Digestiva.

    Science.gov (United States)

    de la Coba Ortiz, Cristóbal; Argüelles Arias, Federico; Martín de Argila de Prados, Carlos; Júdez Gutiérrez, Javier; Linares Rodríguez, Antonio; Ortega Alonso, Aida; Rodríguez de Santiago, Enrique; Rodríguez-Téllez, Manuel; Vera Mendoza, María Isabel; Aguilera Castro, Lara; Álvarez Sánchez, Ángel; Andrade Bellido, Raúl Jesús; Bao Pérez, Fidencio; Castro Fernández, Manuel; Giganto Tomé, Froilán

    2016-04-01

    In the last few years a significant number of papers have related the use of proton-pump inhibitors (PPIs) to potential serious adverse effects that have resulted in social unrest. The goal of this paper was to provide a literature review for the development of an institutional position statement by Sociedad Española de Patología Digestiva (SEPD) regarding the safety of long-term PPI use. A comprehensive review of the literature was performed to draw conclusions based on a critical assessment of the following: a) current PPI indications; b) vitamin B12 deficiency and neurological disorders; c) magnesium deficiency; d) bone fractures; e) enteric infection and pneumonia; f) interactions with thienopyridine derivatives; e) complications in cirrhotic patients. Current PPI indications have remained unchanged for years now, and are well established. A general screening of vitamin B12 levels is not recommended for all patients on a PPI; however, it does seem necessary that magnesium levels be measured at therapy onset, and then monitored in subjects on other drugs that may induce hypomagnesemia. A higher risk for bone fractures is present, even though causality cannot be concluded for this association. The association between PPIs and infection with Clostridium difficile is mild to moderate, and the risk for pneumonia is low. In patients with cardiovascular risk receiving thienopyridines derivatives it is prudent to adequately consider gastrointestinal and cardiovascular risks, given the absence of definitive evidence regardin potential drug-drug interactions; if gastrointestinal risk is found to be moderate or high, effective prevention should be in place with a PPI. PPIs should be cautiously indicated in patients with decompensated cirrhosis. PPIs are safe drugs whose benefits outweigh their potential side effects both short-term and long-term, provided their indication, dosage, and duration are appropriate.

  19. Detección molecular de las translocaciones más comunes en Leucemia aguda mediante RT-PCR

    Directory of Open Access Journals (Sweden)

    L. García

    2001-07-01

    Full Text Available Evaluar la incidencia de las translocaciones t(4;11, t(1;19, t(9;22 y t(12;21 en leucemia linfoide aguda (LLA y t(15;17, t(8;21 e Inv.(16 en leucemia mieloide aguda (LMA. Correlacionar los resultados obtenidos con el diagnóstico morfológico y citogenético.

  20. Influencia de la alimentación sobre el ritmo circadiano de las enzimas digestivas en el cultivo de juveniles de la langosta de agua dulce Cherax quadricarinatus (Parastacidae

    Directory of Open Access Journals (Sweden)

    Hernán J Sacristán

    2013-09-01

    Full Text Available Se analiza en juveniles en etapa de engorde (7 g de Cherax quadricarinatus, el ritmo circadiano de los niveles de proteínas totales, la actividad de las proteasas, lipasas y amilasas, y su posible modificación en función del momento de alimentación matutino (8 h y vespertino (17 h. En general, la actividad de las enzimas digestivas de los juveniles de C. quadricarinatus no mostró un patrón circadiano de secreción, a excepción de las lipasas, donde se observó un incremento de actividad hacia la tarde-noche y disminución hacia las primeras horas de la mañana. Los niveles de proteína total, la actividad de proteinasas y amilasas registradas en la glándula digestiva, permanecieron prácticamente inalterados en todos los experimentos. A pesar de ello, se observó tendencia a que los niveles de actividad de proteinasas disminuyan luego del pulso de alimentación, recuperando los niveles anteriores 3 h después, independientemente del horario de alimentación. En cambio la actividad de amilasa no mostró ninguna tendencia por efecto del horario de alimentación. El estudio de los patrones de secreción de las enzimas digestivas y sus posibles modificaciones, podría ser utilizado como una herramienta para establecer los momentos del día más propicios para la alimentación de los juveniles en cultivo.

  1. Antiagregation and anticoagulation, relationship with upper gastrointestinal bleeding Antiagregación y anticoagulación, relación con la hemorragia digestiva alta

    Directory of Open Access Journals (Sweden)

    Philip Wikman-Jorgensen

    2011-07-01

    de la incidencia de hemorragias digestivas altas (HDA. Nuestro objetivo fue evaluar la proporción de HDA relacionadas con tratamientos antiagregantes o anticoagulantes y describir las características clínicas de estos pacientes en nuestro medio. Material y métodos: se realizó una búsqueda retrospectiva en los archivos de nuestro hospital de todos aquellos pacientes con diagnóstico de hemorragia digestiva alta, ingresados en el periodo 01/01/2004-31/12/2007. Incluimos los pacientes en tratamiento con antiagregantes y/o anticoagulantes. Analizamos la información referente a los fármacos que tomaban, la lesión sangrante subyacente, la gravedad de la hemorragia, las recidivas, la mortalidad y las características clínicas. Resultados: se recogieron 523 episodios de HDA, de los cuales 137 (26,1% eran pacientes en tratamiento antiagregante y/o anticoagulante. Los pacientes incluidos eran hombres en el 60,2% de los casos y tenían una media de edad de 75,6 (±10,8 años. El 65,5% (74 de ellos presentaba HTA, el 43,4% (49 diabetes mellitus (DM tipo 2, el 37,2% (42 dislipemia y el 13,3% (15 demencia. El fármaco más frecuentemente implicado fue el ácido acetilsalicílico en el 36,3% (41, seguido del acenocumarol en el 27,4% (31, el clopidogrel en el 18,6% (21, doble antiagregación (AAS + clopidogrel en 6,2% (7, triple terapia (AAS + clopidogrel + acenocumarol en 1 (0,9%, triflusal en el 4,4% (5, heparinas de bajo peso molecular en el 5,3% (6 y ticlopidina en un paciente (0,9%. Únicamente el 36,3% (41 recibían tratamiento con inhibidores de la bomba de protones. Hubo un total de 24 recidivas y 4 muertes. Conclusiones: el 26,1% de las hemorragias digestivas altas atendidas en nuestro medio son de origen iatrogénico. Llama la atención el bajo grado de gastroprotección.

  2. Esofagitis necrosante aguda: análisis retrospectivo Acute esophageal necrosis: a retrospective case series

    Directory of Open Access Journals (Sweden)

    R. Ramos

    2008-09-01

    Full Text Available Introducción: la esofagitis necrosante aguda es una entidad rara. Se reconoce por el aspecto negro difuso del esófago a la endoscopia. Su incidencia e patogénesis se desconoce. Pacientes y métodos: se analizaron retrospectivamente 11 pacientes con esofagitis necrosante aguda desde el punto de vista de los datos clínicos, de laboratorio y endoscopicos en 2 años. Resultados: se analizaron las endoscopias realizadas a 3.976 pacientes, observándose esofagitis necrosante aguda en 11 pacientes. El estado nutricional era malo en 6 pacientes. La resolución completa de la esofagitis se observó en cuatro pacientes. Durante el seguimiento se observó una estenosis en un paciente y un nuevo episodio de esofagitis necrosante aguda en otro paciente. Siete pacientes fallecieron, pero esta elevada mortalidad parece deberse a las enfermedades de base y no es atribuible a las lesiones de la esofagitis necrosante. Conclusiones: la incidencia de esofagitis necrosante aguda en nuestra serie fue 0,28%. La esofagitis necrosante aguda tiene una elevada mortalidad.Background: acute esophageal necrosis has been considered a rare event. It is defined as the presence of diffuse dark pigmentation of the esophagus on upper endoscopy. Its incidence has not yet been established. The pathogenesis remains unknown. Patients and methods: a retrospective analysis of clinical, laboratory, endoscopic, and histological data, and of the clinical course of 11 patients with acute necrotizing esophagitis was carried out over a 2-year period. Results: among 3,976 patients who underwent upper endoscopy, 11 (0.28% with acute esophageal necrosis were identified. Nutritional status was poor for 6 patients. Complete resolution of acute esophageal necrosis without further recurrence was observed in 4. One stricture appeared during follow-up and other patient developed new-onset acute esophageal necrosis. Seven patients died, but no death was directly related to acute esophageal necrosis

  3. Estado oxidante e antioxidante de crianças com bronquiolite aguda

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    Rusen Dundaroz

    2013-08-01

    Full Text Available OBJETIVO: O estresse oxidativo demonstrou contribuir para a patogênese de doenças pulmonares inflamatórias agudas e crônicas. Nosso objetivo foi avaliar o estado oxidante/antioxidante de crianças com bronquiolite aguda por meio de mensuração da capacidade antioxidante total do plasma, estado oxidante total e índice de estresse oxidativo. MÉTODOS: As crianças com bronquiolite aguda encaminhadas para o Departamento de Emergência Pediátrica do hospital universitário entre janeiro e abril 2012 foram comparadas a controles saudáveis de mesma idade. Os pacientes com bronquiolite aguda tiveram essa doença classificada como leve e moderada. O estado oxidante e antioxidante foi avaliado pela mensuração da capacidade antioxidante total do plasma, estado oxidante total e índice de estresse oxidativo. RESULTADOS: Foram incluídas 31 crianças com bronquiolite aguda com idade de três meses a dois anos e 37 crianças saudáveis. O estado oxidante total (EOT foi maior em pacientes com bronquiolite aguda do que no grupo de controle (5,16±1,99 µmol H2O2 em comparação a 3,78±1,78 µmol H2O2 [p = 0,004]. A capacidade antioxidante total (CAT foi significativamente menor em crianças com bronquiolite que no grupo de controle (2,51±0,37 µmol Trolox equivalente/L em comparação a 2,75±0,39 µmol Trolox Eqv/L (p = 0,013. Os pacientes com bronquiolite moderada apresentaram níveis de EOT mais elevados que os com bronquiolite leve e os do grupo de controle (p = 0,03, p < 0,001. Os pacientes com bronquiolite moderada apresentaram níveis de IEO mais elevados que os do grupo de controle (p = 0,015. O nível de saturação de oxigênio de pacientes com bronquiolite foi inversamente correlacionado ao nível de EOT (r = -0,476, p < 0,05. CONCLUSÃO: O equilíbrio entre os sistemas oxidante e antioxidante é interrompido em crianças com bronquiolite moderada, indicando que o fator de estresse poderá ter um papel na patogênese da doença.

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

    International Nuclear Information System (INIS)

    Li Suping; Kuang Anren

    2008-01-01

    Objective: To perform literature search and review on the controversial relationship between therapies of hyperthyroidism due to Graves' disease (GD) and the course of Graves' ophthalmopathy (GO). Methods: We searched the database of MEDLINE (1966-2006.3), EMBASE (1984-2005), Cochrane Library(2006 No. 1), CBMdisc (1978.1-2006.4) and CNKI (1994-2006). The methodological quality of the studies selected for review was assessed according to the quality assessment criteria suggested by the Cochrane systematic review guideline. Meta-analysis was performed by RevMan 4.2 software. Results: Eight studies were included in the systematic review. Meta-analysis showed that there was statistically significant difference between mi and other forms of therapy [surgery or antithyroid drugs (ATD)] (test value: 2.31, 5.97, 3.70, 5.55; all P 0.05). There were not yet any studies on the impact between early prevention of hypothyroidism after mi therapy and GO. Conclusions: Based on meta-analysis on literature data, if early measures are not performed to prevent hypothyroidism after mi therapy, it may induce or aggravate GO more frequently than ATD or surgical treatment. Symptomatic relief of GO after 131 I therapy is also less effective than the other 2 forms of therapy. Therefore, 131 I therapy should be delivered carefully in those patients with GO. (authors)

  5. Miastenia grave ocular Severe ocular myastenia

    Directory of Open Access Journals (Sweden)

    Yaimir Estevéz Miranda

    2010-01-01

    Full Text Available La miastenia grave es una enfermedad autoinmune de la unión neuromuscular que se caracteriza por la variabilidad de la debilidad muscular, que empeora o está provocada por el ejercicio del músculo o de los grupos musculares implicados, mientras que el descanso la mejora. La primera descripción de la enfermedad data de 1672, su relación con una afección del timo no se estableció hasta 1901. La enfermedad es poco frecuente, afecta a todas las etnias por igual, y no tiene predilección geográfica. Se reporta un paciente masculino de 28 años de edad atendido en el Servicio de Oftalmología Pediátrica del Instituto Cubano de Oftalmología "Ramón Pando Ferrer" por presentar visión doble, ptosis palpebral ligera en ojo derecho que empeora con el transcurso del día. Por el interrogatorio y el cuadro clínico se sospecha de una miastenia grave, se remite al clínico y el neurólogo. En los estudios realizados de neuroimágenes, tomografía y electroencefalograma no se encontraron alteraciones. Se decide valorar el caso con el servicio de Neuroftalmología de nuestro centro y por el Instituto de Neurología y es confirmado el diagnóstico.Myasthenia gravis is an autoimmune illness of the neuromuscular joint that is characterized by the variability of the muscular weakness that worsens or caused by exercising of the muscle or the involved muscular groups; resting helps in improving the condition of the muscle. The first description of the illness dates back to 1672, but its linking to a thymus disorder was not discovered until 1901. This illness is not very frequent, affects equally to all the races, and it does not predominate in any particular geographic region. This paper presented a male patient aged 28 years who went to the Ophthalmologic Service at "Ramón Pando Ferrer" Cuban Institute of Ophthalmology because he suffered from double vision, slight palpebral ptosis in his right eye that became worse as the day went by. After the

  6. Pretibial myxedema without ophthalmopathy: an initial presentation of Graves' disease.

    Science.gov (United States)

    Lohiya, Sheela; Lohiya, Vipin; Stahl, Elizabeth J

    2013-07-01

    To report a rare case of Graves' disease without ophthalmopathy presenting with pretibial myxedema (PM) as an initial presentation. We present the clinical history, physical findings, laboratory studies and biopsy data of a 62-year-old man with a history of uncontrolled type 2 diabetes (DM2) presenting with arm and leg skin lesions in the absence of other physical findings. Histopathology confirmed PM. Graves' disease and its association with PM without Graves' ophthalmopathy and the pertinent literature are reviewed. A 60-year-old man with a history of uncontrolled DM2 presented for glycemic management. He described symptoms of anxiety, insomnia and fatigue for the last 5 to 6 months. He described diffuse chest pain, occasionally associated with palpitations, and a 50-pound weight loss. He also complained of severe itching and burning of his arms and legs for the past several months. Subsequent thyroid studies revealed hyperthyroidism suggestive of Graves' disease. In the interim, he was hospitalized for atrial flutter and was cardioverted. After being started on methimazole, his symptoms abated. His skin lesions were biopsied, and the leg biopsy was consistent with PM. He however had no lid lag or proptosis characteristic of Graves' disease. He subsequently underwent radioiodine ablation. His hyperglycemia was better control led after treatment of his hyperthyroidism. PM is an autoimmune manifestation of Graves' disease. Almost all cases of thyroid dermopathy are associated with relatively severe ophthalmopathy. Usually ophthalmopathy appears first and dermopathy much later. However, this case represents a rare initial presentation of Graves' disease with PM without ophthalmologic symptoms or findings. Hyperthyroidism is typically associated with worsening glycemic control and increased insulin requirements. In patients with diabetes having hyperthyroidism, deterioration in glycemic control should be anticipated and treatment should be adjusted accordingly

  7. Graves' disease: diagnostic and therapeutic challenges (multimedia activity).

    Science.gov (United States)

    Kahaly, George J; Grebe, Stefan K G; Lupo, Mark A; McDonald, Nicole; Sipos, Jennifer A

    2011-06-01

    Graves' disease is the most common cause of hyperthyroidism in the United States. Graves' disease occurs more often in women with a female:male ratio of 5:1 and a population prevalence of 1% to 2%. A genetic determinant to the susceptibility to Graves' disease is suspected because of familial clustering of the disease, a high sibling recurrence risk, the familial occurrence of thyroid autoantibodies, and the 30% concordance in disease status between identical twins. Graves' disease is an autoimmune thyroid disorder characterized by the infiltration of immune effector cells and thyroid antigen-specific T cells into the thyroid and thyroid-stimulating hormone receptor expressing tissues, with the production of autoantibodies to well-defined thyroidal antigens, such as thyroid peroxidase, thyroglobulin, and the thyroid-stimulating hormone receptor. The thyroid-stimulating hormone receptor is central to the regulation of thyroid growth and function. Stimulatory autoantibodies in Graves' disease activate the thyroid-stimulating hormone receptor leading to thyroid hyperplasia and unregulated thyroid hormone production and secretion. Below-normal levels of baseline serum thyroid-stimulating hormone receptor, normal to elevated serum levels of T4, elevated serum levels of T3 and thyroid-stimulating hormone receptor autoantibodies, and a diffusely enlarged, heterogeneous, hypervascular (increased Doppler flow) thyroid gland confirm diagnosis of Graves' disease (available at: http://supplements.amjmed.com/2010/hyperthyroid/faculty.php). This Resource Center is also available through the website of The American Journal of Medicine (www.amjmed.com). Click on the “Thyroid/Graves' Disease” link in the “Resource Centers” section, found on the right side of the Journal homepage. Copyright © 2011 Elsevier Inc. All rights reserved.

  8. Estudio de validación diagnóstica de la escala de Glasgow-Blatchford para la predicción de mortalidad en pacientes con hemorragia digestiva alta en un hospital de Lima, Perú (junio 2012-diciembre 2013)

    OpenAIRE

    Cassana Abad, Carla Alessandra; Scialom, Silvia; Segura, Eddy R.; Chacaltana, Alfonso

    2015-01-01

    Antecedentes y propósito del estudio: la hemorragia digestiva alta es una causa importante de ingreso hospitalario y constituye la principal emergencia gastroenterológica, con una tasa de mortalidad de hasta el 14%. En el Perú no existen estudios sobre el uso de la escala de Glasgow-Blatchford para predecir mortalidad por hemorragia digestiva alta. El objetivo de este estudio es realizar la validación externa de la escala de Glasgow-Blatchford y establecer su mejor punto de corte para predeci...

  9. Inibição da guanilato ciclase pelo azul de metileno no choque circulatório causado por pancreatite aguda necrosante: uma palavra de cuidado embasada em modelo suíno

    Directory of Open Access Journals (Sweden)

    Caroline Floreoto Baldo

    Full Text Available OBJETIVO: estudar o uso terapêutico do bloqueio da guanilato ciclase pelo azul de metileno em um modelo experimental de pancreatite aguda grave em suínos. MÉTODOS: a pancreatite aguda necrotizante foi induzida em porcos anestesiados por infusão ductal pancreática retrógrada de 1ml/kg de taurocolato de sódio a 5% e 8U/kg de enteroquinase. Três grupos foram estudados (n=5: controle (C, pancreatite (PA, "bolus" de azul seguido por pancreatite (AM+PA. Os dados incluíram enzimas séricas e do líquido abdominal, variáveis hemodinâmicas, hemogasometria arterial, volume de líquido abdominal, marcadores inflamatórios plasmáticos, nitrito/nitrato e mieloperoxidase e malondialdeído plasmático. Aplicou-se a análise de variância seguida do pós-teste de Bonferroni (p<0,05. RESULTADOS: os valores de amilase e lipase foram três e dez vezes mais elevados no grupo PA. A atividade da mieloperoxidase foi 50% superior no grupo PA. Os dados hemodinâmicos indicaram choque hipovolêmico precoce seguido de choque cardiogênico. Observou-se grave translocação de líquidos para a cavidade peritoneal. A nitrito/nitrato plasmática permaneceu inalterada. O grupo AM+PA teve aumento de cinco vezes do mieloperoxidase em comparação com o grupo C. CONCLUSÕES: a utilização de azul de metileno em suínos com pancreatite não demonstrou efeitos significativos sobre variáveis hemodinâmicas e inflamatórias. Seu uso terapêutico na pancreatite necro-hemorrágica pode ser inadequado e extremo cuidado deve ser tomado dado o aumento da peroxidação lipídica evidenciado pelo aumento dos valores do malondialdeído.

  10. Cerebelite aguda causada por vírus Epstein-Barr: relato de caso

    Directory of Open Access Journals (Sweden)

    Teive Hélio A.G.

    2001-01-01

    Full Text Available A cerebelite aguda pode ocorrer em associação a infecção pelo vírus da varicela-zoster, enterovirus, caxumba, micoplasma e outros agentes infecciosos. A cerebelite aguda é uma complicação rara da infecção pelo vírus Epstein-Barr (EBV. Relatamos o caso de uma mulher de 21 anos com história de 12 dias de evolução com náuseas, vômitos, ataxia de marcha e membros, tremor cefálico e de membros, opsoclono, mioclonias e rash cutâneo. Sorologia para EBV foi positiva. A infecção pelo EBV, com complicações neurológicas, pode não se apresentar com os sinais e sintomas clássicos da mononucleose infeciosa.

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

    International Nuclear Information System (INIS)

    Zhang Zhongshu Xu Ruiji; Wang Guohong

    2006-01-01

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

  12. Epidemiological survey of graves' disease in Tianjin area

    International Nuclear Information System (INIS)

    Gao Shuo; Fang Peihua; Lai Zemin; Chen Bingzhong; Lu Tizhang; Zhou Yinbao; Tan Jian; Ni Xiaoyan

    2002-01-01

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

  13. Hickam's dictum: Myasthenia Gravis presenting concurrently with Graves' disease.

    Science.gov (United States)

    Sehgal, Shekhar; Rebello, Roshan; Wolmarans, Louise; Elston, Marianne

    2017-09-07

    We present two patients with Graves' disease and concurrent myasthenia gravis. The impact of the dual diagnosis on the clinical course and the potential for a delayed diagnosis of myasthenia gravis is discussed. Patient 1, a 28-year-old man was diagnosed with Graves' disease following his second respiratory arrest. His history was strongly suggestive of a second pathology. Patient 2, a 66-year-old Cantonese woman with established Graves' disease presented with thionamide-related neutropaenia. Examination revealed bilateral ptosis and right lateral rectus palsy. Both patients had thyrotoxicosis secondary to Graves' disease with concurrent myasthenia gravis. Although neuromuscular weakness is common in Graves' disease, coexisting myasthenia gravis (MG) is rare and can cause profound morbidity. Ocular signs in both diseases may cause diagnostic confusion although ptosis suggests coexisting MG. In both cases, the thyrotoxicosis delayed the diagnosis of MG. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  14. Vitamin D and Graves' disease: a meta-analysis update.

    Science.gov (United States)

    Xu, Mei-Yan; Cao, Bing; Yin, Jian; Wang, Dong-Fang; Chen, Kai-Li; Lu, Qing-Bin

    2015-05-21

    The association between vitamin D levels and Graves' disease is not well studied. This update review aims to further analyze the relationship in order to provide an actual view of estimating the risk. We searched for the publications on vitamin D and Graves' disease in English or Chinese on PubMed, EMBASE, Chinese National Knowledge Infrastructure, China Biology Medical and Wanfang databases. The standardized mean difference (SMD) and 95% confidence interval (CI) were calculated for the vitamin D levels. Pooled odds ratio (OR) and 95% CI were calculated for vitamin D deficiency. We also performed sensitivity analysis and meta-regression. Combining effect sizes from 26 studies for Graves' disease as an outcome found a pooled effect of SMD = -0.77 (95% CI: -1.12, -0.42; p Graves' disease were more likely to be deficient in vitamin D compared to the controls (OR = 2.24, 95% CI: 1.31, 3.81) with a high heterogeneity (I2 = 84.1%, p Graves' disease.

  15. Dor aguda no joelho do paciente idoso Acute knee pain in elderly patients

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    Gilberto Luís Camanho

    2008-09-01

    Full Text Available A dor aguda no joelho de pacientes idosos é freqüente, sendo caracterizada por seu aparecimento súbito, sem causa aparente, com exame radiográfico dentro dos padrões da normalidade, na maioria dos casos. A etiologia da dor aguda no joelho é decorrente de insuficiência das estruturas, e seu quadro clínico difere completamente daquele determinado pela osteoartrose, sendo sempre unilateral e ocorre na grande maioria em pacientes do sexo feminino, após a quinta década de vida, e na região medial do joelho (local de maior carga. Com o propósito de analisar as possíveis etiologias para a dor aguda do joelho de pacientes acima de 60 anos de idade, suas características e tratamento, os autores discutem as etiologias relacionadas à dor aguda: lesão meniscal, fratura por fadiga e osteonecrose idiopática.Acute knee pain in elderly patients is not uncommon, and is characterized by a sudden onset, no apparent cause, and by normal radiographic findings in most cases. The etiology of acute knee pain is the result of insufficient structures, and clinical symptoms are totally different from the symptoms seen in osteoarthrosis. This acute pain in the knee is always unilateral and in the medial region of the knee joint (site with the heaviest load, predominantly in females after the fifth decade of live. In order to consider the possible etiologies for acute knee joint pain in patients older than 60 years, its characteristics and treatment, the authors discuss etiologies related to acute pain: lesion of the meniscus, stress fracture, and idiopathic osteonecrosis.

  16. Perfiles clínicos y hemodinámicos en pacientes con falla cardiaca aguda

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    Luis Eduardo Calderón

    2017-09-01

    Conclusiones: la falla cardíaca aguda descompensada es el perfil de presentación clínica más común en nuestra población con dos tercios del total de casos. El perfil hemodinámico más frecuente fue el “caliente y húmedo” (Stevenson B, resultados que concuerdan con lo observado en estudios locales y registros internacionales.

  17. Primeiro consenso brasileiro do tratamento da fase aguda do acidente vascular cerebral

    Directory of Open Access Journals (Sweden)

    2001-01-01

    Full Text Available Este texto apresenta a síntese das conclusões do Iº Consenso Brasileiro do Tratamento da Fase Aguda do Acidente Vascular Cerebral (AVC. Tratou-se de reunião patrocinada e coordenada pela Sociedade Brasileira de Doenças Cerebrovasculares, com neurologistas especializados nas doenças cerebrovasculares, que analisaram os principais itens da conduta dos AVC.

  18. Relación entre las infecciones respiratorias agudas altas y el asma bronquial

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    Verónica Soler Fonseca

    Full Text Available Introducción: la infección respiratoria es la enfermedad más frecuente en los seres humanos, pues es responsable de la mitad de todas las enfermedades agudas. En Cuba al igual que en el resto del mundo, el asma bronquial constituye un importante problema de salud con incidencia relevante en los niños. Se señala que las infecciones virales están involucradas en la patogénesis del asma, sobre todo en el paciente pediátrico. Objetivo: identificar la influencia de las Infecciones Respiratorias Agudas Altas en la aparición y exacerbación de las crisis de asma bronquial. Métodos: se realizó un estudio descriptivo, transversal y prospectivo de los pacientes ingresados con asma bronquial en el servicio de enfermedades respiratorias del Hospital Pediátrico Docente de San Miguel del Padrón, durante todo el año 2008. Resultados: el tiempo de evolución de la IRAA más frecuente que desencadenó la crisis de asma bronquial fue de más de 7 días, con un 54,8 %. Un total de 188 pacientes presentaron rinofaringitis aguda catarral relacionada con la aparición de la crisis de asma bronquial, lo que representó el 82,4 % del total de la muestra. Conclusiones: predominó el grupo de 1 a 4 años con manifestaciones respiratorias altas de posible etiología viral sin diferencias apreciables en relación con el sexo. La mayoría de los pacientes que participaron en el estudio presentaron IRAA de etiología viral (Rinofaringitis, que precedieron la aparición y exacerbación de las crisis agudas de asma bronquial.

  19. Necessidades básicas das esposas de pacientes infartados na fase aguda do tratamento

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    Edna Ikumi Umebayashi Takahashi

    1990-12-01

    Full Text Available Trata-se de um estudo exploratório que teve por finalidade as necessidades básicas das esposas de pacientes infartados, na fase aguda do tratamento. Foi utlizado como referencial para análise os conceitos de Nacessidades Básicas de MASLOW. Os resultados permitiram identificar como principais necessidades afetadas das esposas: segurança, amor e gregária, estima.

  20. NECESSIDADES BÁSICAS DAS ESPOSAS DE PACIENTES INFARTADOS, NA FASE AGUDA DO TRATAMENTO

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    Edna Ikumi Umebayashi Takahashi

    Full Text Available Trata-se de um estudo exploratório que teve por finalidade identificar as necessidades básicas das esposas de pacientes infartados, na fase aguda do tratamento. Foi utilizado como referencial para análise os conceitos de Necessidades Básicas de Maslow. Os resultados permitiram identificar como principais necessidades afetadas das esposas: segurança, amor e gregária, estima.

  1. Necessidades básicas das esposas de pacientes infartados na fase aguda do tratamento

    Directory of Open Access Journals (Sweden)

    Edna Ikumi Umebayashi Takahashi

    Full Text Available Trata-se de um estudo exploratório que teve por finalidade as necessidades básicas das esposas de pacientes infartados, na fase aguda do tratamento. Foi utlizado como referencial para análise os conceitos de Nacessidades Básicas de MASLOW. Os resultados permitiram identificar como principais necessidades afetadas das esposas: segurança, amor e gregária, estima.

  2. Transient hypothyroidism after 131I treatment of Graves disease

    International Nuclear Information System (INIS)

    Liu Jianfeng; Fang Yi; Zhang Xiuli; Ye Genyao; Xing Jialiu; Zhang Youren

    2003-01-01

    Objective: To evaluate the results of the transient hypothyroidism after 131 I treatment of Graves disease. Methods: A total of 32 transient hypothyroidism patients treated with 131 I for Graves disease were studied and followed up. Results: Transient hypothyroidism occurred within 2-6 months after 131 I treatment and 19 patients were symptomatic. At diagnosis of transient hypothyroidism, T 3 and T 4 levels were decreased had normal, TSH levels were increased, normal or low. Follow-up examination found that 20 patients were normal and 12 patients had relapse of hyperthyroidism. Conclusions: Therapy of Graves disease with low doses of 131 I causes a high incidence of transient hypothyroidism. After recovery of transient hypothyroidism, some patients have relapse of hyperthyroidism

  3. Radiation retinopathy after orbital irradiation for Graves' ophthalmopathy

    International Nuclear Information System (INIS)

    Kinyoun, J.L.; Kalina, R.E.; Brower, S.A.; Mills, R.P.; Johnson, R.H.

    1984-01-01

    Recent reports indicate that orbital irradiation for Graves' ophthalmopathy is sometimes beneficial, particularly for dysthyroid optic neuropathy, and is not associated with serious complications. We are aware, however, of four patients who were found to have radiation retinopathy after orbital irradiation for Grave's ophthalmopathy. All four patients have decreased central acuity, and three of the four are legally blind in one or both eyes. Computer reconstruction of the dosimetry, based on computed tomography and beam profiles, shows that errors in dosage calculations and radiotherapy technique probably account for the radiation retinopathy in three of the four patients. Radiotherapy for Graves' ophthalmopathy should be administered only by competent radiotherapists who are experienced in the treatment of this disease. Similar errors in dosage calculations and treatment techniques may account for other reports of radiation retinopathy after reportedly safe dosages

  4. Esclerodermia, tireoidite e miastenia grave: estudo de um caso

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    Antonio L. dos Santos Werneck

    1993-11-01

    Full Text Available Uma paciente de 36 anos com miastenia grave desenvolveu após dois anos intolerância ao frio, o que conduziu ao diagnóstico de tireoidite de Hashimoto. Quatro anos mais tarde apresentou pele espessada nas mãos (esclerodermia limitada. O quadro clínico e os exames complementares encaminharam o diagnóstico para a forma CREST de esclerodermia sistêmica progressiva. Discute-se a dificuldade diagnóstica da esclerodermia, assim como suas síndromes de superposição. Doença de Hashimoto e miastenia grave constituem associação pouco frequente. A presença de esclerodermia e miastenia grave é rara. Não encontramos na literatura a coincidência destas três doenças.

  5. Clinical experience of radiation therapy for Graves` ophthalmopathy

    Energy Technology Data Exchange (ETDEWEB)

    Takahashi, Takeo; Mitsuhashi, Norio; Nagashima, Hisako; Sakurai, Hideyuki; Murata, Osamu; Ishizeki, Kei; Shimaya, Sanae; Hayakawa, Kazushige; Niibe, Hideo [Gunma Univ., Maebashi (Japan). School of Medicine

    1996-11-01

    The effect of radiation therapy for Graves` ophthalmopathy was evaluated. Ten patients with Graves` ophthalmopathy were treated with radiation therapy between 1992 and 1993 in Gunma University Hospital. All patients had a past history of hyperthyroidism and received 2,000 cGy to the retrobulbar tissues in 20 fractions. Nine of ten patients were treated with radiation therapy after the failure of corticosteroids. Six patients (60%) showed good or excellent responses. The exophthalmos type was more responsive to radiation therapy than the double vision type in this series. Two of five patients with the exophthalmos type demonstrated excellent responses, and their symptoms disappeared almost completely. The improvement of symptoms appeared within 3-6 months, and obvious clinical effects were demonstrated after 6 months of radiotherapy. Radiation therapy was well tolerated, and we have not observed any side effects of radiation therapy. In conclusion, radiation therapy is effective treatment for Graves` ophthalmopathy. (author)

  6. Clinical experience of radiation therapy for Graves' ophthalmopathy

    International Nuclear Information System (INIS)

    Takahashi, Takeo; Mitsuhashi, Norio; Nagashima, Hisako; Sakurai, Hideyuki; Murata, Osamu; Ishizeki, Kei; Shimaya, Sanae; Hayakawa, Kazushige; Niibe, Hideo

    1996-01-01

    The effect of radiation therapy for Graves' ophthalmopathy was evaluated. Ten patients with Graves' ophthalmopathy were treated with radiation therapy between 1992 and 1993 in Gunma University Hospital. All patients had a past history of hyperthyroidism and received 2,000 cGy to the retrobulbar tissues in 20 fractions. Nine of ten patients were treated with radiation therapy after the failure of corticosteroids. Six patients (60%) showed good or excellent responses. The exophthalmos type was more responsive to radiation therapy than the double vision type in this series. Two of five patients with the exophthalmos type demonstrated excellent responses, and their symptoms disappeared almost completely. The improvement of symptoms appeared within 3-6 months, and obvious clinical effects were demonstrated after 6 months of radiotherapy. Radiation therapy was well tolerated, and we have not observed any side effects of radiation therapy. In conclusion, radiation therapy is effective treatment for Graves' ophthalmopathy. (author)

  7. An update on the medical treatment of Graves' hyperthyroidism.

    Science.gov (United States)

    Marinò, Michele; Latrofa, Francesco; Menconi, Francesca; Chiovato, Luca; Vitti, Paolo

    2014-11-01

    Medical treatment of Graves' hyperthyroidism is based on the use of thionamides; namely, methimazole and propylthiouracil. In the past, methimazole was preferred by European endocrinologists, whereas propylthiouracil was the first choice for the majority of their North American colleagues. However, because of the recent definition of a better side-effect profile, methimazole is nowadays the first choice world while. Although thionamides are quite effective for the short-term control of Graves' hyperthyroidism, a relatively high proportion of patients relapses after thionamide withdrawal. Other possible medical treatments, include iodine and compounds containing iodine, perchlorate, lithium (as an adjuvant in patients undergoing radioiodine therapy), β-adrenergic antagonists, glucocorticoids, and some new molecules still under investigation. Management of Graves' hyperthyroidism using thionamides as well as the other available medical treatments is here reviewed in detail, with a special mention of situations such as pregnancy and lactation, as well as neonatal and fetal thyrotoxicosis.

  8. F-18-FDG PET of the thyroid in Graves' disease

    International Nuclear Information System (INIS)

    Boerner, A.R.; Voth, E.; Schicha, H.; Wienhard, K.; Wagner, R.

    1998-01-01

    This study evaluates F-18-FDG PET of the thyroid in Graves' disease. Methods: Thirty patients were investigated the day before radioiodine therapy, 15 patients 3-10 days after radioiodine therapy. Twenty patients with cancer of the head or neck and normal thyroid function served as controls. Results: F-18-FDG uptake was higher in Graves' disease patients than in controls. Negative correlations of F-18-FDG uptake with half-life of radioiodine and absorbed radiation dose due to radioiodine therapy were found along with a positive correlation to autoantibody levels. Conclusion: Thus F-18-FDG PET is likely to give information on the biological activity of Graves' disease as well as on early radiation effects. (orig.) [de

  9. 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.

  10. 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

  11. Serum immunoglobulin G4 levels and Graves' disease phenotype.

    Science.gov (United States)

    Martin, Carmen Sorina; Sirbu, Anca Elena; Betivoiu, Minodora Andreea; Florea, Suzana; Barbu, Carmen Gabriela; Fica, Simona Vasilica

    2017-02-01

    We investigated, at diagnosis, the relationship between serum immunoglobulin G4 levels and the main characteristics of Graves' disease: hyperthyroidism severity, goiter size, presence of active Graves' ophthalmopathy, antithyroid antibodies status, and titer. This prospective study included 80 newly diagnosed Graves' disease patients. The main parameters measured at diagnosis: thyroid-stimulating hormone, free thyroxine, free triiodothyronine, total triiodothyronine, thyroglobulin, antithyroid peroxidase antibodies, anti-thyroglobulin antibodies, thyroid-stimulating hormone receptor antibodies, immunoglobulin G4. In Graves' disease patients, serum immunoglobulin G4 levels were higher than in general population (p = 0.028) and higher in men compared to women (p = 0.002). Only one female patient with intense hypoechoic goiter, high anti-thyroglobulin antibody, and antithyroid peroxidase antibody titers had an elevated serum immunoglobulin G4 level at diagnosis. Patients with immunoglobulin G4 levels above the 75th percentile (>237.52 mg/dl, N = 20) were younger at Graves' ophthalmopathy onset (p 286.28 mg/dl, N = 8) had lower total triiodothyronine values (p = 0.001) than patients with IgG below the 90th percentile. No significant correlations were found between smoking status (p = 0.58), goiter size (p = 0.50), the presence of ophthalmopathy (p = 0.42) or thyroid-stimulating hormone receptor antibody titers (p = 0.45) and the mean value of immunoglobulin G4 levels at diagnosis. Our data suggest that Graves' disease patients with elevated immunoglobulin G4 levels at diagnosis have a phenotype characterized by higher anti-thyroglobulin antibody and antithyroid peroxidase antibody titers, less severe T3 hyperthyroidism, younger age at ophthalmopathy onset and require a shorter duration of the first methimazole treatment cycle.

  12. Thyroid Ultrasonography in Differentiation between Graves' Disease and Hashimoto's Thyroiditis.

    Science.gov (United States)

    Pishdad, P; Pishdad, G R; Tavanaa, S; Pishdad, R; Jalli, R

    2017-03-01

    Graves' disease and Hashimoto's thyroiditis are the most common causes of hyper and hypothyroidism, respectively. Differentiation of these 2 diseases, if the patient is euthyroid, may sometimes be extremely difficult on the basis of clinical and laboratory findings. The purpose of this study was to determine the sensitivity and specificity of gray scale sonography in differentiation of Graves' disease from Hashimoto's thyroiditis. This study included 149 patients divided into three groups, patients with Graves' disease (34 patients, mean age = 36.8 ± 10.17 years), Patients with Hashimoto's thyroiditis (62 patients, mean age = 33.4 ± 12.16 years) and control group (53 healthy people, mean age = 34.74 ± 16.87 years). Members of all groups were referred to a single radiologist for thyroid sonography for evaluation of thyroid echogenicity pattern. A total of 117 women and 32 men were examined by sonography. The most common sonographic pattern in Hashimoto and Graves' was homogenous hypo-echogenicity which was observed in 45.2% and 47.1% of cases, respectively. Peripheral hypo-echogenicity pattern was seen in 40.3% of Hashimoto's group with 100% specificity and 40.3% sensitivity. Central-hypoechogenic pattern was observed in 17.6% of Graves' group with 100% and 17.6% specificity and sensitivity, respectively. Our findings indicate that sonography has high specificity but low sensitivity in the diagnosis of either Graves' disease or Hashimoto's thyroiditis. It is therefore not possible to differentiate between these two diseases using sonography alone. Confirmation by laboratory data is also needed.

  13. Tratamiento quirúrgico de las colecciones agudas y crónicas del pericardio

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    Orestes Noel Mederos Curbelo

    Full Text Available Introducción: las colecciones agudas o crónicas del pericardio con frecuencia producen una compresión del corazón que en los casos crónicos conlleva invalidez y, en los agudos, peligro de muerte por taponamiento cardíaco. Objetivo: caracterizar a los pacientes intervenidos quirúrgicamente en el Hospital Universitario "Comandante Manuel Fajardo" entre 1995 y 2012 a causa de colecciones pericárdicas. Métodos: se realizó un estudio descriptivo transversal con los pacientes atendidos quirúrgicamente en dicha institución por colecciones del pericardio. Constituyeron el universo 24 pacientes: 22 con colecciones agudas y 2 con colecciones crónicas. Resultados: la causa más frecuente de los derrames agudos fue la pericarditis aguda idiopática (25 %. Las colecciones crónicas fueron por pericarditis fibrosa de causa idiopática en el 100 % de los enfermos. La intervención realizada fue la resección del pericardio y el drenaje de las colecciones agudas mediante toracotomía izquierda o por vía preperitoneal subxifoidea. En las colecciones de origen maligno se realizó la resección pericárdica con fines paliativos y, en los derrames por lesión traumática del corazón, la sutura de este órgano fue el tratamiento quirúrgico empleado en todos los casos. En las pericarditis constrictivas, la pericardiectomía radical fue el tratamiento empleado en el 100 % de los casos. Conclusiones: el tratamiento quirúrgico en las colecciones agudas y crónicas del pericardio permite drenar el contenido por una ventana pericárdica obtenida por toracoscopia o por vía preperitoneal subxifoidea, mientras que la toracotomía izquierda es útil en las emergencias. En los derrames crónicos con fibrosis y síntomas de insuficiencia cardíaca, la pericardiectomía radical mediante esternotomía media ofrece los mejores resultados.

  14. La enfermedad de Graves, signos y síntomas

    OpenAIRE

    Young, P.; Finn, B. C.; Bruetman, J. E.

    2007-01-01

    La enfermedad de Graves es la causa más común de hipertiroidismo, es de patogenia autoinmune. Se distingue clínicamente de otras formas de hipertiroidismo por la presencia de bocio difuso, oftalmopatía y ocasionalmente mixedema pretibial. En este artículo describimos la vida y obra de Robert Graves, realizando posteriormente una revisión de los signos y síntomas de la enfermedad. En el mundo de la medicina actual, en donde la tecnología juega un rol preponderante, queremos recordar la importa...

  15. Dissociative disorder due to Graves' hyperthyroidism: a case report.

    Science.gov (United States)

    Mizutani, Kaoru; Nishimura, Katsuji; Ichihara, Atsuhiro; Ishigooka, Jun

    2014-01-01

    We report the case of a 20-year-old Japanese woman with no psychiatric history with apparent dissociative symptoms. These consisted of amnesia for episodes of shoplifting behaviors and a suicide attempt, developing together with an exacerbation of Graves' hyperthyroidism. Patients with Graves' disease frequently manifest various psychiatric disorders; however, very few reports have described dissociative disorder due to this disease. Along with other possible causes, for example, encephalopathy associated with autoimmune thyroid disease, clinicians should be aware of this possibility. Copyright © 2014 Elsevier Inc. All rights reserved.

  16. Treating the thyroid in the presence of Graves' ophthalmopathy

    DEFF Research Database (Denmark)

    Hegedüs, Laszlo; Bonnema, Steen J; Smith, Terry J

    2012-01-01

    The etiology of Graves' orbitopathy (GO) remains enigmatic. Optimal therapeutic choices for the hyperthyroidism associated with Graves' disease (GD) in the presence of GO remain controversial. Whether antithyroid drugs (ATDs), radioiodine (RAI), or thyroidectomy should be favored in such patients...... - independent of extent - do not influence the natural course of GO. RAI can cause de novo development or progression of GO, which is largely preventable with oral steroid prophylaxis. In patients with mild GO, the thyroid treatment is largely independent of GO. Moderate to severe GO should be treated promptly...

  17. Graves' disease presenting as pseudotumor cerebri: a case report

    Directory of Open Access Journals (Sweden)

    Freitas Cláudia

    2011-02-01

    Full Text Available Abstract Introduction Pseudotumor cerebri is an entity characterized by elevated intracranial pressure with normal cerebrospinal fluid and no structural abnormalities detected on brain MRI scans. Common secondary causes include endocrine pathologies. Hyperthyroidism is very rarely associated and only three case reports have been published so far. Case presentation We report the case of a 31-year-old Luso-African woman with clinical symptoms and laboratory confirmation of Graves' disease that presented as pseudotumor cerebri. Conclusion This is a rare form of presentation of Graves' disease and a rare cause of pseudotumor cerebri. It should be remembered that hyperthyroidism is a potential cause of pseudotumor cerebri.

  18. CT volumetric measurements of the orbits in Graves' disease

    International Nuclear Information System (INIS)

    Krahe, T.; Schlolaut, K.H.; Poss, T.; Trier, H.G.; Lackner, K.; Bonn Univ.; Bonn Univ.

    1989-01-01

    The volumes of the four recti muscles and the orbital fat was measured by CT in 40 normal persons and in 60 patients with clinically confirmed Graves' disease. Compared with normal persons, 42 patients (70%) showed an increase in muscle volume and 28 patients (46.7%) an increase in the amount of fat. In nine patients (15%) muscle volume was normal, but the fat was increased. By using volumetric measurements, the amount of fat in the orbits in patients with Graves' disease could be determined. (orig.) [de

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

    International Nuclear Information System (INIS)

    Miller, J.L.

    1982-01-01

    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 ( 131 I). At present 131 I is the current treatment of chioce for Graves' disease. In a follow-up study of 21 714 patients who were treated with 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 131 I used destroys the ability of the thyroid cells to replicate and thus transmit genetically damaged material

  20. Severe aplastic anaemia and Grave's disease in a paediatric patient.

    Science.gov (United States)

    Kumar, Manjusha; Goldman, Jeffrey

    2002-07-01

    Severe aplastic anaemia (SAA) is considered to be an autoimmune disorder affecting the haematopoietic cells and most often is idiopathic. An association between SAA and other autoimmune diseases is rare and has been described in adults for eosinophilic fasciitis, thymomas, systemic lupus erythematosus and thyroid disorders. We describe the first paediatric patient with chronic relapsing SAA and Grave's disease. We discuss the difficulty in diagnosis of Grave's disease, the possibility of its manifestation due to withdrawal of immunosuppressants, and issues to consider in the treatment of this disease in the setting of bone marrow failure.

  1. Graves' ophthalmopathy evaluated by infrared eye-movement recordings

    International Nuclear Information System (INIS)

    Feldon, S.E.; Unsoeld, R.

    1982-01-01

    Thirteen patients with varying degrees of Graves' ophthalmopathy were examined using high-resolution infrared oculography to determine peak velocities for horizontal eye movements between 3 degrees and 30 degrees. As severity of the orbital disease increased, peak velocities became substantially lower. Vertical-muscle surgery failed to have any effect on peak velocity of horizontal eye movements. In contrast, orbital decompression caused notable improvement in peak velocity of eye movements. Eye-movement recordings, which provide a measure of extraocular muscle function rather than structure, may provide a safe, sensitive, and accurate method for classifying and following up patients with Graves' ophthalmopathy

  2. A controlled monitoring study of simulated clandestine graves using 3D ground penetrating radar

    CSIR Research Space (South Africa)

    van Schoor, Michael

    2017-06-01

    Full Text Available A controlled three-dimensional ground penetrating radar monitoring study over simulated clandestine graves was conducted near Pretoria, South Africa, in which the detectability of graves as a function of post-burial interval was assessed...

  3. Genotypes in relation to phenotypic appearance and exposure to environmental factors in Graves' hyperthyroidism

    NARCIS (Netherlands)

    Vos, Xander G.; Endert, Erik; Tijssen, Jan G. P.; Wiersinga, Wilmar M.

    2012-01-01

    Background: Genetic polymorphisms and environmental factors are both involved in the pathogenesis of Graves' disease, but their interaction and effect on Graves' phenotypes have scarcely been investigated. Objective: To test the hypothesis that subjects with susceptibility genotypes develop more

  4. Effect of hyperthermia on experimental acute pancreatitis Efeito da hipertermia na pancreatite aguda experimental

    Directory of Open Access Journals (Sweden)

    José Luiz Jesus de Almeida

    2006-12-01

    Full Text Available BACKGROUD: Recent studies indicate that hyperthermia can change inflammatory mechanisms and protect experimental animals from deleterious effects of secretagogue-induced acute pancreatitis AIM: To evaluate the effects of hyperthermia post-treatment on cerulein-induced acute pancreatitis in rats METHODS: Twenty animals were divided in two groups: group I (n = 10, rats with cerulein-induced acute pancreatitis undergone hyperthermia, and group II (n = 10, animals with cerulein-induced acute pancreatitis that were kept normothermic. In all groups, amylase serum levels, histologic damage, vascular permeability and pancreatic water content were assessed. Acute pancreatitis was induced by administration of two cerulein injections (20 mcg/kg. A single dose of Evans' blue dye was administered along with the second dose of cerulein. All animals also received a subcutaneous injection of saline solution. After this process, animals undergone hyperthermia were heated in a cage with two 100 W lamps. Body temperature was increased to 39.5ºC and maintained at that level for 45 minutes. Normothermia rats were kept at room temperature in a second cage RESULTS: Control animals had typical edema, serum amylase activity and morphologic changes of this acute pancreatitis model. Hyperthermia post-treatment ameliorated the pancreatic edema, whereas the histologic damage and the serum amylase level remained unchanged CONCLUSIONS: The findings suggest a beneficial effect of the thermal stress on inflammatory edema in experimental acute pancreatitis.RACIONAL: Estudos recentes indicam que a hipertermia pode modificar mecanismos inflamatórios e proteger animais experimentais dos efeitos deletérios da pancreatite aguda induzida por secretagogos OBJETIVO: Avaliar a eficácia da hipertermia como tratamento da pancreatite aguda induzida por ceruleína em ratos MÉTODOS: Vinte animais foram divididos em dois grupos: grupo I (n = 10, ratos com pancreatite aguda induzida por

  5. 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

  6. Microcristais biliares na pancreatite aguda idiopática: indício para etiologia biliar oculta subjacente

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    CHEBLI Júlio Maria Fonseca

    2000-01-01

    Full Text Available As principais causas de inflamação pancreática no mundo são a litíase biliar e o alcoolismo crônico. Admite-se que 10 a 30% das pancreatites agudas sejam idiopáticas. Sugere-se que parte destas são causadas por microlitíase ou barro biliar, identificados pela presença de microcristais no sedimento biliar. Neste estudo, realizou-se análise microscópica da bile obtida por colangiopancreatografia endoscópica, em pacientes com pancreatite aguda idiopática, pancreatite aguda biliar e pancreatite crônica alcoólica - 20 em cada grupo. Pacientes com pancreatite aguda idiopática e microcristais na bile foram submetidos a colecistectomia. Naqueles inaptos à cirurgia efetuou-se esfincterotomia endoscópica ou tratamento com ácido ursodesoxicólico. Pacientes com pancreatite aguda idiopática sem cristais não receberam tratamento específico. A prevalência de microcristais biliares em pacientes com pancreatite aguda idiopática (75% e pancreatite aguda biliar (90% foi significativamente maior que naqueles com pancreatite crônica alcoólica (15%. A detecção de microcristais apresentou sensibilidade de 90%, especificidade de 85%, valor preditivo positivo de 85,7%, valor preditivo negativo de 89,4% e acurácia de 87,5% em identificar pancreatite de origem biliar. Nos pacientes com pancreatite aguda idiopática recurrente, cursando com microcristais, houve redução significante dos episódios de pancreatite após tratamento específico. No seguimento deste grupo durante 23,3 meses, recidiva ocorreu apenas naqueles que apresentavam "fator biliar persistente" (coledocolitíase ou microcristais. Todos os pacientes com pancreatite aguda idiopática submetidos a colecistectomia apresentavam colecistite crônica, e microlitíase foi observada em um paciente. No seguimento ultra-sonográfico, colelitíase foi detectada em um dos casos. No subgrupo de cinco pacientes com pancreatite aguda idiopática sem microcristais houve uma recidiva. Estudo

  7. 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.

  8. 77 FR 39406 - Safety Zone; Tom Graves Memorial Fireworks, Port Bay, Wolcott, NY

    Science.gov (United States)

    2012-07-03

    ...-AA00 Safety Zone; Tom Graves Memorial Fireworks, Port Bay, Wolcott, NY AGENCY: Coast Guard, DHS. ACTION..., NY. This safety zone is intended to restrict vessels from a portion of Port Bay during the Tom Graves... necessary to ensure the safety of spectators and vessels during the Tom Graves Memorial Fireworks. This zone...

  9. Grave's Disease and Primary Biliary Cirrhosis—An Unusual and Challenging Association

    OpenAIRE

    Shetty, Shiran; Rajasekaran, Senthilkumar; Venkatakrishnan, Leela

    2013-01-01

    Jaundice in Grave's diseases is uncommon, but when it does occur, complication of thyrotoxicosis (heart failure/infection) or intrinsic liver disease should be considered. Grave's disease can cause asymptomatic elevation of liver enzymes, jaundice and rarely acute liver failure. It is associated with other autoimmune diseases like autoimmune hepatitis, or primary biliary cirrhosis. The cause of jaundice in Grave's disease is multifactorial.

  10. Grave's Disease and Primary Biliary Cirrhosis-An Unusual and Challenging Association.

    Science.gov (United States)

    Shetty, Shiran; Rajasekaran, Senthilkumar; Venkatakrishnan, Leela

    2014-03-01

    Jaundice in Grave's diseases is uncommon, but when it does occur, complication of thyrotoxicosis (heart failure/infection) or intrinsic liver disease should be considered. Grave's disease can cause asymptomatic elevation of liver enzymes, jaundice and rarely acute liver failure. It is associated with other autoimmune diseases like autoimmune hepatitis, or primary biliary cirrhosis. The cause of jaundice in Grave's disease is multifactorial.

  11. Quality control of 131I treatment of graves' disease

    International Nuclear Information System (INIS)

    Liu Zeng; Liu Guoqiang

    2009-01-01

    To make a preliminary quality control (QC) criteria and apply on the various stages of clinic 131 I treatment of Graves' disease in order to decrease the early happening of hypothyroidism and enhance the onetime 131 I cure rate of Graves' disease, the quality control criteria in the stochastic outpatient with 131 I treatment, such as plan of the indication, contraindication, method of treatment, matters needing attention, follow-up observation and curative effect appraisal, patient selection, RAIU, thyroid gland weight measurement and 131 I dose criteria for the various steps of 131 I medication were determined. The 131 I treatment effects of Graves' disease including the once-cure rate, the improving rate, duplicate cure rate and the early happening rate of hypothyroidism were analyzed in patients with applying QC and without QC ccriteria. The results showed that the oncecure rate in patients with applying QC criteria was increased from 76.6% to 90.9% (P≤0.01); the improving rate was decreased from 12.2% to 7.0% (P≤0.01); the duplicate cure rate was increased from 90.1% to 93.0% (P>0.05); the early happening rate of hypothyroidism was decreased from 11.0% to 2.1% (P≤0.01). The 131 I treatment of Graves' disease applying with QC criteria had tremendously improved the oncecure rate and decreased the early happening of hypothyroidism rate. (authors)

  12. Graves' orbitopathy as a rare disease in Europe

    DEFF Research Database (Denmark)

    Perros, Petros; Hegedüs, L; Bartalena, L.

    2017-01-01

    BACKGROUND: Graves' orbitopathy (GO) is an autoimmune condition, which is associated with poor clinical outcomes including impaired quality of life and socio-economic status. Current evidence suggests that the incidence of GO in Europe may be declining, however data on the prevalence of this dise...

  13. The plundering of the ship graves from Oseberg and Gokstad

    DEFF Research Database (Denmark)

    Bill, Jan; Daly, Aoife

    2012-01-01

    Not the least of the unusual revelations that have come from the wonderfully preserved ninth-century Norwegian ship burials at Oseberg and Gokstad, is the fact that both had been later broken into-by interlopers who defaced the ship, damaged the grave goods and pulled out and dispersed the bones...

  14. Classification of the eye changes of Graves' disease

    NARCIS (Netherlands)

    Wiersinga, W. M.; Prummel, M. F.; Mourits, M. P.; Koornneef, L.; Buller, H. R.

    1991-01-01

    Classification of the eye changes of Graves' disease may have clinical use in the description of the present eye state, in the assessment of treatment results, and in the choice of therapy. Requirements for any classification system should include simplicity, clinical nature (i.e., easily carried

  15. Diabetes mellitus: a risk factor in patients with Graves' orbitopathy

    NARCIS (Netherlands)

    Kalmann, R.; Mourits, M. P.

    1999-01-01

    AIMS: To assess the prevalence of dysthyroid optic neuropathy (DON) in patients with diabetes mellitus (DM) and Graves' orbitopathy (GO) and to investigate the complications of surgery for GO in these patients. METHODS: The records of 482 consecutive patients with GO referred in a 5 year period were

  16. Contrast sensitivity function in Graves' ophthalmopathy and dysthyroid optic neuropathy

    NARCIS (Netherlands)

    Suttorp-Schulten, M. S.; Tijssen, R.; Mourits, M. P.; Apkarian, P.

    1993-01-01

    Contrast sensitivity function was measured by a computer automated method on 38 eyes with dysthyroid optic neuropathy and 34 eyes with Graves' ophthalmopathy only. The results were compared with 74 healthy control eyes. Disturbances of contrast sensitivity functions were found in both groups when

  17. 131I therapy of Graves' disease using lithium

    International Nuclear Information System (INIS)

    Sato, Kenshi

    1983-01-01

    Lithium is known to cause goiter and hypothyroidism. In the mechanism of goitrogenesis, there is general agreement that lithium inhibits the release of the thyroid hormones from the thyroid gland without significantly impairing other thyroid functions. The present study was undertaken, therefore, to investigate the usefulness of lithium in the radioiodine treatment of Graves' disease. Nine patients with Graves' disease who were all, except one, previously treated with antithyroid drugs were studied. 600 mg of lithium carbonate were administered daily to investigate the effects on thyroidal 131 I uptake, disappearance rate of 131 I from the prelabeled thyroid and the serum concentrations of thyroid hormones. Lithium showed no significant effect on the thyroidal 131 I uptake when the 24 hour thyroidal 131 I uptakes were determined both before and during lithium treatment in the five cases. On the other hand, lithium clearly prolonged the mean value of effective half-lives of 131 I to approximately 8 days vs. 5.1 days before lithium treatment (p 4 and T 3 levels significantly decreased during lithium treatment, from 21.3 to 12.4μg/dl (n=9, p 131 I for the Graves' disease can be reduced by using lithium, the radiation exposure to the total body is decreased. Moreover, it is possible to perform the 131 I therapy while improving the thyrotoxicosis with lithium. Finally, it is concluded that lithium is a very useful drug to be combined with the 131 I therapy of Graves' disease. (author)

  18. [Guideline for the treatment of Graves' disease with antithyroid drug].

    Science.gov (United States)

    Nakamura, Hirotoshi

    2006-12-01

    We have published "Guideline for the Treatment of Graves' Disease with Antithyroid Drug in Japan 2006" in the middle of May from the Japan Thyroid Association. The background, working process, composition, aim and significance of this guideline are described. The most remarkable feature of this guideline is "evidence based".

  19. 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

  20. CASE REPORT : GRAVE'S DISEASE PRESENTING AS PARANOID SCHIZOPHRENIA

    Science.gov (United States)

    Singh, S.K.; Hatwal, A.; Agarwal, J.K.; Bajpai, H.S.; Sharma, I.

    1989-01-01

    SUMMARY The case of a 37 year old male is described who initially presented as paranoid schizophrenia unresponsive to anti-psychotic drug treatment and subsequently developed features of Grave's disease. Treatment with carbimazole alone improved his psychiatric symptoms. PMID:21927380

  1. [Rituximab: a new therapeutic alternative in Grave's disease].

    Science.gov (United States)

    Tello-Winniczuk, Nina; Díaz-Jouanen, Efraín

    2011-01-01

    Graves' disease is the most frequent cause of hyperthyroidism, affecting mainly young aged women, with an etiology of autoimmune basis. One of its manifestations, Graves' ophthalmopathy whose pathophysiology is unknown, represents one of the greatest therapeutic challenges in these patients, because they require aggressive treatment with steroids and multiple subsequent reconstructive surgeries in certain cases. It also represents a high burden to the health system. Drugs targeting B cells have been very effective for many autoimmune diseases. Rituximab is a murine humanized monoclonal antibody against CD20 + cells currently being studied in various autoimmune diseases including Graves' disease. The objective of this paper is to expose possible mechanisms by which rituximab could act in both hyperthyroidism and ophthalmopathy of Graves' disease, as well as the experience with its use acquired so far. The employment of rituximab in recently diagnosed patients or with mild ophthalmopathy is questionable with the evidence available today however, we think that it may have a role in refractory cases or those who have a contraindication for steroid use.

  2. Aspergillosis in immunocompromised children acute myeloid leukemia and bone marrow aplasia.: Report of two cases Aspergilose em crianças imunocomprometidas com leucemia mielóide aguda e aplasta de medula óssea: Registro de 2 casos

    Directory of Open Access Journals (Sweden)

    Maria Zilda de Aquino

    1994-10-01

    Full Text Available Two cases of Aspergillosis in immunocompromised children are reported. Both were caused by Aspergillns flavus. Early diagnosis and treatment led to the remission of the process. One patient had acute myeloid leukemia; the fungus was isolated from the blood. The other patient with bone marrow aplasia, presented an invasive aspergillosis of the paranasal sinuses with dissemination of fungal infection; the diagnosis was obtained by histology and culture of biopsied tissue from a palatal ulceration.No presente trabalho são registrados dois casos de aspergilose em crianças imunocomprometidas. O estudo micológico completo identificou Aspergillus flavus como agente dos dois processos. A presença cada vez mais frequente da aspergilose invasiva deve-se ao número crescente de pacientes imunocomprometidos, muitos com hemopatias graves submetidos à quimioterapia. O diagnóstico precoce em um dos casos possibilitou remissão do processo. Tratava-se de paciente com leucemia mielóide aguda, tendo sido isolado o fungo do sangue circulante. O segundo caso evoluiu para óbito, com infecção fúngica generalizada.

  3. Personalised immunomodulating treatments for Graves' disease: fact or fiction?

    Science.gov (United States)

    Struja, Tristan Mirko; Kutz, Alexander; Fischli, Stefan; Meier, Christian; Müller, Beat; Schütz, Philipp

    2017-08-14

    Although Graves' disease has been recognised for more than 100 years, its physiopathological mechanisms are incompletely understood. Treatment strategies today mainly focus on suppression of thyroid hormone production by use of antithyroid drugs or radio-iodine, but neglect the underlying immunological mechanisms. Although Graves' disease is often seen as a prototype for an autoimmune mechanism, it is more likely to be a heterogeneous syndrome showing characteristics of both autoimmunity and immunodeficiency. The interplay of these two mechanisms may well characterise the physiopathology of this disease and its complications. Immunodeficiency may be either genetically determined or secondarily acquired. Various triggering events lead to autoimmunity with stimulation of the thyroid gland resulting in the clinical syndrome of hyperthyroidism. Also, relapse risk differs from patient to patient and can be estimated from clinical parameters incorporated into the Graves' Recurrent Events After Therapy (GREAT) score. Accurate risk stratification may help to distinguish high-risk patients for whom a more definitive treatment approach should be used from others where there is a high probability that the disease will recover with medical treatment alone. Several smaller trials having found positive effects of immunosuppressive drugs on recurrence risk in Graves' disease; therefoore, there is great potential in the use of novel immunomodulating drugs in addition to the currently used antithyroid drugs for the successful treatment of this condition. Further in-depth exploration of susceptibility, triggering factors and immunological mechanisms has the potential to improve treatment of Graves' disease, with more personalised, risk-adapted treatment strategies based on the different physiopathological concepts of this heterogeneous condition.

  4. Follow-up of newborns of mothers with Graves' disease.

    Science.gov (United States)

    Levy-Shraga, Yael; Tamir-Hostovsky, Liran; Boyko, Valentina; Lerner-Geva, Liat; Pinhas-Hamiel, Orit

    2014-06-01

    Overt neonatal Graves' disease is rare, but may be severe, even life threatening, with deleterious effects on neural development. The main objective of this study was to describe the course of thyrotropin (TSH) and free thyroxin (fT4) levels, as well as postnatal weight gain in relation to fT4 levels, in neonates born to women with Graves' disease without overt neonatal thyrotoxicosis. Such information is important to deduce the optimal schedule for evaluation. We conducted a retrospective chart review of neonates born to mothers with Graves' disease between January 2007 and December 2012. The records were reviewed for sex, gestational age, birth weight, maternal treatment during pregnancy, and maternal thyroid stimulating immunoglobulin (TSI) level. For each visit in the clinic, the data included growth parameters, presence of symptoms suspected for hyperthyroidism, blood test results (levels of TSH, fT4, and TSI), and treatment. Ninety-six neonates were included in the study (49 males), with a total of 320 measurements of thyroid function tests (TSH and fT4). Four neonates (4%) had overt neonatal Graves' disease; one of them along with nine others were born preterm. In 77 (92.9%) of the remaining 83 neonates (the subclinical group), fT4 levels were above the 95th percentile on day 5. All had normal fT4 on day 15. A negative association was found between fT4 and weight gain during the first two weeks. In this cohort, most neonates born to mothers with Graves' disease had a subclinical course with abnormal fT4 levels that peaked at day 5. After day 14, all measurements of fT4 returned to the normal range, although measurements of TSH remained suppressed for up to three months. Elevated fT4 was associated with poor weight gain.

  5. SUBTOTAL THYROIDECTOMY IN THE MANAGEMENT OF GRAVE'S DISEASE.

    Science.gov (United States)

    Vincent, P J; Garg, M K; Singh, Y; Bhalla, V P; Datta, S

    2001-07-01

    Treatment options for Grave's disease include radio-iodine ablation, which is the standard treatment in the USA, antithyroid drug therapy, which is popular in Japan, and surgery, which is commonly employed in Europe and India. There are very few reports about the outcome of surgery in Grave's disease in the Indian setting. Surgery for Grave's disease is an attractive option in under developed countries to cut short prolonged drug treatment, costly follow up and avoid the need for radio-isotope facilities for 1311 ablation. Aim of the present study was to assess the result of subtotal thyroidectomy in 32 cases of Grave's Disease referred for surgery by the endocrinologist in a teaching hospital. Patients were prepared for surgery with Lugol's iodine and propranalol. Subtotal thyroidectomy was performed by a standard technique, which included dissection and exposure of recurrent laryngeal nerves and parathyroid glands. Actual estimation of weight of the remnant gland was not part of the study. Duration of follow up ranged from 6 months to 4 years. 13 of 32 cases were males. Age ranged from 20 to 57 years. There was 1 death in the immediate post-operative period. There were no cases of permanent hypoparathyroidism or recurrent laryngeal nerve palsy. 1 patient developed temporary hypoparathyroidism. 1 patient developed recurrence of hyperthyroidism and 3 cases developed hypothyroidism all within 2 years of surgery. The study has demonstrated the safety and effectiveness of surgery for Grave's Disease in comparison to the reported high incidence of hypothyroidism following radio-iodine therapy and high recurrence rate after anti thyroid drug therapy.

  6. Graves' orbitopathy as a rare disease in Europe: a European Group on Graves' Orbitopathy (EUGOGO) position statement

    NARCIS (Netherlands)

    Perros, P.; Hegedüs, L.; Bartalena, L.; Marcocci, C.; Kahaly, G. J.; Baldeschi, L.; Salvi, M.; Lazarus, J. H.; Eckstein, A.; Pitz, S.; Boboridis, K.; Anagnostis, P.; Ayvaz, G.; Boschi, A.; Brix, T. H.; Currò, N.; Konuk, O.; Marinò, M.; Mitchell, A. L.; Stankovic, B.; Törüner, F. B.; von Arx, G.; Zarković, M.; Wiersinga, W. M.

    2017-01-01

    Graves' orbitopathy (GO) is an autoimmune condition, which is associated with poor clinical outcomes including impaired quality of life and socio-economic status. Current evidence suggests that the incidence of GO in Europe may be declining, however data on the prevalence of this disease are sparse.

  7. The Eye/Brain Radioactivity Ratio for Assessment of Graves Ophthalmopathy

    International Nuclear Information System (INIS)

    Lee, B. W.; Sung, S. K.; Suh, K. S.; Park, W.; Choi, D. J.; Kim, J. S.

    1988-01-01

    In Graves' disease, changes in orbital tissue and structure are caused by inflammatory infiltration, which induces increase of capillary permeability and breakdown of blood-tissue barriers. Using the uptake of 99m Tc-DTPA in inflammatory lesion, Eye/Brain radioactivity ratios in brain scintigraphy were evaluated in 15 normal controls and 40 Graves' patients. The results were as follows; 1) Eye/Brain radioactivity ratio was significantly higher in Graves' ophthalmopathy group than in control group (p 99m Tc-DTPA brain scintigraphy may be useful to determine the activity of Graves' ophthalmopathy and whether treatment of Graves' ophthalmopathy is necessary or not.

  8. TOXICIDAD AGUDA DE Aleurites moluccana POR VIA ORAL EN RATAS SPRAGUE-DAWLEY

    Directory of Open Access Journals (Sweden)

    Laura Rocío Orellana-Cuéllar

    2014-12-01

    Full Text Available Objetivo: Determinar la toxicidad aguda por Aleurites moluccana por administración oral en ratas Sprague-Dawley. Metodología: Estudio experimental realizado en el Instituto de Patología de la Facultad de Medicina-UNMSM. Se usaron treinta ratas Sprague-Dawley, hembras y machos, de 6 semanas de edad. Se formaron aleatoriamente tres grupos de diez ratas: grupo A1, recibió 8,2 mg/Kg de peso de A. moluccana; grupo  A2, recibió 2000 mg/Kg de peso de A. moluccana; grupo control, recibió agua ad libitum. Se evaluaron los signos clínicos de toxicidad, los pesos, variables bioquímicas y las características histopatológicas de hígado, riñón, corazón, intestino, bazo y gónadas. Se consideró significativo un p0,05. Los grupos  A1 y A2 presentaron signos clínicos de toxicidad y la muerte de tres ratas; células hepáticas binucleadas y regenerativas en el hígado; y hemorragia glomerular en el riñón. Conclusiones: Las variables clínicas e histopatológicas en hígado y riñón demostraron que la Aleurites moluccana produce toxicidad aguda, las variables bioquímicas no demostraron este efecto. Palabras Claves: Aleurites moluccana, Toxicidad aguda, Ratas Sprague-Dawley.

  9. Pancreatitis aguda por hipertrigliceridemia severa: reporte de caso y revisión de la literatura

    OpenAIRE

    Herrera Del Águila, Dwight Denis; Garavito Rentería, Jorge; Linarez Medina, Karen; Lizarzaburu Rodríguez, Víctor

    2015-01-01

    La pancreatitis aguda por hipertrigliceridemia se presenta en aproximadamente 1-4 % de los casos, es la tercera causa de pancreatitis luego de la etiología biliar y alcohólica. La hipertrigliceridemia puede ser producida por causas primarias asociadas a trastornos genéticos en el metabolismo de los lípidos, y por casusas secundarias. Se presenta el caso de un paciente varón de 32 años de edad, natural de Huancayo, con antecedentes de diabetes mellitus tipo 2, dislipidemia mixta severa con hip...

  10. Sarcoidosis aguda: Variante de Síndrome de Löfgren sin eritema nodoso

    OpenAIRE

    Pérez, Gerardo; Facal, Jorge

    2014-01-01

    El síndrome de Löfgren, es una variante aguda de la sarcoidosis, que se caracteriza por fiebre, eritema nodoso, adenomegalias hiliares pulmonares y artritis. En general, tiene un curso benigno y autolimitado, que contrasta con las formas crónicas que requieren uso de corticoides y tienen tendencia a la recidiva. Se describe aquí el caso clínico de un paciente joven, de sexo masculino, con artritis pero sin eritema nodoso, lo que dificultó el planteo diagnóstico de síndrome de Löfgren. Se real...

  11. Inmunofenotipos aberrantes en leucemias agudas en una población hospitalaria de Buenos Aires

    Directory of Open Access Journals (Sweden)

    Viviana Novoa

    2013-02-01

    Full Text Available La citometría de flujo multiparamétrica es el método de elección para la caracterización inmunofenotípica de las células hematopoyéticas clonales presentes en los distintos procesos leucémicos agudos. El objetivo fue analizar la expresión de antígenos de membrana y evaluar la presencia de fenotipos aberrantes en los blastos de pacientes con diagnóstico de leucemia aguda, que permiten el monitoreo de la respuesta al tratamiento. Se revisaron los inmunofenotipos de 364 muestras de pacientes adultos derivadas a nuestro laboratorio en un período de 7 años. El inmunofenotipo se realizó por citometría de flujo con un amplio panel de anticuerpos monoclonales con el que se evaluó la expresión de antígenos de linaje linfoide, mieloide y también antígenos de maduración. De las 364 muestras estudiadas, 60.2% presentaron un fenotipo compatible con leucemia mieloide aguda (LMA, 28.8% con leucemia linfoblástica B (LLA-B, 6.6% con leucemia linfoblástica T (LLA-T y 4.4% con leucemias agudas poco frecuentes. La presencia de fenotipos aberrantes se observó en 89% de los casos, los fenotipos aberrantes identificados fueron: 1 infidelidad de linaje: LMA (54%, LLA-B (40%, LLA-T (29%; 2 ausencia de expresión antigénica: LMA (21%, LLA-B (35%, LLA-T (70%; 3 alteración de la expresión antigénica: LMA (67%, LLA-B (66%, LLA-T (84%; 4 asincronismo madurativo: LMA (26%, LLA-B (37% y 5 fenotipo ectópico: LLA-T 96%. El análisis por citometría de flujo multiparamétrica de las leucemias agudas permitió la identificación de fenotipos aberrantes en la mayoría de nuestros pacientes, que son de utilidad para el monitoreo de la respuesta al tratamiento.

  12. Infecciones respiratorias agudas en los niños. Posibles medidas de control

    OpenAIRE

    Mohs Villalta, Edgar

    1985-01-01

    Artículo científico -- Universidad de Costa Rica. Instituto de Investigaciones en Salud, 1985 Las infecciones respiratorias agudas que representan el 50% aproximadamente, de los casos de enfermedades que deben notificarse a las autoridades y de las consultas pediátricas de pacientes ambulatorios en los países en desarrollo, son también una de las principales causas de las enfermedades contraídas en los hospitales y de mortalidad por enfermedades nosocomiales. En 1982, por *mph:), fueron la...

  13. El problema Patogénico de las Pancreatitis Agudas. Lesiones producidas por la Etionina.

    OpenAIRE

    Pera Blanco-Morales, Cristóbal

    2016-01-01

    Cuando en el año 1952 realizamos una extensa revisión del problema de la necrosis aguda del páncreas, conveníamos en que eran tres las razones que justifican el gran interés que el estudio de esta afección conserva en la actualidad: a) Las dudas existentes acerca de su etiología y patogénesis. b) La extraordinaria gravedad del proceso que conduce a la muerte en una elevada proporción de casos. c) La incertidumbre sobre cua...

  14. PARTO PRETÉRMINO Y SUFRIMIENTO FETAL SECUNDARIOS A PERITONITIS POR APENDICITIS AGUDA PERFORADA

    OpenAIRE

    Hidalgo M,Juan José; Molina P,Marta; Varo GM,Begoña; Rivas R,Salvador; Bernabeu A,José Ramón; Perales M,Alfredo

    2009-01-01

    La apendicitis aguda es la urgencia quirúrgica no obstétrica más frecuente durante el embarazo. Se ha asociado a parto pretérmino y a morbimortalidad fetal y materna, especialmente cuando se complica con peritonitis. Los cambios anatómicos, fisiológicos y bioquímicos que se producen durante la gestación pueden alterar los síntomas y signos típicos asociados a la apendicitis. Esto puede retrasar el diagnóstico y dar lugar a un aumento de la morbimortalidad materna y fetal. Presentamos el caso ...

  15. Efecto de la restitución temprana de la nutrición oral en la pancreatitis aguda leve

    OpenAIRE

    Vega Sandoval, Carlos Andres; Isaza Restrepo, Andres; Moscoso Daza, Alejandro

    2010-01-01

    Aunque el manejo nutricional de los pacientes con Pancreatitis Aguda Severa ha sido bien establecido por la evidencia disponible, el inicio de la vía oral en Pancreatitis Leve no ha sido igualmente estudiado. El objetivo de este estudio es evaluar el efecto del inicio temprano de la nutrición por vía oral en estos pacientes. Métodos: Realizamos un descriptivo serie de comparación de casos en los cuales comparamos la evolución y resultados del manejo de los pacientes con pancreatitis aguda ant...

  16. Aspectos disautonômicos da porfiria aguda intermitente: a propósito de seis casos

    Directory of Open Access Journals (Sweden)

    Charles P. Tilbery

    1979-06-01

    Full Text Available Foram estudados seis casos de porfiria aguda intermitente, sendo enfocados os aspectos disautonômicos apresentados durante a longa permanência hospitalar dos doentes (média de 64 dias. Foram observados taquicardia sinusal e hipertensão arterial (4 casos, parada cardíaca (3 casos e depressão respiratória (5 casos. Os autores tecem comentários a propósito da fisiopatologia destas alterações e chamam a atenção sobre o prognóstico sombrio da porfiria aguda intermitente.

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

    International Nuclear Information System (INIS)

    Wang Chaodian; Shi Yuhong; Yan Bing

    2013-01-01

    Objective: To explore the value of serum thyrotrophin receptor antibody (TRAb) on the pathological mechanism of Graves ophthalmopathy. Methods: Two hundred and nineteen newly diagnosed Graves disease patients who were divided into Graves ophthalmopathy group (n=121) and without Graves ophthalmopathy group (n=98) were tested serum concentration with thyroid function, thyroperoxidase antibodies (TPOAb), thyroglobulin antibodies (TgAb) and TRAb. According to the consensus statement of the European Group on Graves ophthalmopathy, clinical activity score (CAS) and severity evaluation were carried out on Graves ophthalmopathy patients. Results: There was no significant difference in serum concentration of free thyroxine (FT 4 ), free triiodothyronine (FT 3 ), TPOAb and TRAb between the Graves ophthalmopathy group and the without Graves ophthalmopathy group. Serum concentration of TRAb was not correlated with the severity and CAS of Graves ophthalmopathy. Conclusions: The CAS and the severity of Graves ophthalmopathy were irrelevant to the serum concentration of TRAb. Therefore, the correlation between TRAb and Graves ophthalmopathy still needs further study. (authors)

  18. Ultrasonographic Features of Papillary Thyroid Carcinoma in Patients with Graves' Disease

    Science.gov (United States)

    Chung, Jin Ook; Cho, Dong Hyeok; Chung, Dong Jin

    2010-01-01

    Background/Aims To characterize ultrasonographic findings in papillary thyroid carcinoma (PTC) combined with Graves' disease. Methods Medical records and ultrasonographic findings of 1,013 patients with Graves' disease and 3,380 patients without Graves' disease were analyzed retrospectively. A diagnosis of PTC was based on a pathologic examination. Results The frequency of hypoechogenicity was lower in patients with PTC and Graves' disease than in patients with PTC alone (p Graves' disease was significantly higher than in those with PTC alone (p Graves' disease was characterized by more ill-defined borders and less frequency of overall calcification, punctate calcification, and heterogeneous echogenicity, although the difference was not statistically significant. Conclusions Our results suggest that patients with Graves' disease more frequently have atypical PTC findings on ultrasonography. PMID:20195406

  19. Clinical significance of determination of serum TRAb levels in patients with relapsing graves' disease

    International Nuclear Information System (INIS)

    Guo Chunlei; Zhou Jiaqiang; Li Wenpeng

    2004-01-01

    Objective: To explore the clinical significance of changes of serum TRAb levels in patients with relapsing Graves' disease. Methods: Serum TRAb (with RRA) and several other thyroid-related hormones (TT 4 , TT 3 , TSH, FT 3 , with CLIA) were determined in the following subjects: 1. 25 cases of relapsing Graves' disease after previous successful treatment; 2. 18 cases of recently diagnosed Graves' disease; 3. 31 cases of successfully treated Graves' disease; 4. 15 cases of simple goiter; 5. 10 cases of nodular goiter; 6. 18 cases of hypothyroidism due to Hashimoto disease. Results: Positive rate of TRAb was 76.00% in patients with relapsing Graves' disease and 77.78% in recently diagnosed Graves' disease cases, both being significantly higher than that in all the other sets of patients studied (P<0.01). Conclusion: Determination of serum TRAb levels was helpful for the diagnosis of relapse in Graves' disease

  20. Management of precancerous conditions and lesions in the stomach (MAPS): guideline from the European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter Study Group (EHSG), European Society of Pathology (ESP), and the Sociedade Portuguesa de Endoscopia Digestiva (SPED)

    Science.gov (United States)

    Dinis-Ribeiro, M.; Areia, M.; de Vries, A. C.; Marcos-Pinto, R.; Monteiro-Soares, M.; O'Connor, A.; Pereira, C.; Pimentel-Nunes, P.; Correia, R.; Ensari, A.; Dumonceau, J. M.; Machado, J. C.; Macedo, G.; Malfertheiner, P.; Matysiak-Budnik, T.; Megraud, F.; Miki, K.; O'Morain, C.; Peek, R. M.; Ponchon, T.; Ristimaki, A.; Rembacken, B.; Carneiro, F.; Kuipers, E. J.

    2012-01-01

    Atrophic gastritis, intestinal metaplasia, and epithelial dysplasia of the stomach are common and are associated with an increased risk for gastric cancer. In the absence of guidelines, there is wide disparity in the management of patients with these premalignant conditions. The European Society of Gastrointestinal Endoscopy (ESGE), the European Helicobacter Study Group (EHSG), the European Society of Pathology (ESP) and the Sociedade Portuguesa de Endoscopia Digestiva (SPED) have therefore combined efforts to develop evidence-based guidelines on the management of patients with precancerous conditions and lesions of the stomach (termed MAPS). A multidisciplinary group of 63 experts from 24 countries developed these recommendations by means of repeat online voting and a meeting in June 2011 in Porto, Portugal. The recommendations emphasize the increased cancer risk in patients with gastric atrophy and metaplasia, and the need for adequate staging in the case of high grade dysplasia, and they focus on treatment and surveillance indications and methods. PMID:22198778

  1. Distonia aguda relacionada ao uso de bromoprida em pacientes pediátricos Acute dystonia after use of bromopride in pediatric patients

    Directory of Open Access Journals (Sweden)

    Eliane Roseli Barreira

    2009-03-01

    Full Text Available OBJETIVO: Descrever dois casos de distonia aguda após uso de bromoprida em crianças e realizar revisão da literatura em relação aos mecanismos fisiopatológicos de indução de liberação extrapiramidal, sua sintomatologia e tratamento. DESCRIÇÃO DO CASO: Caso 1: adolescente de 13 anos com quadro de dor e hipertonia cervical associados a febre, náuseas e vômitos, com hipótese inicial de meningite. A investigação subsequente revelou que o quadro iniciou-se após ingestão de uma única dose de bromoprida. O paciente apresentou boa resposta ao tratamento com difenidramina, sem necessidade de coleta de líquor. Caso 2: Lactente de seis meses que desenvolveu sintomas graves de liberação extrapiramidal relacionados à superdosagem de bromoprida, com reversão rápida dos sintomas após administração de biperideno. COMETÁRIOS: Este é o primeiro relato de distonia aguda após uso de bromoprida em crianças. Embora muito utilizada no Brasil como agente pró-cinético e antiemético, nenhum estudo clínico até o momento demonstrou melhor perfil de segurança da bromoprida em relação aos demais antieméticos antagonistas da dopamina. Até que tais estudos sejam realizados, sugere-se cautela na prescrição de bromoprida. Medidas não-farmacológicas devem ser recomendadas no tratamento de vômitos e da doença do refluxo gastresofágico. Quando o tratamento farmacológico for indispensável, deve-se dar preferência a drogas com perfil de segurança mais bem estabelecido.OBJECTIVE: To report the case of two patients with acute dystonia induced by bromopride in children, followed by a review of the mechanisms of induction of movement disorders by antidopaminergic anti-emetic drugs, its clinical symptoms and treatment. CASE DESCRIPTION: Case 1: a 13 years old teenager who developed acute hypertonia and neck pain associated to fever and vomiting, suggestive of meningitis. Further investigation revealed that symptoms were associated with

  2. Fatores preditivos de coledocolitíase em doentes com pancreatite aguda biliar Predictors of choledocholithiasis in patients sustaining acute biliary pancreatitis

    Directory of Open Access Journals (Sweden)

    José Gustavo Parreira

    2004-12-01

    Full Text Available OBJETIVO: Avaliar o papel da fosfatase alcalina (FA, gama glutamiltransferase (gamaGT e ultra-sonografia (US como fatores preditivos de coledocolitíase em doentes com pancreatite aguda biliar (PAB. MÉTODOS: Os dados foram coletados prospectivamente durante um período de 31 meses. Quarenta doentes foram incluídos, sendo 30 mulheres, com média etária de 49 + 16 anos. Foram registrados os dados de todos os doentes com pancreatite aguda biliar. Aqueles doentes ictéricos e com a forma grave da doença foram excluídos. As dosagens de FA e GGT, assim como a US, eram realizadas na admissão e 48 horas antes da cirurgia. Todos os pacientes foram submetidos à colangiografia intra-operatória (CIO ou à colangiografia retrógrada endoscópica (CPRE pré-operatória, que era definida baseada na probabilidade de coledocolitíase. Com o intuito de identificar os indicadores de coledocolitíase, as variáveis foram comparadas entre os pacientes com ou sem coledocolitíase. Os testes t de Student, Qui-quadrado e Fisher foram empregados para a análise estatística, considerando-se pBACKGROUND: To assess the role of alkaline phosphatase (AP, gamil-glutamyltransferase (gammaGT and abdominal ultrasound (US as predictors of choledocholithiasis in patients sustaining acute biliary pancreatitis. METHODS: Data was prospectively collected during a period of 31 months. Forty patients were included, 30 were female and the mean age was 49 + 16. All patients sustaining acute biliary pancreatitis were enrolled. Patients with clinical jaundice and severe pancreatitis were excluded. Serum content of AP and gGT as well as US were assessed at admission and 48 hours before cholecistectomy. All patients underwent intra-operative cholangiography (IOC or pre-operative endoscopic retrograde cholangiography (ERCP, which was indicated based on the odds of choledocholithiasis. In order to identify the predictors of choledocholithiasis, variables were compared between patients

  3. Prevalência e caracterização clínica dos doentes com insuficiência respiratória parcial grave internados numa UCI

    Directory of Open Access Journals (Sweden)

    Alexandra Borba

    2008-05-01

    Full Text Available Resumo: Objectivos: A insuficiência respiratória parcial aguda (IRPA grave é uma situação comum na prática dos cuidados intensivos, mas os estudos existentes são insuficientes. Com este trabalho pretendeu-se estudar a prevalência e caracterizar clinicamente a população de doentes internados numa UCI que apresentam insuficiência respiratória parcial aguda grave.Material e métodos: Numa unidade de cuidados intensivos médico-cirúrgica avaliaram-se retrospectiva-mente os doentes internados durante o ano de 2004.Resultados: 37,6% dos doentes apresentaram IRPA grave. A análise estatística demonstrou que estes doentes diferiam dos doentes sem IRPA nos tempos de internamento e ventilação, índices de gravidade e mortalidade.Conclusão: A IRPA é uma situação com elevada prevalência e relevância em cuidados intensivos, mas as carac-terísticas destes doentes estão mal definidas, em parte devido à ausência de critérios claros na sua definição. Para melhor compreender este fenómeno são necessá-rios mais estudos, prospectivos e multicêntricos.Rev Port Pneumol 2008; XIV (3: 339-352 Abstract: Objective: The authors analysed patients with severe partial respiratory failure (SPRF admitted to a general Intensive Care Unit (ICU. The prevalence and clinical characteristics of these patients were evaluated.This work aims to study the rate of and to clinically characterise the patient population admitted to an Intensive Care Unit with acute severe partial respiratory failure.Material and methods: In 16-bed ICU of a central Hospital in Lisbon, patients admitted in the year 2004 were analysed. Patients with SPRF were recruited form patients with an ICU stay>24 hours. They were selected according to PaO2 and FiO2 and clinically characterized.Results: During the study period 472 patients were admitted, and 378 presented an ICU stay>24 hours and were enrolled. From those, 142 (37.6% met criteria for SPRF. Of these, 45 (31.7% a pulmonary

  4. Case report of Graves' disease manifesting with odynophagia and heartburn.

    Science.gov (United States)

    Evsyutina, Yulia; Trukhmanov, Alexander; Ivashkin, Vladimir; Storonova, Olga; Godjello, Elina

    2015-12-28

    Graves' disease is an autoimmune disease, which can manifest with a variety of extrathyroidal clinical syndromes like ophthalmopathy, pretibial myxedema (dermopathy), acropathy, cardiomyopathy, and encephalopathy. Though quite rare, this disease can also manifest with gastrointestinal symptoms such as dysphagia, heartburn, nausea, vomiting and diarrhea. We report a clinical case of Graves' disease manifesting with dysfunction of the esophagus and heartburn in a 61-year-old man. In the muscular layer of the esophagus we found dystrophic changes led to its atony, which was documented by endoscopy and high-resolution manometry. The pathology features of esophageal symptoms were: focal proliferation of the basal cells, vascular distension, and dystrophy of the epithelial cells. Antithyroid treatment led to decrease of all clinical symptoms after 5 d of Thiamazole administration. Complete restoration of peristalsis in the esophagus, according to manometry, was observed in 1 mo after initiation of treatment.

  5. The role of radiation therapy in Graves` ophthalmopathy

    Energy Technology Data Exchange (ETDEWEB)

    Chowdhury, A.D.; Moriaty, M.J. [Saint Luke`s Hospital, Dublin (Ireland)

    1996-11-01

    Graves` ophthalmopathy can occur in 25-30% of patients with hyperthyroidism. This condition can result in serious visual disturbance and disfigurement. The treatment options for symptomatic disease are oral corticosteroids or orbital irradiation. Ten patients with Graves` ophthalmopathy were treated with external beam radiotherapy at Saint Lukes Hospital from March 1991 to February 1994. Eight of these patients had excellent response with minimal morbidity. A dose of 2000 cGy in 10 fractions over 2 weeks is considered to be sufficient to alleviate symptoms in most patients. It is concluded that orbital radiotherapy is effective and well tolerated, and should replace corticosteroid therapy as the initial treatment modality in these patients. A minimum follo-up of 6 months is considered adequate for detecting radiation-induced complications. 7 refs., 1 fig.

  6. 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.

  7. Ecocardiograma e fatores de risco cardiovascular em obesos graves

    OpenAIRE

    Elaine Gonçalves Moreira Rocha, Isaura

    2003-01-01

    Introducão: Alterações em parâmetros hemodinâmicos e na função cardíaca ocorrem na obesidade grave, em associação a outros fatores de risco cardiovascular, como dislipidemia, hipertensão arterial e diabete melito. Material e métodos: Foi descrito o perfil clínico, metabólico, ecocardiográfico e o risco de doença cardiovascular, avaliado através do escore de Framingham, em 32 obesos graves candidatos à gastroplastia, no Hospital das Clínicas da Universidade Federal de Pernambuco, entre jane...

  8. Hyperthyroidism and Graves' disease: Is an ultrasound examination needed?

    Directory of Open Access Journals (Sweden)

    Lakshminarayanan Varadhan

    2016-01-01

    Full Text Available Aim: The aim of our study was to assess the limitation of clinical examination in determining the morphology of thyroid gland in patients with hyperthyroidism and its implications. Methods: A retrospective analysis of consecutive patients with hyperthyroidism seen in a tertiary endocrine clinic were analyzed. Sub-analysis was performed on patients with proven Graves' disease. Results: Of the 133 patients included in this study with hyperthyroidism, 60 (45% patients had significant nodularity on ultrasound (US. However, only 67% of these were identified on clinical examination. In patients with confirmed Graves' disease (n = 73, the discordance between US and clinical examination was very similar (18 of 30 patients, 60%. Conclusion: US should form an essential part of the evaluation of hyperthyroidism as the morphology of thyroid gland could be variable and nodules in these glands would also need to be appropriately investigated. This would also significantly influence decision-making and appropriate immediate and follow-up management plan.

  9. Generalised pruritus as a presentation of Grave's disease.

    Science.gov (United States)

    Tan, Ce; Loh, Ky

    2013-01-01

    Pruritus is a lesser known symptom of hyperthyroidism, particularly in autoimmune thyroid disorders. This is a case report of a 27-year-old woman who presented with generalised pruritus at a primary care clinic. Incidental findings of tachycardia and a goiter led to the investigations of her thyroid status. The thyroid function test revealed elevated serum free T4 and suppressed thyroid stimulating hormone levels. The anti-thyroid antibodies were positive. She was diagnosed with Graves' disease and treated with carbimazole until her symptoms subsided. Graves' disease should be considered as an underlying cause for patients presenting with pruritus. A thorough history and complete physical examination are crucial in making an accurate diagnosis. Underlying causes must be determined before treating the symptoms.

  10. [Orbital decompression in Grave's disease: comparison of techniques].

    Science.gov (United States)

    Sellari-Franceschini, S; Berrettini, S; Forli, F; Bartalena, L; Marcocci, C; Tanda, M L; Nardi, M; Lepri, A; Pinchera, A

    1999-12-01

    Grave's ophthalmopathy is an inflammatory, autoimmune disorder often associated with Grave's disease. The inflammatory infiltration involves the retrobulbar fatty tissue and the extrinsic eye muscles, causing proptosis, extraocular muscle dysfunction and often diplopia. Orbital decompression is an effective treatment in such cases, particularly when resistant to drugs and external radiation therapy. This work compares the results of orbital decompression performed by removing: a) the medial and lateral walls (Mourits technique) in 10 patients (19 orbits) and b) the medial and lower walls (Walsh-Ogura technique) in 17 patients (31 orbits). The results show that removing the floor of the orbit enables better reduction of proptosis but more easily leads to post-operative diplopia. Thus it proves necessary to combine the two techniques, modifying the surgical approach on a case-by-case basis.

  11. Particularidades del síndrome de dificultad respiratoria aguda en edades pediátricas

    Directory of Open Access Journals (Sweden)

    Valentín Santiago Rodríguez Moya

    Full Text Available Desde las primeras descripciones del síndrome de dificultad respiratoria aguda los pediatras intensivistas reconocieron que posee particularidades que la hacen diferente en la población pediátrica. El objetivo de este trabajo es divulgar la definición específica en el modelo infantil, aunque existen similitudes en la fisiopatología del síndrome de dificultad respiratoria en adultos y niños. Se revisaron los conceptos vigentes sobre el síndrome de dificultad respiratoria aguda desde su descripción, a través de los diferentes consensos (desde el de 1994 hasta el de 2015 y se señalaron las recomendaciones en el tratamiento y seguimiento de esta entidad. Los tópicos que se trataron fueron: concepto; prevalencia y epidemiología; fisiopatología, severidad y enfermedades asociadas; soporte ventilatorio; tratamientos secundarios específicos sobre el pulmón; tratamientos concomitantes; monitoreo general y pulmonar; soporte ventilatorio no invasivo; terapia extracorpórea y el seguimiento a largo plazo. Las recomendaciones propuestas en la última conferencia de consenso para el tratamiento del síndrome de dificultad respiratoria en edades pediátricas permiten optimizar el tratamiento e identificar necesidades futuras de investigación del tema.

  12. Retinopatia de Purtscher-like e pancreatite aguda Purtscher-like retinopathy and acute pancreatitis

    Directory of Open Access Journals (Sweden)

    Kelly Fernandes de Paula Rodrigues

    2008-04-01

    Full Text Available Retinopatia de Purtscher-like é uma baixa súbita da visão associada à imagem de múltiplas áreas branco-amareladas (manchas algodonosas e hemorragias no pólo posterior de ambos os olhos. O exato mecanismo da injúria ainda não é claro, mas provavelmente seria de natureza embólica.Tem sido descrita em uma variedade de condições, incluindo pancreatite aguda, síndrome de embolia gordurosa, insuficiência renal, nascimento (parto e pós-parto, desordens do tecido conectivo, entre outras. Serão relatados três casos de pancreatite aguda confirmada pelos exames laboratoriais e história clínica, associadas a alterações no exame do fundo de olho, compatíveis com esta retinopatia.Purtscher-like retinopathy is acute loss of vision associated image of the multiple areas of retinal whitening and hemorrhage in the posterior pole of both eyes. The exact mechanism of injury remains unclear, current evidence suggests that it is embolic in nature. In a variety of conditions are been described including acute pancreatitis, fat embolism syndrome, renal failure, childbirth, and connective tissue disorders. Will are related three cases of the acute pancreatitis which was confirmed by complementary laboratory studies and clinical history, associated from exam of the fundus of the eye, similar is this retinopathy.

  13. [Efficacy of treatment with I(131) in paediatric Graves disease].

    Science.gov (United States)

    Enes Romero, P; Martín-Frías, M; de Jesús, M; Caballero Loscos, C; Alonso Blanco, M; Barrio Castellanos, R

    2014-01-01

    Radioiodine is an important therapeutic option in young patients with Grave's disease (GD). In the United States it is a widespread therapy, but in Europe its use in paediatrics is still controversial. To report our experience in radioiodine therapy of paediatric GD patients and analyse its effectiveness and safety. We retrospectively studied our paediatric population (de Pediatría. Published by Elsevier Espana. All rights reserved.

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

    DEFF Research Database (Denmark)

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

    2013-01-01

    BACKGROUND: We recently demonstrated that moderate alcohol consumption is associated with a considerable reduction in the risk of autoimmune hypothyroidism, similar to findings in other autoimmune diseases such as systemic lupus erythematosus and rheumatoid arthritis. We aimed to study a possible....... 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....

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

    International Nuclear Information System (INIS)

    McDougall, I.R.

    1993-01-01

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

  16. 233. Explante emergente de una corevalve por leak grave objetivo

    Directory of Open Access Journals (Sweden)

    F. Gomera

    2012-04-01

    Conclusiones: La implantación de TAVI está demostrando ser una buena opción para el tratamiento de la estenosis aórtica grave no susceptible de sustitución quirúrgica. Sin embargo, está terapia aún está lejos de estar libre de complicaciones que requieran cirugía urgente de rescate.

  17. Hyperthyroidism and Graves? disease: Is an ultrasound examination needed?

    OpenAIRE

    Varadhan, Lakshminarayanan; Varughese, George Iype; Sankaranarayanan, Sailesh

    2016-01-01

    Aim: The aim of our study was to assess the limitation of clinical examination in determining the morphology of thyroid gland in patients with hyperthyroidism and its implications. Methods: A retrospective analysis of consecutive patients with hyperthyroidism seen in a tertiary endocrine clinic were analyzed. Sub-analysis was performed on patients with proven Graves' disease. Results: Of the 133 patients included in this study with hyperthyroidism, 60 (45%) patients had significant nodularity...

  18. A Patient with Grave's Disease and Tuberculous Lymphadenitis.

    Science.gov (United States)

    Rahaman, M F; Chowdhury, M H; Khan, A H; Rahman, M; Barman, T K; Chowdhury, M J

    2016-04-01

    Immune reactivity between Mycobacteria and human antigens can play an important role in the pathogenesis of autoimmune disease. We report a case of Graves's disease and tuberculous lymphadenitis to explain the mechanism of correlation between immune-mediated diseases and tuberculosis and to raise awareness of the importance of screening for TB in this context, especially in endemic country. Screening for latent TB at immune mediated disease diagnosis and regular timely screening thereafter may be beneficial.

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

    International Nuclear Information System (INIS)

    Hilbertz, T.; Markl, A.; Pickardt, C.R.; Boergen, K.P.; Muenchen Univ.; Muenchen Univ.

    1988-01-01

    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.) [de

  20. Treatment of Graves' disease and the course of ophthalmopathy

    International Nuclear Information System (INIS)

    Sridama, V.; DeGroot, L.J.

    1989-01-01

    Contradictory results have been obtained with regards to the effect of various treatment modes on the exacerbation of Graves' ophthalmopathy, probably because the number of patients in each study was small and some studies were analyzed only in relation to one type of treatment. To circument these problems, we studied the course of Graves' ophthalmopathy after various modes of therapy for thyrotoxicosis among 537 patients with Graves' disease. A total of 537 patients with Graves' disease were prospectively studied over an 11-year period. Thirty-one patients were lost to follow-up during the first six months after treatment and were excluded from the study. Of those remaining, 426 received one form of treatment, 79 received two kinds of therapy, and one received three kinds of therapy. Thus, surgical treatments numbered 164, radioactive iodine-131 ( 13 1I) treatments numbered 241, and medical treatments numbered 182. Ocular signs were considered improved or exacerbated by the following criteria: decrement or increment of the exophthalmos of 2 mm or more, improvement or deterioration of visual acuity, and regression or progression of extraocular muscle involvement causing diplopia. Among patients who did not have infiltrative ophthalmopathy before treatment, there was no difference in the occurrence of posttreatment exophthalmos in the surgically, medically, and 131I-treated patients (7.1%, 6.7%, and 4.9%, respectively). The incidence and the degree of progression of ophthalmopathy in patients who already had exophthalmos before treatment were similar in the medically, surgically, and 131I-treated groups (19.2%, 19.8%, and 22.7%, respectively). Most of the progression occurred in the posttreatment euthyroid stage. The incidence of improvement of ophthalmopathy was also similar 14.1%, 12.6%, and 12.3% in the medically, surgically, and 131I-treated patients

  1. PREGO (presentation of Graves' orbitopathy) study: changes in referral patterns to European Group On Graves' Orbitopathy (EUGOGO) centres over the period from 2000 to 2012

    NARCIS (Netherlands)

    Perros, Petros; Žarković, Miloš; Azzolini, Claudio; Ayvaz, Göksun; Baldeschi, Lelio; Bartalena, Luigi; Boschi, Antonella; Bournaud, Claire; Brix, Thomas Heiberg; Covelli, Danila; Ćirić, Slavica; Daumerie, Chantal; Eckstein, Anja; Fichter, Nicole; Führer, Dagmar; Hegedüs, Laszlo; Kahaly, George J.; Konuk, Onur; Lareida, Jürg; Lazarus, John; Leo, Marenza; Mathiopoulou, Lemonia; Menconi, Francesca; Morris, Daniel; Okosieme, Onyebuchi; Orgiazzi, Jaques; Pitz, Susanne; Salvi, Mario; Vardanian-Vartin, Cristina; Wiersinga, Wilmar; Bernard, Martine; Clarke, Lucy; Currò, Nicola; Dayan, Colin; Dickinson, Jane; Knežević, Miroslav; Lane, Carol; Marcocci, Claudio; Marinò, Michele; Möller, Lars; Nardi, Marco; Neoh, Christopher; Pearce, Simon; von Arx, George; Törüner, Fosun Baloş

    2015-01-01

    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. Prospective observational study of European Group On Graves' Orbitopathy (EUGOGO) centres. All new referrals with a

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

    Czech Academy of Sciences Publication Activity Database

    Mazuch, Marian; Hladík, Marek

    2013-01-01

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

  3. Predictive factors for intraoperative excessive bleeding in Graves' disease.

    Science.gov (United States)

    Yamanouchi, Kosho; Minami, Shigeki; Hayashida, Naomi; Sakimura, Chika; Kuroki, Tamotsu; Eguchi, Susumu

    2015-01-01

    In Graves' disease, because a thyroid tends to have extreme vascularity, the amount of intraoperative blood loss (AIOBL) becomes significant in some cases. We sought to elucidate the predictive factors of the AIOBL. A total of 197 patients underwent thyroidectomy for Graves' disease between 2002 and 2012. We evaluated clinical factors that would be potentially related to AIOBL retrospectively. The median period between disease onset and surgery was 16 months (range: 1-480 months). Conventional surgery was performed in 125 patients, whereas video-assisted surgery was performed in 72 patients. Subtotal and near-total/total thyroidectomies were performed in 137 patients and 60 patients, respectively. The median weight of the thyroid was 45 g (range: 7.3-480.0 g). Univariate analysis revealed that the strongest correlation of AIOBL was noted with the weight of thyroid (p Graves' disease, and preparation for blood transfusion should be considered in cases where thyroids weigh more than 200 g. Copyright © 2014. Published by Elsevier Taiwan.

  4. Piezosurgery in Modified Pterional Orbital Decompression Surgery in Graves Disease.

    Science.gov (United States)

    Grauvogel, Juergen; Scheiwe, Christian; Masalha, Waseem; Jarc, Nadja; Grauvogel, Tanja; Beringer, Andreas

    2017-10-01

    Piezosurgery uses microvibrations to selectively cut bone, preserving the adjacent soft tissue. The present study evaluated the use of piezosurgery for bone removal in orbital decompression surgery in Graves disease via a modified pterional approach. A piezosurgical device (Piezosurgery medical) was used in 14 patients (20 orbits) with Graves disease who underwent orbital decompression surgery in additional to drills and rongeurs for bone removal of the lateral orbital wall and orbital roof. The practicability, benefits, and drawbacks of this technique in orbital decompression surgery were recorded. Piezosurgery was evaluated with respect to safety, preciseness of bone cutting, and preservation of the adjacent dura and periorbita. Preoperative and postoperative clinical outcome data were assessed. The orbital decompression surgery was successful in all 20 orbits, with good clinical outcomes and no postoperative complications. Piezosurgery proved to be a safe tool, allowing selective bone cutting with no damage to the surrounding soft tissue structures. However, there were disadvantages concerning the intraoperative handling in the narrow space and the efficiency of bone removal was limited in the orbital decompression surgery compared with drills. Piezosurgery proved to be a useful tool in bone removal for orbital decompression in Graves disease. It is safe and easy to perform, without any danger of damage to adjacent tissue because of its selective bone-cutting properties. Nonetheless, further development of the device is necessary to overcome the disadvantages in intraoperative handling and the reduced bone removal rate. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Treatment of Grave's hyperthyroidism-prognostic factors for outcome

    International Nuclear Information System (INIS)

    Alfadda, A.; Malabu, Usman H.; El-Desouki, Mahmoud I.; Al-Rubeaan, Khalid A.; Al-Ruhaily, Atallah D.; Fouda, Mona A.; Al-Maatouq, Mohamed A.; Sulimani, Riad A.

    2007-01-01

    To determine clinical and biochemical features of Grave's disease at presentation predict response to medical and radioiodine treatment. We carried out a retrospective 10-year study of 194 consecutive Saudi subjects with Grave's disease who was treated with antithyroid drugs, radioiodine therapy, or both, between January 1995 and December 2004 at King Khalid University Hospital, Riyadh, Saudi Arabia. At diagnosis, the mean age was 32+-0.9 years. Only 26% of patients had successful outcome after a course of antithyroid medication. None of the clinical or biochemical factors were associated with a favorable outcome of antithyroid treatment. One dose of radioiodine [13-15 mCi (481-555 MBq)] cured hyperthyroidism in 83% of patients. Presence of ophthamopathy at presentation was shown to be a significant contributing factor to failure to respond to a single dose of radioiodine (odds ratio, 6.4; 95%CI, 1.51-24.4; p<0.01). Failure of radioiodine treatment was also associated with higher serum free T3 concentration at presentation (p=0.003). In patients with Grave's hyperthyroidism, radioiodine treatment is associated with higher success rate than antithyroid drugs. A dose of 13-15 mCi (481-555 MBq) seems to practical and effective, and should be considered as first line therapy. Patients with high free T3 concentration and, those with ophthalmopathy at presentation were more likely to fail radioiodine treatment. A higher dose of radioiodine may be advisable in such patients. (author)

  6. Graves' disease and toxic nodular goiter - radioiodine therapy

    International Nuclear Information System (INIS)

    Schicha, H.; Dietlein, M.

    2002-01-01

    At the 15th conference on the human thyroid in Heidelberg in 2001 the following aspects of the radioiodine therapy of benign thyroid disorders were presented: General strategies for therapy of benign thyroid diseases, criterions for conservative or definitive treatment of hyperthyroidism as first line therapy and finally preparation, procedural details, results, side effects, costs and follow-up care of radioiodine therapy as well as legal guidelines for hospitalization in Germany. The diagnosis Graves' hyperthyroidism needs the decision, if rather a conservative treatment or if primary radioiodine therapy is the best therapeutic approach. In the USA 70-90% of these patients are treated with radioiodine as first line therapy, whereas in Germany the conservative therapy for 1-1.5 years is recommended for 90%. This review describes subgroups of patients with Graves' disease showing a higher probability to relapse after conservative treatment. Comparing benefits, adverse effects, costs, and conveniences of both treatment strategies the authors conclude that radioiodine therapy should be preferred as first line therapy in 60-70% of the patients with Graves' hyperthyroidism. (orig.) [de

  7. Hyperparathyroidism after radioactive iodine therapy for Graves' disease

    International Nuclear Information System (INIS)

    Kawamura, Juichi; Tobisu, Kenichi; Sanada, Shingo

    1983-01-01

    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 scrum calcium levels examined at 5-year intervals. (author)

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

    International Nuclear Information System (INIS)

    Takamatsu, J.; Hosoya, T.; Naito, N.

    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

  9. Lesao óssea em leucemias agudas linfoblásticas tipo T e TIPO nao T / nao B

    OpenAIRE

    Martins, Fernando Lopes

    2013-01-01

    Resumo: O AUTOR APRESENTA OS RESULTADOS DO ESTUDO RADIOLÓGICO DE ESQUELETO DE 61 PACIENTES PORTADORES DE LEUCEMIA AGUDA LINFOBLÁSTICA, CORRELACIONANDO A PRESENÇA OU NÃO DE Lesões ÓSSEAS COM A CLASSIFICAÇÃO IMUNOLÓGICA DE LAL TIPO T E TIPO não T / não B

  10. Efeito econômico do uso da oxigenação extracorpórea para suporte de pacientes adultos com insuficiência respiratória grave no Brasil: uma análise hipotética

    OpenAIRE

    Park, Marcelo; Mendes, Pedro Vitale; Zampieri, Fernando Godinho; Azevedo, Luciano Cesar Pontes; Costa, Eduardo Leite Vieira; Antoniali, Fernando; Ribeiro, Gustavo Calado de Aguiar; Caneo, Luiz Fernando; Cruz Neto, Luiz Monteiro da; Carvalho, Carlos Roberto Ribeiro; Trindade, Evelinda Marramon

    2014-01-01

    Objetivo: Analisar o custo-utilidade do uso da oxigenação extracorpórea para pacientes com síndrome da angústia respiratória aguda grave no Brasil. Métodos: Com bancos de dados de estudos previamente publicados, foi construída uma árvore encadeada de decisões. Os custos foram extraídos da média de 3 meses do preço pago pelo Sistema Único de Saúde em 2011. Com 10 milhões de pacientes simulados com desfechos e custos predeterminados, uma análise da relação de incremento de custo e de anos d...

  11. TSHR intronic polymorphisms (rs179247 and rs12885526) and their role in the susceptibility of the Brazilian population to Graves' disease and Graves' ophthalmopathy.

    Science.gov (United States)

    Bufalo, N E; Dos Santos, R B; Marcello, M A; Piai, R P; Secolin, R; Romaldini, J H; Ward, L S

    2015-05-01

    Intronic thyroid-stimulating hormone receptor polymorphisms have been associated with the risk for both Graves' disease and Graves' ophthalmopathy, but results have been inconsistent among different populations. We aimed to investigate the influence of thyroid-stimulating hormone receptor intronic polymorphisms in a large well-characterized population of GD patients. We studied 279 Graves' disease patients (231 females and 48 males, 39.80 ± 11.69 years old), including 144 with Graves' ophthalmopathy, matched to 296 healthy control individuals. Thyroid-stimulating hormone receptor genotypes of rs179247 and rs12885526 were determined by Real Time PCR TaqMan(®) SNP Genotyping. A multivariate analysis showed that the inheritance of the thyroid-stimulating hormone receptor AA genotype for rs179247 increased the risk for Graves' disease (OR = 2.821; 95 % CI 1.595-4.990; p = 0.0004), whereas the thyroid-stimulating hormone receptor GG genotype for rs12885526 increased the risk for Graves' ophthalmopathy (OR = 2.940; 95 % CI 1.320-6.548; p = 0.0083). Individuals with Graves' ophthalmopathy also presented lower mean thyrotropin receptor antibodies levels (96.3 ± 143.9 U/L) than individuals without Graves' ophthalmopathy (98.3 ± 201.9 U/L). We did not find any association between the investigated polymorphisms and patients clinical features or outcome. We demonstrate that thyroid-stimulating hormone receptor intronic polymorphisms are associated with the susceptibility to Graves' disease and Graves' ophthalmopathy in the Brazilian population, but do not appear to influence the disease course.

  12. Simultaneous induction of Graves' hyperthyroidism and Graves' ophthalmopathy by TSHR genetic immunization in BALB/c mice.

    Directory of Open Access Journals (Sweden)

    Nan Xia

    Full Text Available Graves' disease is the most common form of autoimmune thyroid disorder, characterized by hyperthyroidism due to circulating autoantibodies. To address the pathological features and establish a therapeutic approach of this disease, an animal model carrying the phenotype of Graves' disease (GD in concert with Graves' Ophthalmopathy (GO will be very important. However, there are no ideal animal models that are currently available. The aim of the present study is to establish an animal model of GD and GO disease, and its pathological features were further characterized.A recombinant plasmid pcDNA3.1- T289 was constructed by inserting the TSHR A-subunit gene into the expression vector pcDNA3.1, and genetic immunization was successfully performed by intramuscular injection of the plasmid pcDNA3.1-T289 on female 8-week-old BALB/c mice. Each injection was immediately followed by in vivo electroporation using ECM830 square wave electroporator. Morphological changes of the eyes were examined using 7.0T MRI scanner. Levels of serum T4 and TSHR antibodies (TRAb were assessed by ELISA. The pathological changes of the thyroid and orbital tissues were examined by histological staining such as H&E staining and Alcian blue staining.More than 90% of the immunized mice spontaneously developed goiter, and about 80% of the immunized mice manifested increased serum T4 and TRAb levels, combined with hypertrophy and hyperplasia of thyroid follicles. A significantly increased synthesis of hyaluronic acid was detected in in the immunized mice compared with the control groups.We have successfully established an animal model manifesting Graves' hyperthyroidism and ophthalmopathy, which provides a useful tool for future study of the pathological features and the development of novel therapies of the diseases.

  13. Complicaciones de las otitis medias agudas y crónicas en el niño Complications of acute and chronic otitis media in the child

    Directory of Open Access Journals (Sweden)

    Julianis Loraine Quintero Noa

    2013-03-01

    Full Text Available Gracias al descubrimiento de los antibióticos, la incidencia de complicaciones en las otitis medias agudas y crónicas ha descendido significativamente, aunque continúan siendo un peligro potencial de morbilidad y mortalidad. La disminución de las complicaciones puede condicionar retrasos diagnósticos por falta de sospecha clínica, enmascaramiento por tratamientos antibióticos previos y mal pronóstico, por lo cual siguen siendo procesos graves que ponen en peligro la vida del enfermo. Se definen actualmente con igual sistema de clasificación: extracraneales e intracraneales. Las primeras se subdividen en extratemporal e intratemporal, y constituyen un problema de salud en la población pediátrica a pesar del uso extendido de antibióticos. La evaluación clínico-otomicroscópica e imaginológica se reporta como criterio diagnóstico predictivo de sospecha y de confirmación. La parálisis facial, el vértigo, los vómitos, la cefalea, el dolor irradiado a la mastoides o a la región temporoparietal, y la hipertermia, deben alertar al médico sobre la presencia de una complicación supurada.Thanks to the discovery of antiobiotics, the incidence of complications in the chronic and acute otitis media has significantly decreased, though they remain a potential mortality and morbidity risk. The reduction of complications can be conditional on some diagnostic delays, on account of lack of clinical suspicions, symptoms disguised by previous antibiotic treatments and wrong prognosis; therefore, the complications continue to be severe processes that endanger the patient's life. They are currently classified as extracranial and intracranial. The former are divided into extratemporal and intratemporal and represent a health problem for the pediatric population despite the extended use of antibiotics. The clinical, otomicroscopic and imaging assessment is reported as a diagnostic criterion predictive of suspicions and of confirmation. Facial

  14. Estudio de factores predisponentes de enfermedad diarreica aguda en la comunidad de San Simón, Yucatán en base a un análisis de vulnerabilidad nutricional y ambiental

    Directory of Open Access Journals (Sweden)

    Mariel Gullian-Klanian

    2011-01-01

    Full Text Available Durante el periodo 2005-2008, 32.1% de los residentes de la comunidad de San Simón padecieron de enfermedad diarreica aguda (EDA. Durante este periodo la población más afectada fue la infantil, específicamente los niños menores de 10 años de los cuales 40% se encontraban en diferente rango de desnutrición. Objetivo: Identificar factores predisponentes de enfermedad diarreica aguda (EDA de origen bacteriano en San Simón en base a un análisis de vulnerabilidad (AV nutricional y ambiental. Metodología: La descripción socio-demográfica y ambiental de la comunidad se realizó en base a datos obtenidos de un censo poblacional. Los datos del censo se agruparon en 2 indicadores: indicadores de demanda de servicios (D e indicadores de oferta de servicios (O los cuales sirvieron para calcular el índice de vulnerabilidad de la comunidad [AV (AV=D/S]. Mediante indicadores antropométricos se determinó la vulnerabilidad nutricional en 106 personas. Como factor indicador de EDA se realizó el diagnóstico microbiológico y serológico de Escherichia coli O157:H7 y Salmonella spp. en hortalizas (n=45 y animales portadores (n=64. La presencia de estas bacterias se tomó como factor de amenaza. La valoración del riesgo de la población de padecer EDA se consideró teniendo en cuenta la predisposición hacia la amenaza y su efecto sobre la salud de la población. Resultados: El estado nutricional, el porcentaje de morbilidad y el bajo nivel de educación, fueron los indicadores de mayor peso en el AV. Se presentaron 43.2 % de casos de desnutrición grave en niños. El 60.6 % de las mujeres y el 53.5% de los hombres presentaron obesidad. Respecto al riesgo, 80.6% de los cerdos fueron portadores de E. coli O157:H7. El 35.7% de las aves y 8.3% de las hortalizas presentaron Salmonella spp. Conclusiones: San Simón presenta un riesgo ambiental alto (R=39±10.6 y una vulnerabilidad intermedia (V=4.9 de padecer EDA.

  15. Early onset of organ failure is the best predictor of mortality in acute pancreatitis El fracaso orgánico precoz como mejor factor predictivo de mortalidad en la pancreatitis aguda

    Directory of Open Access Journals (Sweden)

    I. Poves Prim

    2004-10-01

    Full Text Available Background: APACHE II is a multifactorial scoring system for predicting severity in acute pancreatitis (AP. Organ failure (OF has been correlated with mortality in AP. Objectives: to evaluate the usefulness of APACHE II as an early predictor of severity in AP, its correlation with OF, and the relevance of an early establishment of OF during the course of AP. Patients and methods: from January 1999 to November 2001, 447 consecutive cases of AP were studied. APACHE II scores and Atlanta criteria were used for defining severity and OF. Results: twenty-five percent of patients had severe acute pancreatitis (SAP. APACHE II at 24 h after admission showed a sensitivity, specificity, and positive and negative predictive value of 52, 77, 46, and 84%, respectively, for predicting severity. Mortality for SAP was 20.5%. Seventy percent of patients who developed OF did so within the first 24 hours of admission, and their mortality was 52%. Mortality was statistically significant (p Introducción: el APACHE II se ha utilizado como factor predictivo de gravedad en la pancratitis aguda (PA. La instauración de fracaso orgánico (FO en la PA se correlaciona con una mayor mortalidad. Objetivos: evaluar la utilidad del APACHE II como factor predictivo precoz de gravedad en la PA, su correlación con el FO y la relevancia del establecimiento precoz del FO en la PA. Pacientes y métodos: desde enero de 1999 hasta noviembre de 2001 se estudiaron 447 pacientes ingresados consecutivamente por PA. Se utilizó el sistema APACHE II y los criterios de Atlanta para evaluar la gravedad. Resultados: el 25% de los pacientes presentaron una pancreatitis aguda grave (PAG. El APACHE II a las 24 horas del ingreso mostró una sensibilidad, especificidad, valor predictivo positivo y negativo del 52, 77, 46 y 84%, respectivamente, como marcador de gravedad. La mortalidad global de la PAG fue del 20,5%. El 70% de los pacientes que presentaron FO lo hicieron en las primeras 24 horas

  16. Estudio de factores predisponentes de enfermedad diarreica aguda en la comunidad de San Simón, Yucatán en base a un análisis de vulnerabilidad nutricional y ambiental

    Directory of Open Access Journals (Sweden)

    Esfefanía Suárez Wegan

    2011-07-01

    Full Text Available Durante el periodo 2005-2008, 32.1% de los residentes de la comunidad de San Simón padecieron de enfermedad diarreica aguda (EDA. Durante este periodo la población más afectada fue la infantil, específicamente los niños menores de 10 años de los cuales 40% se encontraban en diferente rango de desnutrición. Objetivo: Identificar factores predisponentes de enfermedad diarreica aguda (EDA de origen bacteriano en San Simón en base a un análisis de vulnerabilidad (AV nutricional y ambiental. Metodología: La descripción socio-demográfica y ambiental de la comunidad se realizó en base a datos obtenidos de un censo poblacional. Los datos del censo se agruparon en 2 indicadores: indicadores de demanda de servicios (D e indicadores de oferta de servicios (O los cuales sirvieron para calcular el índice de vulnerabilidad de la comunidad [AV (AV=D/S]. Mediante indicadores antropométricos se determinó la vulnerabilidad nutricional en 106 personas. Como factor indicador de EDA se realizó el diagnóstico microbiológico y serológico de Escherichia coli O157:H7 y Salmonella spp. en hortalizas (n=45 y animales portadores (n=64. La presencia de estas bacterias se tomó como factor de amenaza. La valoración del riesgo de la población de padecer EDA se consideró teniendo en cuenta la predisposición hacia la amenaza y su efecto sobre la salud de la población. Resultados: El estado nutricional, el porcentaje de morbilidad y el bajo nivel de educación, fueron los indicadores de mayor peso en el AV. Se presentaron 43.2 % de casos de desnutrición grave en niños. El 60.6 % de las mujeres y el 53.5% de los hombres presentaron obesidad. Respecto al riesgo, 80.6% de los cerdos fueron portadores de E. coli O157:H7. El 35.7% de las aves y 8.3% de las hortalizas presentaron Salmonella spp. Conclusiones: San Simón presenta un riesgo ambiental alto (R=39±10.6 y una vulnerabilidad intermedia (V=4.9 de padecer EDA.

  17. Primeras experiencias con drenaje biliar percutáneo de urgencia en la colangitis aguda

    Directory of Open Access Journals (Sweden)

    José Luis González González

    Full Text Available Introducción: la obstrucción biliar es motivo frecuente de morbilidad en los pacientes con metástasis hepáticas, adenopatías periportales y cáncer hepatobiliopancreático. La colangitis aguda es la complicación más temida, debido a su mortalidad. En este trabajo se presentan los primeros abordajes percutáneos realizados por cirujanos del Hospital Clínicoquirúrgico "Hermanos Ameijeiras" como herramienta para el tratamiento urgente de esta entidad. Objetivo: caracterizar el drenaje percutáneo transparietohepático de urgencia en pacientes con colangitis aguda e ictericia obstructiva. Métodos: se realizó un estudio descriptivo, prospectivo y aplicado con 30 pacientes atendidos de esta forma en dicha institución entre enero de 2008 y diciembre de 2010. Resultados: el diagnóstico etiológico preponderante fue el de tumor maligno de la cabeza del páncreas. La localización baja de la lesión duplicó a la localización alta. La mejoría clínica de la ictericia se evidenció en la mayoría de los pacientes después de una semana tras el procedimiento: el drenaje percutáneo constituyó el método definitivo en el 73,3 % de los pacientes. Las edades medias para los distintos diagnósticos etiológicos exhibieron diferencias estadísticamente significativas. No hubo complicaciones ni mortalidad relacionadas con el procedimiento. Conclusiones: el drenaje biliar percutáneo guiado por ultrasonido es una herramienta útil y segura para el tratamiento de urgencia de la colangitis aguda. Es un método que pueden realizar los cirujanos generales con entrenamiento adecuado y específico, y tiene asociadas pocas complicaciones.

  18. Caracterización inmunofenotípica de pacientes con leucemia mieloide aguda

    Directory of Open Access Journals (Sweden)

    Daily Pino Blanco

    Full Text Available Introducción: la leucemia mieloide aguda incluye un grupo heterogéneo de neoplasias caracterizadas por una expansión clonal de mieloblastos, cuya clasificación involucra varios criterios, incluidos los inmunológicos. Objetivo: caracterizar el inmunofenotipo de los pacientes con leucemia mieloide aguda evaluados en el Instituto de Hematología e Inmunología. Métodos: se realizó un estudio descriptivo transversal de los pacientes diagnosticados con este tipo de leucemia, cuyas muestras de sangre fueron procesadas en el Departamento de Inmunología en el período 2008-2012. Se usó un ultramicrométodo inmunocitoquímico que utiliza un panel de anticuerpos monoclonales específicos de antígenos mieloides y linfoides. Las variables analizadas fueron: edad, sexo, subtipo de leucemia y expresión de marcadores inmunológicos, cuyas asociaciones fueron analizadas con los estadígrafos Chi-cuadrado y coeficiente de correlación de Spearman. Resultados: se estudiaron 58 pacientes, 28 del sexo femenino y 30 del masculino. El grupo de edad predominante fue de 0 a 9 años con una mediana de 26 años. El subtipo M4 resultó el más frecuente (30,4 %. Los subtipos M4 y M7 predominaron en niños, mientras que el M0, predominó en adultos, con diferencias estadísticamente significativas (p d»0,05. La combinación de los antígenos panmieloides CD13 y CD33 se presentó en el 91 % de los enfermos. Las combinaciones de CD13/CD33, CD14/CD15, CD33/CD14 y CD33/CD15 mostraron correlación significativa. En el 20,6 % de los pacientes evaluados, fueron detectados, además, antígenos linfoides. No se encontraron diferencias significativas en cuanto al sexo y la edad. El antígeno CD7 fue el más expresado, seguido de los antígenos: CD3, CD20, CD22 y CD79, en igual proporción. Conclusiones: el inmunofenotipaje celular demostró ser un procedimiento útil para confirmar el diagnóstico morfológico y clínico de la leucemia mieloide aguda.

  19. Leucemia linfoblástica aguda em lactentes: 20 anos de experiência

    Directory of Open Access Journals (Sweden)

    Amanda Ibagy

    2013-02-01

    Full Text Available OBJETIVO: Analisar pacientes com menos de dois anos de idade com leucemia linfoblástica aguda atendidos no período de 1990 a 2010, em um centro de referência estadual. MÉTODOS: Estudo clínico, epidemiológico, transversal, descritivo e observacional. Pacientes incluídos tinham menos de dois anos de idade, com leucemia linfoblástica aguda, tratados no período de 1990 a 2010 na unidade de oncologia pediátrica de um centro de referência estadual, totalizando 41 casos. RESULTADOS: Todos os pacientes eram Caucasianos e 60,9% eram do sexo feminino. Com relação à idade, 24,38% tinham menos de seis meses, 17,07% tinham entre seis meses e um ano e 58,53% mais do que um ano de idade. A idade de seis meses foi estatisticamente significante para o desfecho de óbito. Os sinais e sintomas predominantes foram febre, hematomas e petéquias. Uma contagem de leucócitos superior a 100.000 foi observada em 34,14% dos casos; hemoglobina inferior a 11 em 95,13% e contagem de plaquetas inferior a 100.000, em 75,61% dos casos. Infiltração do sistema nervoso central estava presente em 12,91% dos pacientes. Em relação à linhagem, a linhagem B predominou (73%, mas a linhagem de células T foi estatisticamente significativa para o óbito. Trinta e nove por cento dos pacientes tiveram recorrência da doença. Em relação ao estado vital, 70,73% dos pacientes morreram, sendo choque séptico a principal causa. CONCLUSÕES: leucemia linfoblástica aguda em crianças tem uma alta taxa de mortalidade, principalmente em crianças menores de um ano e linhagem derivada de células T.

  20. Grave's Disease and Primary Biliary Cirrhosis—An Unusual and Challenging Association

    Science.gov (United States)

    Shetty, Shiran; Rajasekaran, Senthilkumar; Venkatakrishnan, Leela

    2013-01-01

    Jaundice in Grave's diseases is uncommon, but when it does occur, complication of thyrotoxicosis (heart failure/infection) or intrinsic liver disease should be considered. Grave's disease can cause asymptomatic elevation of liver enzymes, jaundice and rarely acute liver failure. It is associated with other autoimmune diseases like autoimmune hepatitis, or primary biliary cirrhosis. The cause of jaundice in Grave's disease is multifactorial. PMID:25755537

  1. A report of three cases of untreated Graves' disease associated with pancytopenia in Malaysia.

    Science.gov (United States)

    Rafhati, Abdullah Noor; See, Chee Keong; Hoo, Fan Kee; Badrulnizam, Long Bidin Mohamed

    2014-01-01

    Generally, clinical presentations of Graves' disease range from asymptomatic disease to overt symptomatic hyperthyroidism with heat intolerance, tremor, palpitation, weight loss, and increased appetite. However, atypical presentation of Graves' disease with hematological system involvement, notably pancytopenia, is distinctly uncommon. Hereby, we present and discuss a series of three untreated cases of Graves' disease clinically presented with pancytopenia and the hematological abnormalities that responded well to anti-thyroid treatment. With resolution of the thyrotoxic state, the hematological parameters improved simultaneously. Thus, it is crucial that anti-thyroid treatment be considered in patients with Graves' disease and pancytopenia after a thorough hematological evaluation.

  2. Growth hormone and insulin-like growth factor 1 affect the severity of Graves' disease.

    Science.gov (United States)

    Di Cerbo, Alfredo; Pezzuto, Federica; Di Cerbo, Alessandro

    2017-01-01

    Graves' disease, the most common form of hyperthyroidism in iodine-replete countries, is associated with the presence of immunoglobulins G (IgGs) that are responsible for thyroid growth and hyperfunction. In this article, we report the unusual case of a patient with acromegaly and a severe form of Graves' disease. Here, we address the issue concerning the role of growth hormone (GH) and insulin-like growth factor 1 (IGF1) in influencing thyroid function. Severity of Graves' disease is exacerbated by coexistent acromegaly and both activity indexes and symptoms and signs of Graves' disease improve after the surgical remission of acromegaly. We also discuss by which signaling pathways GH and IGF1 may play an integrating role in regulating the function of the immune system in Graves' disease and synergize the stimulatory activity of Graves' IgGs. Clinical observations have demonstrated an increased prevalence of euthyroid and hyperthyroid goiters in patients with acromegaly.The coexistence of acromegaly and Graves' disease is a very unusual event, the prevalence being Graves' disease associated with acromegaly and show that surgical remission of acromegaly leads to a better control of symptoms of Graves' disease.

  3. Clinical significance of determination of serum BGP levels in patients with Graves' disease

    International Nuclear Information System (INIS)

    Tu Liping; Zhang Chunyan; Wang Linglong; Yu Yuefang; Zhu Weijie; Cai Ao

    2006-01-01

    Objective: To study the clinical significance of changes of serum BGP levels in patients with Graves' disease. Methods: Serum BOP levels as well as T 3 , T 4 , FT 3 , FT 4 , TSH, TGA, TMA levels were determined with RIA in 158 patients with Graves' disease and 145 controls. Results: The serum BGP levels in patients with Graves' disease were significantly higher than those in controls (P 3 , T 4 , FT 3 , FT 4 levels, but not with TSH, TGA, TMA. Conclusion: Serum BGP levels is a useful marker for monitoring bone metabolism in patients with Graves' disease. (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

    2017-01-01

    graves are made concrete and increasingly cemented indices of belonging in wrangles over land. Belonging is often justified through the presence of ancestor graves on land. The cementing of graves turns them into more concrete and durable proofs of ownership, and the reburial of relatives to disputed......The paper explores the roles of graves, ancestors and concrete pillars in disputes over land across different land-systems, -conflicts, and territory making in northern Uganda by comparing extended cases between Acholi in Gulu district and Ik in Kaabong district . In the post-conflict Acholi region...

  5. Hemometabolismo cerebral: variações na fase aguda do coma traumático Cerebral hemometabolism: variability in the acute phase of traumatic coma

    Directory of Open Access Journals (Sweden)

    ANTONIO L. E. FALCÃO

    2000-09-01

    Full Text Available OBJETIVO: avaliar as interrelações entre as alterações hemometabólicas cerebrais e sistêmicas em pacientes com traumatismo craniencefálico (TCE grave submetidos a um protocolo terapêutico padronizado. DESENHO: estudo prospectivo, intervencionista em pacientes com coma traumático. LOCAL: uma UTI geral em hospital universitário. PACIENTES E MÉTODOS: vinte e sete pacientes (21M e 6F, idade 14-58 anos, com TCE grave, com três a oito pontos na escala de coma de Glasgow, foram avaliados prospectivamente segundo um protocolo cumulativo padronizado para tratamento da hipertensão intracraniana aguda, o qual incluía medidas rotineiras da pressão intracraniana (PIC e da extração cerebral de oxigênio (ECO2. Foram analisadas as interrelações hemometabólicas envolvendo: pressão arterial média (PAM, PIC, pressão parcial de gás carbônico arterial (PaCO2, ECO2, pressão de perfusão cerebral (PPC e extração sistêmica de oxigênio (ESO2. INTERVENÇÕES: apenas as padronizadas no protocolo terapêutico. RESULTADOS: não houve correlação entre a ECO2 e a PPC (r = -0,07; p = 0,41. Houve correlação inversa entre a PaCO2 e a ECO2 (r = -0,24; p = 0,005 e direta entre a ESO2 e a ECO2 (r = 0,24; p = 0,01. A mortalidade geral dos pacientes foi de 25,9% (7/27. CONCLUSÃO: 1 a PPC não se correlaciona com a ECO2 em quaisquer níveis de PIC; 2 a ECO2 está estreitamente relacionada aos diferentes níveis de PaCO2 ; e 3 durante a hiperventilação otimizada existe um acoplamento entre a ECO2 e a ESO2.OBJECTIVE: to evaluate the interrelationships between cerebral and systemic hemometabolic alterations in patients with severe traumatic brain injury managed according to a standardized therapeutic protocol. DESIGN: prospective, interventional study in patients with traumatic coma. SETTING: a general Intensive Care Unit in a teaching hospital. PATIENTS AND METHODS: twenty-seven patients (21M e 6F, aging 14--58 years, with severe acute brain trauma

  6. Clinical and laboratory parameters in dapsone acute intoxication Parâmetros clínicos e laboratoriais na intoxicação aguda pela dapsona

    Directory of Open Access Journals (Sweden)

    Maria Zilda N Carrazza

    2000-08-01

    Full Text Available OBJECTIVE: To determine the severity of dapsone (DDS acute intoxication – an uncommon medical event – using clinical and laboratory parameters. METHODS: Two hundred and seventy four patients with acute DDS intoxication, aged 1 month to 50 years old, were studied and classified into four age groups. Clinical evaluation was assessed through a protocol and correlated with laboratory parameters. Spectrophotometric methods were used to analyze methemoglobinemia (MHbp and dapsonemia (DDSp. RESULTS: The most prevalent clinical sign of intoxication was cyanosis, seen in 65.7% of the patients and in 100% of children less than 5 years of age. According to laboratory criteria, MHbp-related severe clinical intoxication was seen in 56.2% and DDSp-related occurred in 58% of the patients. Regarding DDSp, intoxication was considered severe when 20 tablets (100 mg each were ingested, a median of 29 mug/ml. Regarding MHbp, intoxication was severe when 7.5 tablets were ingested, a median of 38% of the total Hb. The correlation between MHbp and DDSp was statistically significant (n=144, r=0.32, pOBJETIVO: Definir a gravidade da intoxicação aguda por dapsona (DDS – uma ocorrência médica não usual – usando parâmetros clínicos e laboratoriais. MÉTODOS: Foram estudados 274 pacientes intoxicados por DDS, divididos em quatro grupos etários; as idades variaram de um mês a 50 anos. A avaliação clínica foi efetuada por meio de um questionário e correlacionada com parâmetros laboratoriais. A metemoglobinemia (MHbp e a dapsonemia (DDSp foram analisadas por métodos espectrofotométricos. RESULTADOS: O sinal clínico mais prevalente da intoxicação foi a cianose, presente em 65,7% dos pacientes e em 100% das crianças menores de 5 anos. A intoxicação grave, definida laboratorialmente, de acordo com a MHb ocorreu em 56,2% dos pacientes e, de acordo com a DDSp, em 58%. A intoxicação foi grave, de acordo com a DDSp, quando houve a ingestão mediana de 20

  7. Hemiplejía aguda infantil asociada a infección por enterovirus

    OpenAIRE

    Muñoz, Erika; Caramuta, Luciana; Frenkel, Susana; Cáceres, Lidia

    2005-01-01

    El ictus isquémico en la infancia es una entidad infrecuente, en el 50% de los casos no existe una causa identificable. Sin embargo, con el advenimiento de nuevas técnicas diagnósticas se han podido conocer más afecciones causales. Presentamos el caso de una paciente de 9 años con hemiplejía aguda izquierda, con estudios de neuroimágenes poco significativos y en la cual el análisis del líquido cefalorraquídeo por método de reacción en cadena de polimerasa (PCR) para ARN viral, fue positivo pa...

  8. Diagnósticos de enfermagem em adultos com leucemia mielóide aguda

    OpenAIRE

    Souza, Luccas Melo de; Gorini, Maria Isabel Pinto Coelho

    2006-01-01

    Trata-se de um estudo de casos, que objetivou identificar os Diagnósticos de Enfermagem (DE) de pacientes adultos com Leucemia Mielóide Aguda, a fim de fornecer subsídios à Sistematização da Assistência de Enfermagem. Utilizaram-se as técnicas de entrevista e observação, além da aplicação do Processo de Enfermagem. Durantes os três meses da coleta de dados, outros DEs foram encontrados através de novas buscas nos prontuários dos 6 pacientes. Os 32 DEs encontrados foram agrupados conforme a Te...

  9. Toxicidade aguda do extrato aquoso de folhas de Erythrina velutina em animais experimentais

    Directory of Open Access Journals (Sweden)

    Ariadne Conceição Santos Craveiro

    Full Text Available Este trabalho teve como objetivo a avaliação da toxicidade aguda do extrato aquoso de folhas de Erythrina velutina, espécie vegetal muito usada na medicina popular principalmente como tranqüilizante. O protocolo experimental utilizado seguiu o Guia para a Realização de Estudos de Toxicidade Pré-clínica de Fitoterápicos da Agência Nacional de Vigilância Sanitária (Anvisa, 2004. Ratos Wistar adultos foram tratados por via oral com a dose limite de 5 g/kg do extrato e observados por 14 dias consecutivos. Nenhum animal veio a óbito e nenhum sinal de toxicidade foi detectado nas observações comportamentais ou nas autópsias, indicando uma razoável atoxicidade do extrato.

  10. Ataxia cerebelar aguda na criança Acute cerebellar ataxia in children

    Directory of Open Access Journals (Sweden)

    Valeriana Moura Ribeiro

    1968-03-01

    Full Text Available São relatados os casos de 6 crianças com ataxia cerebelar aguda. Admitem os autores a presença de um fator etiológico de caráter viral comum a todos êles, discutindo os mecanismos patogênicos com base nos casos da literatura. A evolução foi favorável em todos os pacientes, com regressão completa da sintomatologia, dentro do período de 6 a 60 dias.Clinical observations of 6 children with acute cerebellar ataxia and respective laboratorial data are reported. Considerations are made in order to support the hypothesis of involving virus. The evolution of the disorder was a nonfatal one and the patients regained normal cerebellar function within a period of 6 to 60 days.

  11. Leucemia Linfoblástica Aguda Caso clínico

    OpenAIRE

    Jiménez Navarro, Nuria

    2017-01-01

    El cáncer es una de las segundas causas de muerte de nuestra población considerándose también la segunda causa de muerte entre los 0-14 años de edad. Es una enfermedad multifactorial que consigue deteriorar al paciente tanto física como psíquicamente. La leucemia linfoblástica aguda es el cáncer más relevante en niños, constituyendo el 80% de los casos. Está localizado en las células sanguíneas, normalmente en los glóbulos blancos, de la médula ósea, afectando a la función inmunológica. Debid...

  12. Mielitis aguda necrotizante en un paciente con Sida Acute necrotizing myelitis in an AIDS patient

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    M. Corti

    2003-04-01

    Full Text Available Como consecuencia de la infección por el virus de la inmunodeficiencia humana tipo-1 (HIV-1, otros patógenos como citomegalovirus (CMV y herpes simple tipo 1-2 (HSV 1-2 pueden comprometer tanto el sistema nervioso central como el periférico. Estos agentes pueden involucrar también a la médula espinal y causar una mielitis aguda necrotizante. Esta complicación ocurre por lo general en pacientes con enfermedad HIV/sida avanzada y marcada inmunodeficiencia, con recuentos de linfocitos T CD4+ de menos de 50 cél/µL. El cuadro clínico, los cambios en el LCR y las neuroimágenes generan una importante sospecha diagnóstica. Es fundamental el inicio precoz de la terapia antiviral específica. Se presenta un paciente con enfermedad avanzada debida al HIV-1 y mielitis aguda necrotizante por CMV y HSV bajo la forma clínica de síndrome de la cola de caballo.In the setting of HIV infection, cytomegalovirus (CMV and herpes simplex virus type 1-2 (HSV 1-2 can affect both the central and peripheral nervous systems. These agents can involve the spinal cord and produce a necrotizing transverse myelitis. This usually occurs in AIDS patients with severe immunodeficiency: CD4 + lymphocyte counts typically are less than 50 cell/µL. The clinical presentation, CSF and imaging studies can provide a high level of suspicion diagnosis. Prompt initiation of antiviral specific drugs is essential. We report a patient with an acute necrotizing myelitis (cauda equina syndrome secondary to CMV and HSV infections.

  13. Diabetes Mellitus en el servicio de urgencias: manejo de las complicaciones agudas en adultos

    Directory of Open Access Journals (Sweden)

    Eder A. Hernández-Ruiz

    2008-01-01

    Full Text Available La Diabetes Mellitus (DM es una enfermedad de alta prevalencia, reconocida como un problema de salud pública, debido a sus altas tasas de morbilidad y mortalidad asociadas. Diferentes estudios han documentado que la falta de adherencia al tratamiento, constituye uno de los principales factores desencadenantes para las descompensaciones agudas en el paciente diabético. Dentro del espectro de dichas alteraciones se encuentran las crisis hiperglicémicas agudas, las cuales se han dicotomizado en dos entidades clínicas: la Cetoacidosis Diabética (CAD y el Estado Hiperglicémico Hiperosmolar (EHH, que constituyen complicaciones metabólicas potencialmente fatales en el corto plazo y de las cuales pueden encontrarse cuadros superpuestos. Se han establecido criterios diagnósticos específicos buscando realizar un diagnóstico diferencial acertado, que permita un tratamiento idóneo; sin embargo, las tasas de morbilidad y mortalidad siguen siendo considerables. Por su parte, la Hipoglicemia también constituye una emergencia médica que, de no ser tratada oportunamente, puede ocasionar daño neurológico permanente e incluso la muerte. De lo anterior se deduce la importancia de que existan guías claras de manejo de estas alteraciones en todos los centros y servicios donde se preste atención médica de urgencias. Se siguen realizando investigaciones en busca de nuevas estrategias diagnósticas y terapéuticas que permitan un manejo más integral de la DM y sus complicaciones, en aras de mejorar la calidad de vida de los pacientes.

  14. Factores de riesgo de infecciones respiratorias agudas en menores de 5 años

    Directory of Open Access Journals (Sweden)

    María Eulalia Prieto Herrera

    2000-01-01

    Full Text Available Se realizó un estudio analítico, retrospectivo de casos y controles, pareado 1:1 para conocer algunos factores de riesgo de infecciones respiratorias agudas en menores de 5 años del reparto La Yaba, pertenecientes al policlínico Este de Camagüey, durante el año 1996. El universo fueron 90 niños que padecieron infecciones respiratorias agudas durante este período. La fuente de obtención de datos fue la historia clínica familiar e individual. El registro primario fue la encuesta con las variables: lactancia materna, desnutrición, enfermedades asociadas, fumador pasivo, hacinamiento. Se concluyó que la lactancia materna inadecuada (RR 12, 152, la desnutrición (RR 2, 278, la enfermedad parasitaria (RR 1, 643, el fumador pasivo (RR, 536 y el hacinamiento (RR 2, 719 se comportaron como factores de riesgo.An analytic retrospective case-control study was performed, matched 1:1, with the aim of getting to know the risk factors for acute respiratory diseases in children under 5 years of age from La Yaba neighborhood belonging to the health area of the eastern policlinics of Camaguey, during the year 1996. The study material was made up of 90 children that suffered from acute respiratory diseases during that period. The data source was the individual and family medical histories. The primary record was a survey including the following variables: breast feeding, malnutrition, associated diseases, passive smoking, overcrowding. It was concluded that inadequate breast feeding (RR 12, 152, malnutrition (RR 2, 278, parasitic disease (RR 1, 643, passive smoking (RR, 536 and overcrowding (RR 2, 719 behaved as risk factors.

  15. Crisis aguda de Asma Bronquial. Diagnóstico y tratamiento estandarizado

    Directory of Open Access Journals (Sweden)

    Anelia de la Caridad Rojas-Pérez

    2013-01-01

    Full Text Available Se realizó un estudio prospectivo de intervención en 150 pacientes con diagnóstico de Asma Bronquial que acudieron con crisis aguda al Servicio de Urgencias del Hospital Pediátrico de Holguín, de Enero del 2009 hasta Diciembre del 2010; para evaluar la evolución de los mismos después de la aplicación de Guías de Buenas Prácticas. Se aplicó tratamiento a los pacientes según lo establecido, observando su respuesta. Predominó el grupo de 4 a 8 años del sexo masculino, el 52 % de los pacientes presentaron crisis ligeras, buena respuesta al uso de broncodilatadores en aerosol, se aplicó la Prednisona por vía oral en la mayoría de los casos que lo requirieron, el 68,7 % realizó tratamiento domiciliario con respuestas controladas y solo en el 31,3 % se decidió ingreso hospitalario lo que permitió arribar a la siguiente conclusión: Con la aplicación de Guías de Buenas Prácticas Clínicas par a el manejo de la exacerbación aguda del Asma Bronquial se logró una clasificación adecuada de la severidad de la misma, buena respuesta a los tratamientos utilizados y disminución de los ingresos hospitalarios.

  16. Place of radiotherapy in the treatment of Graves' orbitopathy

    International Nuclear Information System (INIS)

    Beckendorf, Veronique; Maalouf, Toufic; George, Jean-Luc; Bey, Pierre; Leclere, Jacques; Luporsi, Elisabeth

    1999-01-01

    Purpose: The aim of this study is to evaluate the response of Graves' orbitopathy to irradiation, and to specify the prognostic factors allowing one to better define the indications of orbital radiotherapy. Methods and Materials: From 1977 to 1996, 199 patients received bilateral orbital irradiation delivering 20 Gy in 10 fractions and 2 weeks for a progressive Graves' orbitopathy. 195 patients were seen between 1 and 6 months after radiotherapy. The different symptoms were studied and their response to radiation was analyzed. Factors such as age, sex, evolution of thyroid disease, history of symptoms, and previous or combined treatments were analyzed. Results: The results revealed that 50 patients (26%) had a good or excellent response, 98 (50%) had a partial response, 37 (19%) were stable, 10 (5%) had a progression of disease. The signs that best responded to radiotherapy were the infiltration of soft tissues and the corneal involvement. Responses of proptosis or oculomotor disorders were more complete when these signs were not advanced at the time of treatment. Irradiation seemed to have the same efficacy when applied as first-line treatment or after failure of corticosteroids. Neither modality of treatment of hyperthyroidism nor thyroid status at the time of orbital irradiation modified the results. The best results were recorded for early or moderately advanced presentation (p = 0.05). Patients treated within a delay of 7 months after the beginning of the ophthalmopathy had better responses than patients treated later (p = 0.10). Conclusion: Radiation therapy was successful in Graves' orbitopathy by stopping the progression of disease in almost all cases, by improving the comfort of patients, by obtaining objective responses, and by avoiding surgical treatments particularly when signs were moderate

  17. Characterization of radioiodine therapy failures in Graves' disease

    International Nuclear Information System (INIS)

    Sabri, O.; Zimny, M.; Schreckenberger, M.; Reinartz, P.; Nowak, B.; Ostwald, E.; Schaefer, W.; Block, S.; Setani, K.; Buell, U.

    2001-01-01

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

  18. Aesthetic refinements in the treatment of graves ophthalmopathy.

    Science.gov (United States)

    Doumit, Gaby; Abouhassan, William; Yaremchuk, Michael J

    2014-09-01

    Graves ophthalmopathy is a chronic, multisystem, autoimmune disorder characterized by increased volume of intraorbital fat and hypertrophic extraocular muscles. Proptosis, impaired ocular motility, diplopia, lid retraction, and impaired visual acuity are treated with orbit decompression and fat reduction. The authors present the addition of skeletal augmentation to further improve periorbital aesthetics. Through a transconjunctival with lateral canthotomy incision, a balanced orbital decompression was executed, removing medial and lateral walls and medial floor. Intraorbital fat was excised. All patients underwent placement of porous polyethylene infraorbital rim implants and midface soft-tissue elevation, increasing inferior orbital rim projection and improving the globe-cheek relationship. From 2009 to 2012, 13 patients (11 female and two male; 26 eyes) with Graves ophthalmopathy underwent surgery at two institutions. Outcomes were evaluated for improvements of proptosis, diplopia, dry eye symptoms, and cosmetic satisfaction. Postoperative follow-up ranged from 0.5 to 3 years (median, 1.5 years). The mean improvement on Hertel exophthalmometry was 5.4 mm. Diplopia resolved in three patients (23 percent). No patients had worsening diplopia, and 12 (92 percent) discontinued use of eye lubricants. All patients had cosmetic satisfaction. One patient suffered temporary inferior orbital nerve paresthesia. There were no infections, hematomas, or ocular complications. Skeletal augmentation is a useful adjunct to orbital decompression and fat excision for treating Graves ophthalmopathy. Balanced orbital decompression with infraorbital rim implants is reliable, effective, and safe, with good, lasting results. Resolution of ocular symptoms is improved, as are the patient's personal well-being and social life, with a high-benefit-to-low-risk. Therapeutic, IV.

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

    International Nuclear Information System (INIS)

    Ozawa, Yasunori; Migita, Masayoshi; Watanabe, Tomoji; Okuda, Itsuko; Takeshita, Akira; Takagi, Akio; Shishiba, Yoshimasa

    1994-01-01

    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 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 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 131 I therapy.(author)

  20. Comportamiento de la hemorragia digestiva alta en el Hospital Universitario «Calixto García» Behavior of high digestive hemorrhage in the "Calixto García" Hospital

    Directory of Open Access Journals (Sweden)

    Ricardo Almeida Varela

    2011-03-01

    Full Text Available INTRODUCCIÓN. Muchos de los ingresos en los cuerpos de guardia se deben a hemorragias digestivas altas, pero con frecuencia no se encuentran datos sobre el comportamiento de éstas en el país. El objetivo de esta investigación fue describir los datos demográficos, etiologías y conductas adoptadas en pacientes con este diagnóstico, y de los fallecimientos ocurridos por esta causa. MÉTODOS. Se realizó un estudio retrospectivo que incluyó a los pacientes con diagnóstico de hemorragia digestiva alta, ingresados en el servicio de cirugía del Hospital Universitario «Calixto García» entre el 2006 y el 2007. RESULTADOS. Por esta causa fueron ingresados 551 pacientes, entre los que prevalecieron los hombres, ancianos, con enfermedades crónicas. Al 92 % se le realizó panendoscopia oral. Las causas más frecuentes de hemorragia reciente fueron las gastroduodenitis agudizadas, y las de hemorragia activa en el momento de la endoscopia fueron las úlceras duodenales. Se indicó tratamiento médico en el 89 % de los casos y quirúrgico en el 11 %. Falleció el 6,8 % de los pacientes y las causas principales fueron las úlceras gastroduodenales, las várices gastroesofágicas y las gastroduodenopatías erosivas. CONCLUSIONES. La hemorragia digestiva alta ocupa un lugar importante entre las causas de ingresos en el Hospital Universitario «Calixto García», en La Habana.INTRODUCTION. Most of admissions in emergency rooms are due to high digestive hemorrhages, but frequently there are not available data on the behavior of this type of hemorrhage in our country. The objective of present research was to describe the demographic data, etiologies and behaviors followed in patients with this diagnosis and also of the deaths provoked by this cause. METHODS. A retrospective study was conducted including patients diagnosed with high digestive hemorrhage admitted in surgery service of the "Calixto García" University Hospital between 2006 and 2007

  1. Chronic gastritis and Helicobacter pylori in digestive form of Chagas' disease Gastrite crônica e Helicobacter Pylori na forma digestiva da doença de Chagas

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    A. J. A. Barbosa

    1993-04-01

    Full Text Available Patients with the digestive form of Chagas'disease frequently present chronic gastritis. As the microorganism Helicobacter pylori is now accepted as the most common cause of human chronic gastritis, the present work was undertaken to verify a possible relationship between the presence of this bacterium and inflammatory changes of antral mucosa in chagasic patients. Seventeen chagasics, with megaesophagus and or megacolon were studied. Fragments from two different regions of antral mucosa were obtained by endoscopy, fixed in 4% neutral formaldehyde and embedded in paraffin. The sections were stained by haematoxylin and eosin for histology analysis, and by carbolfuchsin for H. pylori identification. H. pylori was found in 16 (94.1% chagasic patients, all of them presenting chronic gastritis. Superficial gastritis was seen in 9 (52.9% while atrophic gastritis was present in 8 (47.1% patients. H. pylori was present on gastric mucosa of 8 (100% patients with atrophic gastritis and of 8 (88.8% patients with superficial gastritis. We concluded that the microorganism H. pylori should be considered a possible factor connected with the etiopathogenesis of chronic superficial and atrophic gastritis frequently observed in patients with the digestive form of Chagas' disease.Pacientes com a forma digestiva da doença de Chagas frequentemente apresentam gastrite crônica. Tendo em vista que o microrganismo Helicobacter pylori é hoje considerado a causa mais comum de gastrite crônica no homem, propôs-se a realização deste trabalho para se verificar a possibilidade de esta bactéria estar também associada com as alterações inflamatórias da mucosa gástrica em pacientes com a forma digestiva da doença de Chagas. Fragmentos de duas regiões diferentes da mucosa antral foram obtidos endoscopicamente de 17 pacientes chagásicos com megaesôfago e ou megacolon. Os fragmentos foram processados rotineiramente para inclusão em parafina e cortes de 5 |im de

  2. Preeclampsia grave: características y consecuencias

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    Arturo Pérez de Villa Amil Álvarez

    2015-07-01

    Full Text Available Fundamento: la preeclampsia es un trastorno hipertensivo del embarazo y es una de las principales causas de morbimortalidad perinatal y materna. Objetivo: identificar los factores maternos, terapéuticos, y daños asociados a la preeclampsia grave en gestantes. Método: estudio de serie de casos, que incluyó 69 pacientes diagnosticadas con preeclampsia grave en el período del 1ro de enero de 2012 al 31 de diciembre de 2013, atendidas en el Hospital General Universitario Dr. Gustavo Aldereguía Lima. Se clasificaron en dos grupos correspondiendo ambos a los criterios de preeclampsia grave con y sin asociación de factores agravantes. Se evaluaron variables relacionadas a: características maternas, características de atención médica, características neonatales y fetales. Se aplicó un formulario confeccionado según los datos obtenidos de las historias clínicas, acorde a la Clasificación Internacional de Enfermedades Décima Revisión. Las comparaciones entre grupos se efectuaron por el estadístico X2 aceptándose como significativo una p<0,05. Resultados: la frecuencia de preeclampsia grave fue de 0,8x100 partos. La mayor frecuencia correspondió al rango de edad de 31-35 años. La eclampsia se observó en 0,91x1000 partos. El daño materno ascendió a 30,4 %. El sulfato de magnesio se utilizó como profilaxis en el 89 % de los casos. La frecuencia de eclampsia en las que no se usó fue del 50 %, mientras que en las que se usó fue de solo 6,4 %. La cesárea se realizó en el 85,5 % de las pacientes. El daño neonatal se asoció al 52,3 %. La mortalidad fetal tardía fue de 4,6x100 nacimientos. En las diferencias intergrupos se observaron divergencias significativas respecto al daño neonatal. Conclusión: es evidente la alta asociación de restricción del crecimiento intrauterino con la prematuridad inducida, alto índice de cesárea primitiva y el elevado daño materno, neonatal y fetal. El uso del sulfato de magnesio impresiona con

  3. Radioiodine therapy versus antithyroid medications for Graves' disease.

    Science.gov (United States)

    Ma, Chao; Xie, Jiawei; Wang, Hui; Li, Jinsong; Chen, Suyun

    2016-02-18

    Graves' disease is the most common cause of hyperthyroidism. Both antithyroid medications and radioiodine are commonly used treatments but their frequency of use varies between regions and countries. Despite the commonness of the diagnosis, any possible differences between the two treatments with respect to long-term outcomes remain unknown. To assess the effects of radioiodine therapy versus antithyroid medications for Graves' disease. We performed a systematic literature search in the Cochrane Library, MEDLINE and EMBASE and the trials registers ICTRP Search Portal and ClinicalTrials.gov. The date of the last search was September 2015 for all databases. Randomised controlled trials (RCTs) comparing the effects of radioiodine therapy versus antithyroid medications for Graves' disease with at least two years follow-up. Two authors independently screened titles and abstracts for relevance. One author carried out screening for inclusion, data extraction and 'Risk of bias' assessment and a second author checked this. We presented data not suitable for meta-analysis as descriptive data. We analysed the overall quality of evidence utilising the GRADE instrument. We included two RCTs involving 425 adult participants with Graves' disease in this review. Altogether 204 participants were randomised to radioiodine therapy and 221 to methimazole therapy. A single dose of radioiodine was administered. The duration of methimazole medication was 18 months. The period of follow-up was at least two years, depending on the outcome measured. For most outcome measures risk of bias was low; for the outcomes health-related quality of life as well as development and worsening of Graves' ophthalmopathy risks of performance bias and detection bias were high in at least one of the two RCTs.Health-related quality of life appeared to be similar in the radioiodine and methimazole treatment groups, however no quantitative data were reported (425 participants; 2 trials; low quality evidence

  4. Effects of orbital radiotherapy in 199 cases of Graves' ophthalmopathy

    International Nuclear Information System (INIS)

    Beckendorf, Veronique; Bey, Pierre; George, Jean Louis; Maalouf, Toufic; Leclere, Jacques; Werhya, Gerard; Luporsi, Elisabeth

    1997-01-01

    Purpose/Objective: Retrospective study to assess response of Graves' orbitopathy to standardized retrobulbar radiotherapy. Effects on different classes of signs are analysed and prognostic factors are searched. Indications of this treatment can be precise. Materials and methods: One hundred and ninety-nine consecutive patients who had clinically progressive Graves'orbitopathy were treated with radiotherapy between 1977 and 1996. All patients received a 6 MV Xrays orbital irradiation of 20 Gy in 10 fractions and 2 weeks. Signs and symptoms were classified before and after treatment directly or retrospectively according to the 'NO SPECS' recommended classification [J Clin Endocrinol Metab 1977;44:203]. Index of ophthalmopathy and responses were evaluated as described by Donaldson [J Clin Endocrinol Metab 1973;37:276]. Prognostic factors such as age, gender, therapies and response of hyperthyroidism, duration and associated treatment of eye disease are analysed. An investigation through letters sent to the patients and their ophthalmologists documents long term outcome of 128 patients with a mean follow-up of 6 years (2 to 16 years). Results: On 195 evaluable patients, 50 (26%) achieved a good or excellent response -GER-, 98 (50 %) had slight improvement, 37 (19 %) were stable, 10 (5 %) had progression of Grave's ophthalmopathy. By class of signs, GER occurred in 37%, 34%, 38%, 37.5% of cases, respectively for soft tissues involvement, proptosis, extra ocular muscle involvement and optic neuropathy. Corneal involvements yields the best results with 49% GER. Proptosis when moderate form had good results (55% GER), but advanced presentations had poor responses (17% GER). Proptosis decreased of 1 to 3 mm or remained stable. Six patients treated for optic neuropathy experienced aggravation. Same efficacy was observed when radiotherapy was applied as first line therapy or after failure of corticosteroids and when radiotherapy was delayed up to one year after beginning of

  5. Esclerodermia, tireoidite e miastenia grave: estudo de um caso

    OpenAIRE

    Werneck,Antonio L. dos Santos; Checcacci-Balod,Tamara; Tuma,Graça

    1993-01-01

    Uma paciente de 36 anos com miastenia grave desenvolveu após dois anos intolerância ao frio, o que conduziu ao diagnóstico de tireoidite de Hashimoto. Quatro anos mais tarde apresentou pele espessada nas mãos (esclerodermia limitada). O quadro clínico e os exames complementares encaminharam o diagnóstico para a forma CREST de esclerodermia sistêmica progressiva. Discute-se a dificuldade diagnóstica da esclerodermia, assim como suas síndromes de superposição. Doença de Hashimoto e miastenia gr...

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

    DEFF Research Database (Denmark)

    Hegedüs, Laszlo

    2009-01-01

    Currently there are three well-established treatment options for hyperthyroid Graves' disease (GD): antithyroid drug therapy with thionamides (ATD), radioactive iodine treatment with (131)I, and thyroid surgery. This article reviews the current evidence so the reader can evaluate advantages...... and disadvantages of these treatment modalities. Surgery is rarely used, except for patients who have a large goiter or ophthalmopathy. Fewer than 50% of patients treated with ATD remain in long-term remission. Therefore, radioactive iodine is used increasingly. No data as yet support the routine use of biologic...

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

    Science.gov (United States)

    Carlé, Allan; Bülow Pedersen, Inge; Knudsen, Nils; Perrild, Hans; Ovesen, Lars; Rasmussen, Lone Banke; Jørgensen, Torben; Laurberg, Peter

    2013-07-01

    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 association between alcohol intake and autoimmune Graves' hyperthyroidism. This is a population-based, case-control study. In a well-defined Danish population (2,027,208 person-years of observation), we prospectively identified patients with new overt thyroid dysfunction and studied 272 patients with Graves' hyperthyroidism. For each patient, we recruited four age-gender-region-matched controls with normal thyroid function (n = 1088). Participants gave detailed information on current and previous alcohol intake as well as other factors to be used for analyses. The association between alcohol intake and development of hyperthyroidism was analysed in conditional multivariate Cox regression models. Graves' patients had a lower reported alcohol consumption than controls (median units of alcohol (12 g) per week: 2 vs 4, P hyperthyroidism. Odds ratios (95% confidence interval) compared with the reference group with a recent (last year) consumption of 1-2 units of alcohol per week were as follows: 0 units/week 1·73 (1·17-2·56), 3-10 units/week 0·56 (0·39-0·79), 11-20 units/week 0·37 (0·21-0·65), ≥21 units/week 0·22 (0·08-0·60). Similar results were found for maximum previous alcohol consumption during a calendar year. No interaction was found with the type of alcohol consumed (wine vs beer), smoking habit, age, gender or region of inhabitancy. Moderate alcohol consumption is associated with a considerable reduction in the risk of Graves' disease with hyperthyroidism--irrespective of age and gender. Autoimmune thyroid disease seems to be much more dependent on environmental factors than hitherto anticipated. © 2012 John Wiley & Sons Ltd.

  8. Tratamento do hipertireoidismo da Doença de Graves

    OpenAIRE

    Andrade, Vânia A.; Gross, Jorge L.; Maia, Ana Luiza

    2001-01-01

    A Doença de Graves constitui a forma mais comum de hipertireoidismo e três abordagens terapêuticas são atualmente utilizadas: drogas antitireoidianas (DAT), cirurgia e iodo radioativo (131I). As DAT continuam como tratamento de primeira escolha em pacientes com doença leve, bócios pequenos, crianças e adolescentes, e em situações especiais como na gravidez. Por outro lado, o 131I tem sido cada vez mais utilizado, porque é considerado um tratamento seguro, definitivo e de fácil aplicação. O ri...

  9. Graves' disease. Manifestations and therapeutic options

    Energy Technology Data Exchange (ETDEWEB)

    McFarland, K.F.; Saleeby, G.

    1988-03-01

    Graves' disease is the most common cause of hyperthyroidism. Clinical features include thyroid enlargement, eye signs, tachycardia, heat intolerance, emotional lability, weight loss, and hyperkinesis. Three modes of therapy are available. The preferences of the patient and physician are usually prime considerations in devising the therapeutic plan. Radioactive iodine is the most frequently used and safest method of treatment for adults. Antithyroid drugs are preferred for children and pregnant women. Surgery is usually reserved for patients in whom the other forms of treatment are not acceptable. Considerable patient education during the decision-making process enhances the success of the therapeutic plan.

  10. The treatment of Graves' disease in children and adolescents

    Directory of Open Access Journals (Sweden)

    Hae Sang Lee

    2014-09-01

    Full Text Available Graves' disease (GD accounts for 10%-15% of thyroid disorders in children and adolescents. The use of antithyroid drugs as the initial treatment option in GD is well accepted. An average two years remission is achieved in about 30% of children treated with antithyroid drugs. However, the optimal treatment duration and the predictive marker of remission after antithyroid drug therapy are still controversial. Additionally, 131I therapy and surgery are considered the option for treatment in children and adolescents with GD. We review the treatment options for pediatric GD and the possible determinants of remission and relapse on antithyroid drug treatment in children and adolescents.

  11. Conservative approach versus urgent appendectomy in surgical management of acute appendicitis with abscess or phlegmon Resultados del tratamiento conservador inicial y de la cirugía urgente en la apendicitis aguda evolucionada

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    J. M. Aranda-Narváez

    2010-11-01

    Full Text Available Background: Surgical management of acute appendicitis with appendiceal abscess or phlegmon remains controversial. We studied the results of initial conservative treatment (antibiotics and percutaneous drainage if necessary, with or without interval appendectomy compared with immediate surgery. Methods: We undertook an observational, retrospective cohort study of patients with a clinical and radiological diagnosis of acute appendicitis with an abscess or phlegmon, treated in our hospital between January 1997 and March 2009. Patients younger than 14, with severe sepsis or with diffuse peritonitis were excluded. A study group of 15 patients with acute appendicitis complicated with an abscess or phlegmon underwent conservative treatment. A control group was composed of the other patients, who all underwent urgent appendectomy, matched for age and later randomized 1:1. The infectious risk stratification was established with the National Nosocomial Infections Surveillance System (NNIS index. Dependent variables were hospital stay and surgical site infection. Analysis was with SPSS, with p Introducción: Existe controversia acerca del tratamiento idóneo de la apendicitis aguda evolucionada en forma de absceso o flemón. Realizamos un estudio para la evaluación de resultados del tratamiento conservador inicial (antibiótico y drenaje percutáneo si se precisa, con/sin apendicectomía diferida y del tratamiento quirúrgico urgente. Método: Estudio observacional analítico de cohortes retrospectivas. Criterios de inclusión: pacientes con diagnóstico clínico y radiológico de apendicitis aguda evolucionada en forma de absceso o flemón, tratados en nuestro hospital entre enero 1997 y marzo 2009, excluyendo pacientes pediátricos, con sepsis grave o peritonitis difusa. En 15 pacientes con apendicitis complicada con absceso o flemón (cohorte de estudio se indicó tratamiento conservador inicial. El grupo control se obtuvo del resto de pacientes (en

  12. Treatment of Graves' disease with I131: Case Report

    International Nuclear Information System (INIS)

    Sanchez Povis, J.E.; Sandoval Okuma, J.C.; Contreras Carreno, S.E.; Cabello Morales, E.

    2006-01-01

    Objective: To describe the response and complications in children and teenagers suffering Graves' disease who received radioactive iodine therapy. Material and Methods: The clinical records of the patients attended at Paediatric Endocrinology Unit of Hospital Nacional Cayetano Heredia who received therapy with I 131 were reviewed. Demographic characteristics, thyroid weight, radioactive iodine uptake, I 131 dose and clinical and thyroid function evolution were registered. Results: We include thirteen patients: 1 male and 12 females. The mean thyroid weight obtained was 47.56 ± 10.70 gr. Initial calculated dose was 3.92 ± 0.95 mCi, with a total dose of 4.47 ± 1.66 mCi, and mean following period of 2.76 years. Ten patients received only one dose, 2 patients received two doses and one patient received three doses; all cases remitted. Patients who received only 1 dose showed disease remission at 13.13 weeks and mean remission period of the population was 24.62 weeks. Hypothyroidism prevalence up to six months from initiating treatment was 66.66%, and up to 257 weeks 83.33%. Conclusions: We conclude that I 131 was 100% effective in the treatment of children and adolescents suffering Graves' disease in this small series. (author)

  13. Sudden unexpected death due to Graves' disease during physical altercation.

    Science.gov (United States)

    Wei, Dengming; Yuan, Xiaogang; Yang, Tiantong; Chang, Lin; Zhang, Xiang; Burke, Allen; Fowler, David; Li, Ling

    2013-09-01

    We report a case of a 30-year-old woman who suddenly collapsed after having a physical altercation with her husband. Despite immediate resuscitation, she died on arrival at the hospital. The victim's parents requested an autopsy because they believed that their daughter was killed by her husband. Postmortem examination revealed that the victim had a diffusely enlarged thyroid gland and cardiomegaly with left ventricular hypertrophy. There was no evidence of significant trauma on the body. Further postmortem thyroid function tests and review of her medical history indicated that her death was due to Graves' disease. To the best of our knowledge, this is the first case reported of sudden death due to cardiac arrhythmia from Graves' disease induced by physical and emotional stress associated with the criminal activity of another person. The autopsy findings are described. In addition, the literature is reviewed and the significance of postmortem evaluation of thyroid hormones in the cases of sudden death is discussed. © 2013 American Academy of Forensic Sciences.

  14. Radioiodine-induced hypothyroidism in Graves' disease: factors associated

    International Nuclear Information System (INIS)

    Cunnien, A.J.; Hay, I.D.; Gorman, C.A.; Offord, K.P.; Scanlon, P.W.

    1982-01-01

    A retrospective analysis was done of the records of 454 patients who received their first 131 I treatment for Graves' disease during six periods covering 1951 to 1978. In the earliest group, 3% of patients were hypothyroid 3 mo after 131 I use, and 40% were hypothyroid at 1 yr. In the most recent group, 36% of patients were hypothyroid at 3 mo and 91% were myxedematous at 1 yr. Although no obvious trends were noted, whether in the number of patients pretreated with thionamide drugs, in the mean 24-hr 131 I uptake, or in the calculated dose of 131 I (muCi/estimated gram of thyroid tissue) during the years of the study, the initial mean dose of 131 I administered increased from 8.1 mCi in the earliest group to 13.8 mCi in the latest group. Concurrently, estimates of gland size increased from a mean of 26 g in the first group to 43 g in the last. If, in patients with Graves' disease, the thyroid gland size did not truly increase during the years of the study, the increasing occurrence of early hypothyroidism seen after 131 I use may reflect the conscious or unconscious decision to use larger doses of 131 I calculated on the basis of inflated estimates of thyroid gland weight

  15. Effect of radioiodine on stimulatory activity of Graves' immunoglobulins

    International Nuclear Information System (INIS)

    Atkinson, S.; McGregor, A.M.; Kendall-Taylor, P.; Peterson, M.M.; Smith, B.R.

    1982-01-01

    The effects of 131 I therapy on the activity of thyroid stimulating antibody (TSAb) and thyrotrophin binding inhibiting immunoglobulin (TBII) in nineteen patients with Graves' disease have been studied. Prior to 131 I administration, TSAb was detected in 84%, and TBII in 68% of patients. Following 131 I administration TSAb and TBII were detectable in 100% of patients. The elevation 3 months after treatment of the means of both the TSAb and TBII indices for the group of nineteen patients was highly significant compared with pretreatment values. All the patients went into remission during the course of the study and the TSAb index declined in all patients, becoming undetectable in eleven; TBII also declined in most patients but remained detectable in thirteen. The study furthermore afforded the opportunity for a direct comparison of binding with stimulatory activity. These results show that after 131 I therapy for Graves' hyperthyroidism there is a transient increase in TSAb as well as TBII, followed by a decline, and that the measurement of binding and stimulatory activities are in good general agreement. (author)

  16. Clinical update: treatment of hyperthyroidism in Graves' ophthalmopathy.

    Science.gov (United States)

    Azzam, Ibrahim; Tordjman, Karen

    2010-03-01

    The presence of thyroid eye disease (TED) may influence the treatment of hyperthyroidism in patients with Graves' disease. Moreover, treatment of hyperthyroidism may affect the course of Graves' ophthalmopathy (GO). We review the literature and summarise recent knowledge about the impact of treatment modality for hyperthyroidism in GO. Anti-thyroid drugs (ATDs) remain the simplest and safest way to treat hyperthyroidism in patients with GO, but they are associated with a high relapse rate of hyperthyroidism and they have no effect on the course of GO. Radioactive iodine (RAI) treatment may be associated with exacerbation of GO especially in high risk patients, when glucocorticoid prophylaxis may be indicated. Large prospective trials are still lacking to define the exact effect of RAI on the course of GO, particularly in relation to other known risk factors. Likewise, clear guidelines for prophylactic glucocorticoid therapy are needed. RAI should be cautiously used in patients with more severe ophthalmopathy and concomitant I.V glucocorticoids should be considered. Thyroid surgery, whether total or subtotal thyroidectomy, has no effect on the course of ophthalmopathy. However, total thyroid ablation that combines surgery with radioactive iodine, as a means of achieving thyroid antigen disappearance, is increasingly gaining attention for the treatment of patients with GO, especially those undergoing thyroid surgery, but also for those with severe unresponsive ophthalmopathy. Studies supporting this approach are awaited.

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

    International Nuclear Information System (INIS)

    Haibach, H.

    1976-01-01

    The radioimmunoassay for T 3 is now widely available and is a useful diagnostic tool for hyperthyroidism, especially in T 3 -thyrotoxicosis. It is an essential tool in the management of hyperthyroidism that persists after treatment with normal T 4 serum levels or, in euthyroid cases, with low T 4 serum levels. In these conditions, it reflects the metabolic state more accurately than serum levels of T 4 . A promising new test is the response of radioimmunoassayable TSH to protirelin relin (TRH) administration. An absent response indicates pituitary suppression and thyroid autonomy as seen in frank hyperthyroidism or euthyroid Graves disease, treated or untreated. It is safer and quicker than the conventional T 3 suppression test of thyroid radioactive iodine uptake and may replace it at least partly in the future. The recently recognized sharp decline in the remission rate of patients subjected to thyroid drug therapy in the last decade has made this treatment much less efficacious. By necessity, it will probably lead to greater reliance on treatment with radioactive iodine in the majority of the patients with the hyperthyroidism of Graves disease

  18. [Severe neonatal hyperthyroidism which reveals a maternal Graves' disease].

    Science.gov (United States)

    Guérin, B; Vautier, V; Boin-Gay, V; Estrade, G; Choulot, J-J; Doireau, V

    2004-04-01

    Two of every thousand pregnancies are complicated by Graves' disease. Diagnosis is suggested by maternal disorders (tachycardia, exophthalmia, weight loss.) or fetal disorders (tachycardia, intra-uterine growth retardation, preterm birth.). Due to transfer into the fetal compartment of maternal antibodies which stimulate the fetal thyroid by binding to the thyroid thyrotropin (TSH) receptor, only 1% of children born to these mothers are described as having hyperthyroidism. Neonatal thyrotoxicosis disappears with clearance of the maternal antibodies; clinical signs usually disappear during the first four Months of life. The most frequent neonatal clinical signs of thyrotoxicosis are tachycardia, goiter, hyperexcitability, poor weight gain, hepatosplenomegaly, stare and eyelid retraction. Diagnosis is based on determination of the blood level of triiodothyronine (T3), thyroxine (T4) and TSH. To confirm the nature of hyperthyroidism, thyroid-stimulating immunoglobulins (TSI) should be assayed. The kinetics of TSI provides a guide for therapeutic adaptation and disappearance of TSI is a sign of recovery. Rare cases of familial non-autoimmune hyperthyroidism have been shown to be caused by germline mutation of the thyrotropin receptor. We report a case of severe neonatal hyperthyroidism which led to the diagnosis of maternal Graves' disease.

  19. Graves' disease: cost-effectiveness of clinical and radioiodine treatments

    International Nuclear Information System (INIS)

    Cruz junior, Antonio F.; Takahashi, Miriam H.; Albino, Claudio C.

    2005-01-01

    Full text: In this study, we set out to evaluate the costs and effectiveness of the two most used therapies in Graves' disease: antithyroid drugs (ATD) and radioiodine (RAI). Twenty-tree patients, 7 men and 16 women, with a mean age of 35.4 years, treated with ATD and 35 patients, 5 men and 30 women, mean age of 39.4 years, treated with RAI were studied. After 2 years receiving ATD, 21 patients achieved euthyroidism and 2 remained hyperthyroid. In the RAI group, 21 patients presented hypothyroidism and 13 became euthyroid. To calculate the costs of each therapy, we analysed the number of visits during this period, the laboratory data and the drugs needed, such as tiamazol and/or thyroxine. The group treated only with ATD needed a higher number of visits and laboratory measurements, with the mean total cost of U$ 791.65, while the RAI group spent a mean amount of U$ 366.44. Therefore, the costs of the RAI treatment were 53,7 % lower than clinical therapy with ATD. Conclusion: The present study demonstrates that RAI treatment has a lower cost than ATD, being very effective in controlling the hyperthyroidism of Graves' disease. (author)

  20. Características epidemiológicas e genéticas associadas à gravidade da bronquiolite viral aguda pelo vírus sincicial respiratório

    Directory of Open Access Journals (Sweden)

    Alfonso E. Alvarez

    2013-12-01

    Full Text Available OBJETIVO: avaliar os fatores epidemiológicos e genéticos associados à gravidade da Bronquiolite Viral Aguda (BVA pelo Vírus Sincicial Respiratório (VSR. FONTE DOS DADOS: foram utilizados descritores "bronchiolitis", "risk factor", "genetics" e "respiratory syncytial virus" e todas as combinações entre eles, nas bases de dados PubMed, SciELO e Lilacs publicados após o ano de 2000 e que incluíram indivíduos menores de dois anos de idade. SÍNTESE DOS DADOS: foram encontrados 1.259 artigos e lidos seus respectivos resumos. Destes foram selecionados 81 que avaliaram fatores de risco para a gravidade da BVA para leitura na íntegra, e foram incluídos os 60 estudos mais relevantes. Os fatores epidemiológicos associados com a gravidade da BVA pelo VSR foram: prematuridade, tabagismo passivo, baixa idade, ausência de aleitamento materno, doença pulmonar crônica, cardiopatia congênita, sexo masculino, etnia, coinfecção viral, baixo peso na admissão hospitalar, tabagismo materno na gestação, dermatite atópica, ventilação mecânica no período neonatal, antecedente materno de atopia e/ou asma na gestação, estação do nascimento, baixo nível socioeconômico, síndrome de Down, poluição ambiental, morar em altitude acima de 2.500 metros do nível do mar e parto cesariana. Em contrapartida, algumas crianças com BVA grave não apresentam nenhum desses fatores de risco. Neste sentido, estudos recentes têm verificado a influência de fatores genéticos relacionados à gravidade da BVA pelo VSR. Polimorfismos dos genes TLRs, RANTES, JUN, IFNA5, NOS2, CX3CR1, ILs e VDR têm-se mostrado associados com a evolução mais grave da BVA pelo VSR. CONCLUSÃO: a gravidade da BVA pelo VSR é um fenômeno dependente da interação entre variáveis epidemiológicas, ambientais e genéticas em seus diferentes graus de interação.

  1. Guidelines for the treatment of childhood-onset Graves' disease in Japan, 2016.

    Science.gov (United States)

    Minamitani, Kanshi; Sato, Hirokazu; Ohye, Hidemi; Harada, Shohei; Arisaka, Osamu

    2017-01-01

    Purpose behind developing these guidelines: Over one decade ago, the "Guidelines for the Treatment of Graves' Disease with Antithyroid Drug, 2006" (Japan Thyroid Association (JTA)) were published as the standard drug therapy protocol for Graves' disease. The "Guidelines for the Treatment of Childhood-Onset Graves' Disease with Antithyroid Drug in Japan, 2008" were published to provide guidance on the treatment of pediatric patients. Based on new evidence, a revised version of the "Guidelines for the Treatment of Graves' Disease with Antithyroid Drug, 2006" (JTA) was published in 2011, combined with the "Handbook of Radioiodine Therapy for Graves' Disease 2007" (JTA). Subsequently, newer findings on pediatric Graves' disease have been reported. Propylthiouracil (PTU)-induced serious hepatopathy is an important problem in pediatric patients. The American Thyroid Association's guidelines suggest that, in principle, physicians must not administer PTU to children. On the other hand, the "Guidelines for the Treatment of Graves' Disease with Antithyroid Drug, 2011" (JTA) state that radioiodine therapy is no longer considered a "fundamental contraindication" in children. Therefore, the "Guidelines for the Treatment of Childhood-Onset Graves' Disease with Antithyroid Drug in Japan, 2008" required revision.

  2. Hypocalcaemia following thyroidectomy for treatment of Graves' disease: implications for patient management and cost-effectiveness.

    Science.gov (United States)

    Hughes, O R; Scott-Coombes, D M

    2011-08-01

    No consensus exists on optimal treatment for Graves' disease once anti-thyroid medication fails to induce remission. Total thyroidectomy is a more cost-effective treatment than radioactive iodine or life-long anti-thyroid medication, but hypocalcaemia is an important complication, leading to longer hospital admissions and increased prescription costs. This study aimed to compare the relative risk of hypocalcaemia requiring medical treatment for patients with Graves' disease. Prospective cohort study of patients undergoing total thyroidectomy for Graves' disease and for multinodular goitre, calculating serum calcium levels 24-hours post-operatively and prescription rates. Mean corrected calcium concentrations 24 hours post-operatively were 2.05 mmol/l for Graves' disease patients and 2.14 mmol/l for multinodular goitre patients (p = 0.003). Biochemical hypocalcaemia developed in 92 per cent (n = 34) of Graves' disease patients and 71 per cent (n = 43) of multinodular goitre patients (p = 0.012). Graves' disease patients were more likely to be prescribed calcium supplementation pre-discharge (p = 0.037). Total thyroidectomy for Graves' disease carries an increased risk of hypocalcaemia at 24 hours, and of calcium supplementation pre-discharge. Graves' disease patients should be informed of the increased risk of hypocalcaemia associated with total thyroidectomy, and this risk must be factored into future cost-effectiveness analysis.

  3. Fatal and non-fatal adverse events of glucocorticoid therapy for Graves' orbitopathy

    DEFF Research Database (Denmark)

    Marcocci, Claudio; Watt, Torquil; Altea, Maria Antonietta

    2012-01-01

    The objective of this study was to investigate the side effects of glucocorticoid (GC) therapy observed by European thyroidologists during the treatment of Graves' orbitopathy (GO).......The objective of this study was to investigate the side effects of glucocorticoid (GC) therapy observed by European thyroidologists during the treatment of Graves' orbitopathy (GO)....

  4. Rectus extraocular muscle paths and decompression surgery for Graves orbitopathy: mechanism of motility disturbances

    NARCIS (Netherlands)

    Abràmoff, Michael D.; Kalmann, Rachel; de Graaf, Mieke E. L.; Stilma, Jan S.; Mourits, Maarten P.

    2002-01-01

    PURPOSE: To study possible causes of motility disturbances that may result from orbital decompression surgery in patients with Graves orbitopathy and especially the role of rectus extraocular muscle paths. METHODS: Sixteen patients with Graves orbitopathy were studied before and 3 to 6 months after

  5. 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.

  6. Grave's Eye disease developing following radioiodine treatment for toxic nodular goitre.

    Science.gov (United States)

    Tahrani, A A; Rangan, S; Moulik, P

    2007-07-01

    The development of Grave's ophthalmopathy (GO) following radioiodine (RI) treatment for Grave's thyrotoxicosis, though controversial, is well described. The development of ophthalmopathy following RI treatment for toxic nodular goitre is much less recognised. We report a 49 year-old female patient who developed thyrotoxicosis and GO after receiving RI treatment for toxic nodular goitre and we also review the relevant literature.

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

    International Nuclear Information System (INIS)

    Zhang Lindi; Xu Changde; Xu Huogen; Wang Wei; Zhang Jie; Nie Shufen; Gu Zhenqi; Zeng Jihua

    2006-01-01

    Objective: To investigate the clinical significance of the changes of thyroid-related hormones (FT 3 , FT 4 , s-TSH, TGA, TPO-Ab) levels in patients with Graves' and non-Graves' hyperthyroidism. Methods: Serum FT 3 , FT 4 , TGA, TPO-Ab (with RIA) and s-TSH (with IRMA) were determined in 43 patients with non-Graves' hyperthyroidism, 29 patients with Graves' disease and 40 controls. Results: In both groups of hyperthyroid patients, the serum levels of FT 3 (15.01 ± 11.01 pg/ml in the non - Graves' group and 15.23 ± 9.57pg/ml in the Graves' group), FT 4 (38.30 ± 19.82, 38.87 ± 17.39pg/ml), TGA(33.89 ± 22. 43%, 49.72 ± 20.55% ) and TPO-Ab (1319.24 ± 1037.78, 2023.24 ± 621.00IU/ml) were significantly higher than those (FT 3 , 6.76 ± 2.01pg/ml, FT 4 16.16 ± 2.58pg/ml, TGA 6.76 ± 2.01%, TPO-Ab 0.01 ± 0.01IU/ml) in the controls (all P 3 , FT 4 and s-TSH levels in both groups were not significantly different from each other. Conclusion: In this study, serum TGA and TPO -Ab levels were lower in patients with non-Graves' hyperthyroidism than those in patients with Graves' disease. (authors)

  8. Glucocorticoid administration for Graves' hyperthyroidism treated by radioiodine. A questionnaire survey among members of the European Thyroid Association

    NARCIS (Netherlands)

    Lazarus, J. H.; Bartalena, L.; Marcocci, C.; Kahaly, G. J.; Krassas, G.; Wiersinga, W. M.; Baldeschi, L.; Boboridis, K.; Boschi, A.; Currò, N.; Daumerie, C.; Dickinson, A. J.; Eckstein, A.; Kendall-Taylor, P.; Lane, C. M.; Ludgate, M. E.; Mann, K.; Marinò, M.; Mourits, M. P.; Nardi, M.; Neoh, C.; Orgiazzi, J.; Pearce, S.; Perros, P.; Pinchera, A.; Pitz, S.; Salvi, M.; Sivelli, P.; Stahl, M.; von Arx, G.

    2010-01-01

    Background: Glucocorticoid prophylaxis is required in some instances after radioiodine (RAI) treatment for Graves' hyperthyroidism to prevent progression of Graves' orbitopathy (GO). However, no randomized clinical trial has been performed to ascertain the optimum glucocorticoid therapy. Aim and

  9. 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 Graves......' disease compared to patients with another chronic thyroid disease, nodular goitre, and to investigate determinants of anxiety and depression in Graves' disease.METHODS: 157 cross-sectionally sampled patients with Graves' disease, 17 newly diagnosed, 140 treated, and 251 controls with nodular goitre......'/probable 'depression'. Determinants of anxiety and depression symptoms in Graves' disease were examined using multiple linear regression.RESULTS: In Graves' disease levels of anxiety (p = 0.008) and depression (p = 0.014) were significantly higher than in controls. The prevalence of depression was 10% in Graves...

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

    Science.gov (United States)

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

    2016-04-01

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

  11. Clinical significance and changes of TRAb and TSI assay in patients with Graves' disease

    International Nuclear Information System (INIS)

    Hu Xiaolin; Zhang Haiyan

    2006-01-01

    Objective: To explore the changes and clinical significance of TRAb and TSI detection in patients with Graves' disease. Methods: Serum TRAb and TSI levels were detected by enzyme-linked immunosorbent assay, and thyroid hormone levels were detected by microparticle enzyme immunoassay, including normal controls, Graves' disease in period of onset, catabsis group and hashimotos thyroiditis group. Results: The positive rate of TRAb and TSI in Graves' in period of onset group is 86.67% and 95.0%, TGA and TMA in hashimotos thyroiditis group is 85.29% and 91.18%, respectively. More importantly these results were significant difference than normal controls. Conclusions: It's very important for Graves' disease patients to detect TRAb, TSI, TGA, TMA and thyroid hormone simulta-neously, especially to the curative effect and prognosis criterin in patients with Graves' disease and antidi-astole in patients with hashimotos thyroiditis. (authors)

  12. Regression of the carotid intima media thickness by propylthiouracil therapy in Graves' hyperthyroidism.

    Science.gov (United States)

    Bilir, Cemil; Gökosmanoglu, Feyzi; Caliskan, Mustafa; Cinemre, Hakan; Akdemir, Ramazan

    2012-04-01

    One of the cardiovascular effects of hyperthyroidism is increased carotid intima media thickness (CIMT). The aim of this study is to investigate the CIMT in patients with Graves' hyperthyroidism and the effect of propylthiouracil (PTU) therapy on CIMT. Twenty-six patients with Graves' hyperthyroidism and 33 healthy controls were included in the study. CIMT was measured at the right and left external carotid arteries in every patient in both groups. CIMT was measured before and after the PTU therapy in patients with Graves' hyperthyroidism. There was a significant difference in CIMT between the group of Graves' hyperthyroid patients and the control group (0.72 versus 0.55 mm, P treatment, CIMT decreased significantly compared with the baseline values [0.84 (0.54-1.3) to 0.72 (0.50-1.2), change 0.12 mm, P hyperthyroidism is associated with atherosclerosis as assessed by CIMT. Treatment of Graves' hyperthyroidism with PTU decreases the CIMT.

  13. Raman spectroscopy of gemstones on the necklaces from ancient graves at the Castle of Devin

    International Nuclear Information System (INIS)

    Gregor, M.; Vanco, L.; Kadlecikova, M.; Breza, J.

    2013-01-01

    The subjects of Raman and X-ray analyses were the beads from two necklaces found in ancient graves from the 11'"t"h and 12"t"h centuries at the Castle of Devin. One of the necklaces, consisting of 23 beads, was found in tomb 12/1980. Inside the grave, an incomplete skeleton of a woman was found, oriented in the west - east direction. The skull, shoulder blades and lower limbs were preserved in good condition. The grave contained a rich inventory: a silver ear-ring at the left side of the skull, a necklace between the shoulder blades and a ring on the right side at the height of the right hand. The other necklace, consisting of six stones, was found in grave 145/1985 in which, similarly like in the first grave, a woman's skeleton was discovered. The stones were found below the mandible. All beads are drilled through axially. (authors)

  14. Asma aguda em adultos na sala de emergência: o manejo clínico na primeira hora

    Directory of Open Access Journals (Sweden)

    DALCIN PAULO DE TARSO ROTH

    2000-01-01

    Full Text Available Asma é doença com alta prevalência em nosso meio e ao redor do mundo. Embora novas opções terapêuticas tenham sido recentemente desenvolvidas, parece haver aumento mundial na sua morbidade e mortalidade. Em muitas instituições, as exacerbações asmáticas ainda constituem emergência médica muito comum. As evidências têm demonstrado que a primeira hora no manejo da asma aguda na sala de emergência concentra decisões cruciais que podem determinar o desfecho desta situação clínica. Nesta revisão não-sistemática, os autores enfocaram a primeira hora da avaliação e tratamento do paciente com asma aguda na sala de emergência, descrevendo uma estratégia apropriada para o seu manejo. São consideradas as seguintes etapas: diagnóstico, avaliação da gravidade, tratamento farmacológico, avaliação das complicações e decisão sobre onde se realizará o tratamento adicional. Espera-se que estas recomendações contribuam para que o médico clínico tome a decisão apropriada na primeira hora do manejo da asma aguda.

  15. Characteristics of patients with graves disease and intrathyroid hypovascularity compared to painless thyroiditis.

    Science.gov (United States)

    Uchida, Toyoyoshi; Shigihara, Nayumi; Takeno, Kageumi; Komiya, Koji; Goto, Hiromasa; Abe, Hiroko; Sato, Junko; Honda, Akira; Fujitani, Yoshio; Watada, Hirotaka

    2014-10-01

    The purpose of this study was to assess the frequency and sonographic and laboratory characteristics of Graves disease with intrathyroid hypovascularity in Japanese patients and to compare these characteristics in patients with painless thyroiditis. A total of 194 consecutive patients with Graves disease and 21 patients with painless thyroiditis were enrolled. The patients underwent thyroid volume measurement, mean superior thyroid artery peak systolic velocity (PSV) measurement, power Doppler sonography, and proper blood testing to discriminate between Graves disease and painless thyroiditis. Based on the power Doppler sonographic findings, they were divided into 4 groups: from pattern 0 (most hypovascular thyroid) to pattern III (most hypervascular thyroid). Comparisons of multiple thyroid parameters were made among the groups. The prevalence of Graves disease with pattern 0 (n = 27) was 13.9% among the patients with Graves disease. The sonographic and laboratory data for patients with Graves disease and pattern 0 were compared to those of the 21 patients with painless thyroiditis, which typically shows intrathyroid hypovascularity. Free triiodothyronine and thyroxine levels and the superior thyroid artery PSV were significantly lower in patients with Graves disease and pattern 0 than those with patterns I, II, and III (P thyroid volume and thyrotropin receptor antibody level were significantly lower in patients with Graves disease and pattern 0 than those with pattern III. In the comparison between patients with Graves disease and pattern 0 and those with painless thyroiditis and pattern 0, apart from thyrotropin receptor antibody, only the superior thyroid artery PSV was different. Although the clinical features of patients with Graves disease and intrathyroid hypovascularity were similar to those patients with painless thyroiditis, the superior thyroid artery PSV showed a moderate ability to discriminate these patients. © 2014 by the American Institute of

  16. Uso de la antibioticoterapia perioperatoria en la apendicitis aguda: Use of perioperative antibiotic therapy Acute appendicitis:

    Directory of Open Access Journals (Sweden)

    Gimel Sosa Martín

    2009-09-01

    Full Text Available INTRODUCCIÓN. La apendicitis aguda es la afección que más frecuentemente requiere intervención quirúrgica de urgencia. El uso de profilaxis antimicrobiana disminuye la incidencia de sepsis de la herida quirúrgica y mejora la relación riesgo-beneficio y costo-beneficio de la operación. El presente estudio buscó diseñar e implantar un protocolo terapéutico para el uso de antimicrobianos, según estadio de la apendicitis aguda, para uso en centros de atención secundaria. MÉTODOS. Se realizó un estudio prospectivo de indicación-prescripción con elementos de consecuencias prácticas y un grupo de intervención. Se seleccionaron de manera aleatoria 215 pacientes con diagnóstico de apendicitis aguda, atendidos entre diciembre del 2002 y diciembre del 2006. Se establecieron dos grupos, uno de control y uno experimental. Se instauró un protocolo de profilaxis aplicado al grupo experimental, basado en textos de referencia y adecuado al contexto socioeconómico cubano. RESULTADOS. Se aplicó el protocolo de profilaxis a 105 pacientes. La incidencia de sepsis fue del 8,5 %, significativamente menor a la del grupo control (24,5 %. El costo fue igualmente menor en el grupo experimental. CONCLUSIONES. El uso racional de la terapéutica antimicrobiana para la profilaxis de la infección de la herida quirúrgica mejora la relación riesgo-beneficio y costo-beneficio del procedimiento quirúrgico y la calidad de la atención médica.INTRODUCTION: Acute appendicitis if the affection that more frequent requires of an emergence surgical intervention. Use of antimicrobial prophylaxis decreases sepsis incidence of surgical wound, and to improve the risk-benefit and the cost-benefit relation of surgery. Present study tried to design and to creates a therapeutical protocol for use of antimicrobials, according to acute appendicitis stage to use in secondary care centers. METHODS: We made a prospective study of prescription-indication with the elements

  17. Orden constitucional y graves violaciones de Derechos Humanos

    Directory of Open Access Journals (Sweden)

    Luis Jimena Quesada

    2008-01-01

    Full Text Available El presente trabajo afronta un desafío fundamental para el Derecho constitucional, a saber, el análisis del marco constitucional español referente a la responsabilidad por graves violaciones de derechos humanos. En este sentido, en primer lugar, el trabajo introduce una posición original sobre los tipos de graves violaciones de derechos humanos, las cuales están relacionadas con los más horrendos atentados contra la dignidad humana y contra las bases del sistema democrático, teniendo una proyección tanto en el plano constitucional como en el universal. A continuación, en la parte central del trabajo se examina sucesivamente siguiendo un esquema lógico las diversas etapas de lucha contra la impunidad de los individuos responsables por graves violaciones de derechos humanos: la investigación, el enjuiciamiento y la condena por esos actos criminales, sin olvidar la reparación de las víctimas. En todas esas etapas se toma en consideración el marco legal nacional (terrorismo y crímenes contra la humanidad contemplados en el Código penal y el supranacional (crímenes universales previstos en el Estatuto de la Corte Penal Internacional y en otros tratados internacionales de Derecho internacional penal y humanitario, así como en la Unión Europea; y se tiene en cuenta asimismo el progreso conocido en el ámbito de la jurisprudencia nacional (jurisdicción universal y de la jurisprudencia internacional (la puesta en funcionamiento de la Corte Penal Internacional y de los Tribunales Penales para la ex Yugoslavia y para Ruanda. Finalmente, se incluyen unas conclusiones sobre la necesidad de forjar un compromiso en la lucha contra la impunidad universal (tanto por parte de la ciudadanía como por parte de los poderes públicos, especialmente con «voluntad jurisdiccional», así como sobre los nuevos perfiles o desarrollos de los derechos fundamentales en juego (sobre todo, el derecho a la tutela judicial efectiva, el derecho a la informaci

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

    International Nuclear Information System (INIS)

    Zha Jinshun; Huang Chunling; Jiang Tingyin; Jiang Yan

    2011-01-01

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

  19. Radioiodine therapy in Graves' disease - A retrospective analysis

    International Nuclear Information System (INIS)

    Mittal, B.R.; Bhattacharya, A.; Dutta, P.; Bhansali, A.

    2007-01-01

    Full text: Radioiodine is a safe form of treatment for all patients with primary hyperthyroidism. The thyroid's unique capacity to store iodine (thus also radioiodine) makes it a natural target for radioiodine therapy. We retrospectively analyzed the outcome of radioiodine therapy in a cohort of 151 patients of primary hyperthyroidism treated on an outpatient basis in our institute from January 2001 to November 2006. Of these 151 patients, 113 (38 male, 75 female; age range: 17- 65 years) were of Graves' disease. The median duration of symptoms in these patients was 4 years. (Range: 3 months to 20 years). Diagnosis was established on basis of clinical, biochemical and scintigraphic features. All the patients were treated medically with Neomercazole (Carbimazole) for varying durations (median 3.5 years). The dose range varied from 5 to 80 mg per day (median 20 mg per day). Clinical assessment of thyroid size revealed 39 patients with grade 0, 14 with grade 1, 30 with grade 2, and 30 with grade 3 goiters. Pre-therapy radioactive iodine uptake was done in 28 patients, which showed median values of 50 % at 4 hrs, 57.45 % at 24 hrs, and 56.2 % at 48 hrs respectively. These patients were treated empirically with I-131 in a dose range of 5 to 15 mCi, depending upon the clinical presentation and the RAIU values. Remission of symptoms with a single dose therapy was noticed in 68 patients. Of the 83 patients, 15 became hypothyroid within 3 months. These patients were on Neomercazole for a varying period of 2 to 20 years, at a dose range of 10 to 80 mg per day. 14 patients achieved remission after 2 doses with a cumulative RAI dose in the range of 10 to 19 mCi, at a median period of 7 to 24 months. Eight patients still showed hyperthyroid activity even after a second dose and are on follow-up. Seven patients achieved remission with a cumulative dose range of 17 to 35 mCi at a median duration of 10 months. One patient of Graves' disease who took Neomercazole for 10 years, at

  20. Thyroid mass estimation in Grave's disease by SPECT

    International Nuclear Information System (INIS)

    Pant, G.S.; Sharma, S.K.; Kumar, R.; Pandey, A.K.; Gupta, A.K.

    2002-01-01

    Aim: One of the important parts of treatment of Grave's disease with I-131 is the delivery of accurate dose to the target volume. Three important parameters that need to be accurately measured for dosimetry are; the 24 hr thyroid uptake (%), the thyroid mass and effective half life of I-131 in the gland. In this presentation we describe the estimation thyroid mass by SPECT. We have standardised a method to estimated thyroid volume by SPECT using thyroid phantoms of different sizes and then used them for routine thyroid mass estimation in patients with Graves' disease. Materials and Methods: Due to variation in thyroid weight in patients with Grave's disease, we standardised the scintigraphic (SPECT) technique using thyroid phantoms of different volumes such as 5 ml, 9.5 ml, 10.5 ml, 35 ml, 80 ml, 101ml and 110 ml. Each phantom was filled with 99 mTc solution with different activity concentration (100 μCi, 300 μCi, 600 μCi and 1.0 μCi) and SPECT images were acquired on a VARICAM dual head camera in 128x128 matrix. The acquired data was processed using a standardised Metz filter but without attenuation or scatter correction. Coronal slices were used with suitable threshold for edge detection. An irregular ROI was plotted around each lobe and isthmus of the thyroid gland and the enclosed slice area was measured. The area measured from all the frames was added and multiplied by the slice thickness to get the volume of the thyroid gland. The estimated volume of each phantom was compared and correlated with its actual volume. The thyroid mass in 40 patients was estimated by SPECT and compared with that estimated by ultrasonography.Results and Conclusion: The results of thyroid mass estimation with SPECT in phantom study suggested a 30% threshold for all phantom volumes. However, 35% threshold was used in patients' images for estimating thyroid volume. The estimated volumes by scintigraphy were compared with that estimated by ultrasonography. A correlation coefficient

  1. 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.

  2. Exacerbação aguda da fibrose pulmonar idiopática

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    Natália Melo

    2009-03-01

    Full Text Available Resumo: Alguns doentes com fibrose pulmonar idiopática (FPI apresentam durante a sua evolução fases de agravamento clínico sem causa conhecida, designadas como “exacerbação aguda” ou “fase acelerada” da doença (EA. Caracterizam-se pelo agravamento marcado da dispneia, hipoxemia e pelo aparecimento de novas opacidades pulmonares ou pelo agravamento das já existentes no estudo imagiológico. Os achados histológicos típicos são o dano alveolar difuso (DAD sobreposto a alterações de pneumonia intersticial usual (UIP. Esta entidade clínica associa-se a uma mortalidade elevada, não havendo até ao momento nenhuma terapêutica de comprovada eficácia.Os autores descrevem os casos clínicos de cinco doentes que apresentaram alterações clínicas, funcionais e radiológicas sugestivas de EA-FPI, assim como o tratamento efectuado e a evolução observada, enquadrando-os na discussão das características normalmente apresentadas por esta entidade. Abstract: Some patients with Idiopathic Pulmonary Fibrosis (IPF have disease accelerated deterioration without identifiable cause referred as “acute exacerbation” or “accelerated stage”. It is characterized by severe worsening of dyspnea, hypoxemia and new or progressive opacities on imaging studies. The typical histological findings are diffuse alveolar damage in addition to the features of usual interstitial pneumonia pattern. Mortality in this clinical entity is very high and no efficacious therapeutic have been described.The authors describe the clinical, functional and radiological features, treatment and evolution of five patients with IPF acute exacerbation. A discussion will be carry out concerning the IPF acute exacerbation usual features comparing with the alterations noticed in those patients. Palavras-chave: Fibrose pulmonar idiopática, exacerbação aguda, Key words: Idiopathic

  3. Nuevo enfoque de la interpretación del dolor en una pulpitis aguda

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    Andrés O Pérez Ruiz

    2000-04-01

    Full Text Available El dolor es probablemente el principal motivo de consulta en las urgencias estomatológicas y es precisamente el dolor de la pulpitis aguda el que comentamos en este trabajo. El dolor pulpar en sí mismo es similar al dolor que resulta por inflamación de los órganos viscerales y, por lo tanto, podrían ser inadecuados los intentos de explicarlos por comparación con los nociceptores de estructuras somáticas. Se propone analizar el comportamiento del dolor como consecuencia de una pulpitis aguda, con un nuevo enfoque, asimilándolo como el dolor proveniente de estructuras viscerales con manifestaciones dolorosas alejadas del sitio o zona dañada y en el propio diente en que el tejido ha sido injuriado y evoluciona rápidamente hacia la necrosis. Establecemos una analogía entre el dolor visceral como el generado de la pulpa y el del tipo somático profundo como el correspondiente a la afectación periapical por rápida evolución de la inflamación hacia la necrosis.Pain is probably the chief complaint in dental emergencies and this paper deals precisely with the pain caused by acute pulpitis. The pulpar pain itself is similar to the one resulting from inflammation of the visceral organs and, therefore, the attempts to explain these pains by comparing them with the nociceptors of somatic structures may be inappropiate. It is our objective to analyze the behaviour of pain caused by acute pulpitis with a new approach, assimilating it as the pain from visceral structures with painful manifestations far from the damaged site or zone and it is the own tooth whose tissue has been affected and evolves rapidly to necrosis.We establish an analogy between the visceral pain as the one generated by the pulpa and that of deep somatic type as the corresponding to the periapical affection by the fast evolution of inflammation to necrosis.

  4. Prevención de las infecciones respiratorias agudas: Presente y futuro

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    Roberto Razón Behar

    2003-12-01

    Full Text Available Las infecciones respiratorias agudas (IRA, son las causas más frecuentes de morbilidad en el mundo y de elevada mortalidad particularmente en los países en desarrollo. Los virus son los agentes etiológicos más frecuentes. Los virus influenza a y b, y el virus sincitial respiratorio (VSR son los más importantes por la severidad de la enfermedad y por la alta transmisibilidad. Las bacterias, principalmente el Streptococcus pneumoniae (neumococo, y el Haemophilus influenzae tipo B (Hib, son las causas más frecuentes de neumonías adquiridas en la comunidad. Las estrategias generales en la prevención y en el tratamiento se basan en: evaluar sistemáticamente los conocimientos existentes acerca de las IRA, divulgarlos y aplicarlos, desarrollar una guía nacional para las indicaciones de los antibióticos, aplicar las vacunas existentes: DPT, triple viral (SRP, anti-Hi, incrementar la inmunización contra el neumococo y los virus influenza, particularmente en grupos de riesgo y desarrollar y evaluar nuevas vacunas contra el VSR, Haemophilus influenzae no serotipificables, Bordetella pertussis y otros agentes infecciosos que afectan el aparato respiratorio. Se realiza una revisión de nuevos agentes y drogas antivirales, así como del desarrollo presente y futuro de las inmunizaciones contra los principales virus y bacterias, que causan infecciones respiratorias agudas.Acute respiratory infections (ARI are the most frequent cause of morbidity and of the high mortality in the world, particularly in the developing countries. The viruses are the most common etiological agents.The influenza a and b viruses and the syncytial respiratory virus (SRV are the most important due to the severity of the disease and to their high transmissibility. The bacteria, mainly Streptococcus pneumoniae (Pneumococcus, and Haemophilus influenzae type B (Hib, are the most frequent cause of pneumonias acquired in the community. The general strategies in the prevention and

  5. Efeitos hemodinâmicos da sobrecarga ventricular direita aguda experimental

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    Flávio Brito Filho

    2011-04-01

    Full Text Available FUNDAMENTO: A sobrecarga ventricular direita aguda está associada a situações clínicas de elevada morbimortalidade, tais como: ressecções pulmonares extensas, tromboembolismo pulmonar, transplante pulmonar e edema pulmonar das altitudes. Alguns pontos de sua fisiopatologia permanecem obscuros. OBJETIVO: Avaliar os efeitos hemodinâmicos da sobrecarga ventricular direita aguda experimental em suínos. MÉTODOS: A sobrecarga ventricular direita foi induzida pela oclusão das artérias pulmonares através de ligaduras. Vinte porcos foram utilizados no estudo, sendo alocados em 04 grupos: um controle, não submetido à oclusão vascular pulmonar, e três de sobrecarga ventricular direita submetidos à oclusão das seguintes artérias pulmonares: SVD1 (artéria pulmonar esquerda; SVD2 (artéria pulmonar esquerda e do lobo inferior direito e SVD3 (artéria pulmonar esquerda, do lobo inferior direito e do lobo mediastinal, obstruindo a vasculatura pulmonar em 42, 76 e 82,0% respectivamente. Variáveis de hemodinâmica foram medidas a cada 15 minutos durante a uma hora do estudo. Na análise estatística, foram utilizados ajustes de modelos lineares mistos com estrutura de variâncias e covariâncias. RESULTADOS: Nas comparações intergrupais, houve aumento significativo da frequência cardíaca (p = 0,004, pressão arterial pulmonar média (p = 0,001 e pressão capilar pulmonar (p < 0,0001. Houve redução significativa da pressão arterial média (p = 0,01 e do índice sistólico (p = 0,002. Não houve diferença significativa no índice cardíaco (p = 0,94. CONCLUSÃO: Apesar da intensa sobrecarga ventricular direita promovida pela obstrução de 82,0% da vasculatura pulmonar e pelo aumento significativo da pressão arterial pulmonar não houve disfunção cardiovascular severa e/ou choque circulatório no período estudado.

  6. Micronutrientes: una opción en el tratamiento de las enfermedades diarreicas agudas

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    Carlos Coronel Carbajal

    2000-12-01

    Full Text Available Se realizó un estudio longitudinal y prospectivo a 126 pacientes que ingresaron al Servicio de Diarreas Agudas del Hospital General Docente "Armando Enrique Cardoso", en el período comprendido entre junio de 1998 y enero de 1999. A 71 pacientes se les ofrecieron microelementos (vitamina A, sulfato de zinc y fumarato ferroso con el objetivo de conocer los beneficios de los microelementos en la enfermedad diarreica aguda. Al concluir el estudio se pudo comprobar que el grupo de pacientes suplementados tuvo una estadía más corta y la duración del episodio fue menor. Además se halló que en estos pacientes el número de deposiciones es menor, así como la afectación nutricional. También se comprobó cómo la recuperación nutricional es mucho más rápida, así como la recuperación del apetito. Se pudo mostrar cómo la consistencia de las deposiciones al tercer día de tratamiento, en el grupo que recibió micronutrientes, mejoró.A longitudinal and prospective study was conducted among 126 patients that were admitted in the Service of Acute Diarrheas of "Armando Enrique Cardoso" General Teaching Hospital between June, 1998, and January, 1999. 71 patients were administered microelements (vitamin A, zinc sulfate and ferrous fumarate in order to know their benefits in the acute diarrheal disease. On concluding the study, it was proved that the length of stay and the episode were shorter in the group of supplemented patients. It was also observed that the number of defecations as well as the nutritional affectation were lower in these patients and that the nutritional recovery and the recuperation of appetite were faster. The consistency of the defecations improved on the third day of treatment in the group that received micronutrients.

  7. Respuesta del sistema antioxidante en varones sanos, frente a hiperglicemia aguda inducida

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    Raquel Oré

    2009-09-01

    Full Text Available Objetivo: determinar la respuesta del sistema antioxidante en varones sanos, frente a la hiperglicemia aguda inducida. Diseño: estudio prospectivo, descriptivo, longitudinal, experimental. Lugar: Instituto Nacional de Biología Andina, Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú. Material biológico: Sangre y suero de sujetos aparentemente sanos. Intervenciones: A 13 sujetos adultos clínicamente sanos, entre 20 y 41años, después de 10 horas de ayuno, se administró glucosa vía endovenosa, mediante el método de clamp hiperglicémico, a 125 mg/dL por encima del valor basal, durante 120 minutos. Se realizó mediciones de la glicemia a 0, 5, 10, 15, 20, 30, 40, 50, 60, 70, 80, 90, 100, 110 y 120 minutos. Se tomó la muestra sanguínea con anticoagulante EDTA y otra de sangre total, para obtención de suero, para las pruebas bioquímicas a los 0, 60 y 120 minutos. Principales medidas de resultados: Modificaciones de la glicemia y lipoperoxidación en suero, glutatión y actividad superóxido dismutasa en glóbulos rojos lisados e índices de estrés oxidativo. Resultados: El nivel de glucosa durante el clamp hiperglicémico, luego de alcanzar el ‘equilibrio’, fue 197±17,58 mg/dL. La lipoperoxidación aumentó de 2,54 + 0,51 a 2,90 + 0,58 umol/L, de 0 a 60 minutos, y a 2,66 + 0,55 umol/L a los 120 minutos. El glutatión se redujo en 8,10% a la hora, aumentando 7,08% a los 120 minutos. La actividad superóxido dismutasa se elevó 0,54% a los 60 minutos y 5,66% a los 120 minutos, sobre el basal. Los índices de valoración del estrés oxidativo tuvieron correlación r Pearson positiva, en nivel alto a muy alto. Conclusiones: la hiperglicemia aguda inducida hasta 2 horas elevó el estrés oxidativo, promoviendo generación de defensa antioxidante, con síntesis de glutatión reducido de novo y mayor actividad de la superóxido dismutasa.

  8. Caracterización epidemiológica de la descompensación aguda del asma bronquial

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    Yanin Arteaga Prado

    2013-08-01

    Full Text Available Introducción: el asma bronquial tiene una compleja fisiopatología que involucra la presencia en el paciente de factores genéticos de atopia, mecanismos inmunológicos disfuncionales. Objetivo: caracterizar la asociación de diversos aspectos epidemiológicos con la aparición de descompensaciones agudas del asma bronquial. Material y método: se realizó un estudio descriptivo y transversal a 118 pacientes del área de dos consultorios médicos del Policlínico Universitario "Hermanos Cruz" de la Ciudad de Pinar del Río durante el primer trimestre del 2012. Se comparó el grupo de pacientes que presentaron descompensaciones de la enfermedad con el grupo de pacientes que no se descompensó. Se aplicó un cuestionario para explorar las variables de interés. Para verificar la asociación entre variables se utilizó el estadígrafo ji cuadrado para un valor de significación estadística á=0.05. Resultados: las descompensaciones agudas fueron casi dos veces más frecuentes en el sexo femenino. De manera muy significativa (Z=3,26 p<0,01 una tercera parte de los asmáticos de su enfermedad; las amas de casa y los estudiantes fueron los más afectados. Solo el 38,1 % de los asmáticos tuvo un adecuado seguimiento por un especialista (clínico, pediatra, alergólogo o inmunólogo y de estos solo el 11,1 % presentaron descompensaciones agudas, en tanto se descompensó un 39,7 % de los que no tienen seguimiento especializado. Conclusiones: la degradación de las condiciones de la vivienda favoreció la aparición de descompensaciones agudas del asma. En tres cuartas partes de las casas había animales domésticos, existiendo una fuerte asociación entre esta condición y la aparición de descompensaciones agudas del paciente asmático.

  9. Incidencia y factores de riesgo para adquirir diarrea aguda en una comunidad rural de la selva peruana

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    César Henríquez Camacho

    2002-04-01

    Full Text Available Objetivo: Determinar la incidencia y factores de riesgo para adquirir diarrea aguda en una comunidad rural localizada en la selva del departamento de San Martín, Perú. Material y métodos: Una cohorte de 119 personas fue seleccionada al azar entre la población de 446 habitantes y seguida diariamente por un mes entre enero y febrero de 1999, buscando casos de diarrea aguda, definida como tres ó más cámaras de deposiciones al día por no más de 3 días. Un estudio caso control pareado fue diseñado para determinar los factores de riesgo para adquirir diarrea. Resultados: Fueron observados 18 casos de diarrea aguda; la incidencia fue 15.1 casos por 100 personas-mes (IC 95%: 9.45-23.12. La edad media de los casos fue de 10.7 años (rango: 1-34 años y 66% de los casos fueron niños menores de 10 años de edad. Los factores de riesgo para adquirir diarrea fueron: consumo de alimentos crudos, RR: 2.2 (IC 95%: 1.12-4.33, consumo de alimentos no lavados, RR: 4.47 (IC 95%: 1.56-12.82, falta de lavado de manos antes de alimentarse, RR: 9.61 (95% IC: 1.44-64.16, consumo de agua no hervida, RR: 4.52 (IC 95%: 1.23-16.65 y alimentación fuera de casa, RR: 2.2 (IC 95%: 1.51-3.20. La diferencia en el número promedio (DE de personas que vivían por casa entre casos y controles fue de 4.38 (1.03 vs. 3.22 (0.54, p=0.0003, respectivamente. No hubo diferencia en el tiempo de residencia en la comunidad entre casos y controles, media de 5.61 ( 5.04 años vs. 8.83 (9.79, p=0.5747. Conclusiones: Diarrea aguda es un problema de salud pública en la selva de San Martín. Hacinamiento, carencia de saneamiento y pobres prácticas higiénicas son los responsables para adquirir diarrea aguda en esta comunidad de bajo nivel socioeconómico. Campañas educativas y mejora en las condiciones sanitarias son claramente necesarias para superar este problema.

  10. Hypothyroidism caused by 131I treatment for Graves disease

    International Nuclear Information System (INIS)

    Deng Shouzhen; Lin Xiangtong; He Wanting; Zhang Kaili; Zhang Jinming; Kuai Dayu

    1991-01-01

    The refollow-up has been carried out in hypothyroidism caused by 131 I 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 131 I 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 FT 4 I. 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, FT 4 I and Cholesterol during long term follow-up is beneficial for early diagnosis of hypothyroidism and evaluating the effect of substitution treatment

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

    International Nuclear Information System (INIS)

    Daubner, D.; Spieth, S.; Engellandt, K.; Kummer, R. von

    2012-01-01

    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.) [de

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

    International Nuclear Information System (INIS)

    Lee, Sang Woo; Lee, Jae Tae

    2003-01-01

    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

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

    DEFF Research Database (Denmark)

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

    2001-01-01

    The etiology of Graves' disease (GD), affecting up to 2% of a population in iodine-sufficient areas, is incompletely understood. According to current thinking, the development of GD depends on complex interactions among genetic, environmental, and endogenous factors. However, the relative...... contributions of the genetic and environmental factors remain to be clarified. In this study we report probandwise concordance rates for GD in a new cohort of same sex twin pairs born between 1953 and 1976 (young cohort), ascertained from the nationwide population-based Danish Twin Register. To elucidate...... the magnitude of the genetic and environmental influence in the etiology of GD, these new twin data were pooled with our previously published twin data on GD (old cohort). The old cohort consisted of 2338 same sex twin pairs born between 1870 and 1920 who had participated in questionnaire surveys during...

  14. Marrow hypoplasia: a rare complication of untreated Grave's disease.

    Science.gov (United States)

    Garcia, Juliana; França, Larissa de; Ellinger, Vivian; Wolff, Mônica

    2014-12-01

    Atypical presentation forms of hyperthyroidism are always a challenge to the clinician. We present a female patient with the typical symptoms of thyrotoxicosis, without any thionamides treatment before, associated with pancytopenia, which recovered after euthyroidism state was achieved. Although the major cases of pancytopenia in Grave's disease are seen as a complication of antithyroid drugs (thioamides), in this case report the alteration in blood tests was associated with untreated hyperthyroidism. In the literature review, we found 19 case reports between 1981 to 2012, but it has been related to a hypercellular bone marrow with periferic destruction. Our case, however, is about a hypocellular bone marrow without fibrosis or fat tissue replacement, which proceeded with a periferic improvement following thyroid treatment. Although rare, pancytopenia, when present, may develop as an unusual and severe manifestation in untreated subjects.

  15. Atypical Clinical Manifestations of Graves' Disease: An Analysis in Depth

    Science.gov (United States)

    Hegazi, Mohamed Osama; Ahmed, Sherif

    2012-01-01

    Over the past few decades, there has been an increase in the number of reports about newly recognized (atypical or unusual) manifestations of Graves' disease (GD), that are related to various body systems. One of these manifestations is sometimes the main presenting feature of GD. Some of the atypical manifestations are specifically related to GD, while others are also similarly seen in patients with other forms of hyperthyroidism. Lack of knowledge of the association between these findings and GD may lead to delay in diagnosis, misdiagnosis, or unnecessary investigations. The atypical clinical presentations of GD include anemia, vomiting, jaundice, and right heart failure. There is one type of anemia that is not explained by any of the known etiological factors and responds well to hyperthyroidism treatment. This type of anemia resembles anemia of chronic disease and may be termed GD anemia. Other forms of anemia that are associated with GD include pernicious anemia, iron deficiency anemia of celiac disease, and autoimmune hemolytic anemia. Vomiting has been reported as a presenting feature of Graves' disease. Some cases had the typical findings of hyperthyroidism initially masked, and the vomiting did not improve until hyperthyroidism has been detected and treated. Hyperthyroidism may present with jaundice, and on the other hand, deep jaundice may develop with the onset of overt hyperthyroidism in previously compensated chronic liver disease patients. Pulmonary hypertension is reported to be associated with GD and to respond to its treatment. GD-related pulmonary hypertension may be so severe to produce isolated right-sided heart failure that is occasionally found as the presenting manifestation of GD. PMID:22132347

  16. Association between polymorphisms in the TSHR gene and Graves' orbitopathy.

    Directory of Open Access Journals (Sweden)

    Beata Jurecka-Lubieniecka

    Full Text Available BACKGROUND: Graves' orbitopathy (GO as well as Graves' disease (GD hyperthyroidism originate from an autoimmune reaction against the common auto-antigen, thyroid-stimulating hormone receptor (TSHR. GO phenotype is associated with environmental risk factors, mainly nicotinism, as well as genetic risk factors which initiate an immunologic reaction. In some patients GO is observed before diagnosis of GD hyperthyroidism, while it can also be observed far after diagnosis. The intensity of GO symptoms varies greatly in these patients. Thus, the pathogenesis of GD and GO may correlate with different genetic backgrounds, which has been confirmed by studies of correlations between GO and polymorphisms in cytokines involved in orbit inflammation. The aim of our analysis was to assess genetic predisposition to GO in young patients (age of diagnosis ≤30 years of age, for whom environmental effects had less time to influence outcomes than in adults. METHODS: 768 GD patients were included in the study. 359 of them had clinically evident orbitopathy (NOSPECS ≥2. Patients were stratified by age at diagnosis. Association analyses were performed for genes with a known influence on development of GD - TSHR, HLA-DRB1, cytotoxic T-lymphocyte antigen 4 (CTLA4 and lymphoid protein tyrosine phosphatase (PTPN22. RESULTS: The rs179247 TSHR polymorphism was associated with GO in young patients only. In young GO-free patients, allele A was statistically more frequent and homozygous carriers had a considerable lower risk of disease incidence than patients with AG or GG genotypes. Those differences were not found in either elderly patients or the group analyzed as a whole. CONCLUSIONS: Allele A of the rs179247 polymorphism in the TSHR gene is associated with lower risk of GO in young GD patients.

  17. Total thyroidectomy: is morbidity higher for Graves' disease than nontoxic goiter?

    Science.gov (United States)

    Welch, Kellen C; McHenry, Christopher R

    2011-09-01

    Total thyroidectomy for treatment of Graves' disease is controversial and much of the debate centers on the concern for complications. The purpose of this study was to evaluate the morbidity of total thyroidectomy for Graves' disease and determine if it is different than for patients with nontoxic nodular goiter. The rates of life threatening neck hematoma, recurrent laryngeal nerve (RLN) injury, transient hypocalcemia, and hypoparathyroidism were determined for consecutive patients with Graves' disease treated with total thyroidectomy from 1996 to 2010. Results were compared with patients who underwent total thyroidectomy for nontoxic nodular goiter during the same period, matched for the weight of the excised thyroid gland. Total thyroidectomy was performed in 111 patients with Graves' disease (group I) and 283 patients with nontoxic nodular goiter (group II). Parathyroid autotransplantation was performed in 31(28%) patients in group I and 98 (35%) patients in group II (P = NS). Comparative analysis of morbidity revealed no significant difference in neck hematoma, 0(0%) (I) versus 3(1%) (II); permanent RLN injury, 0(0%) (I) versus 2(1%) (II); and permanent hypoparathyroidism in 1(1%) (I) versus 1 (0.4%) (II) (P = NS). Transient hypocalcemia was more common in patients with Graves' disease, 80(72%) (I) versus 170 (60%) (II) (P Graves' disease; only transient hypocalcemia occurred more often than in patients with nodular goiter. Total thyroidectomy should be presented as a therapeutic option for all patients with Graves' disease. Copyright © 2011 Elsevier Inc. All rights reserved.

  18. Enhancement of soluble CD28 levels in the serum of Graves' disease.

    Science.gov (United States)

    Sun, Zhongwen; Yi, Lixian; Tao, Hong; Huang, Jingfang; Jin, Zhenghong; Xiao, Yang; Feng, Caiyun; Sun, Jing

    2014-01-01

    Graves' disease is an autoimmune disease of the thyroid gland mediated by T cells. CD28, a member of costimulatory molecules, plays a pivotal role in regulating T-cell responses. Plasma-soluble CD28 is one form of CD28 in peripheral blood. To investigate the concentrations of soluble CD28 in patients with Graves' disease, we used a sensitive dual monoclonal antibody sandwich enzyme-linked immunosorbent assay (ELISA) to detect the soluble form of CD28. Our results suggested that mean concentrations of soluble CD28 in plasma of patients with Graves' disease were 1.79 ±1.52 ng/ml, and levels of soluble CD28 in healthy subjects were only 0.83 ±1.35 ng/ml. Concentrations of soluble CD28 detected in patients with Graves' disease were significantly higher than those of healthy subjects (p Graves' disease. Therefore, aberrant elevation of plasma-soluble CD28 in patients with Graves' disease may reflect the dysregulation of immune system, and may serve as a useful biomarker in Graves' disease diagnosis.

  19. Hypocalcaemia after total thyroidectomy for Graves' disease and for benign atoxic multinodular goitre.

    Science.gov (United States)

    Hallgrimsson, Páll; Nordenström, E; Bergenfelz, A; Almquist, M

    2012-10-01

    Postoperative hypocalcaemia has been reported to be more common after total thyroidectomy (TT) for Graves' disease than after TT for benign atoxic multinodular goitre (MNG). The reasons for this potential association are not clear. In the present study, the frequency and risk factors of hypocalcaemia after TT for Graves' vs MNG were compared. Between January 1999 and October 2009, patients with first-time surgery for Graves' disease or MNG treated with a TT were included in the study. Postoperative hypocalcaemia was defined by symptoms, calcium levels and treatment with calcium and/or vitamin D analogues during postoperative hospital stay, at discharge, and at the 6-week and 6-month follow-ups. Outcomes were compared with Mann-Whitney, chi(2) and Fishers' exact test where appropriate and by multivariable logistic regression analysis. There were 128 patients with Graves' disease and 81 patients with MNG. Patients with Graves' disease were younger than patients with MNG (median age, 35 vs 51 years, p Graves' disease (p Graves' disease, there was no difference in the overall frequency of biochemical hypocalcaemia, low levels of PTH and/or treatment with calcium and vitamin D.

  20. 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.

  1. Thyrotoxic Graves' disease with normal thyroidal technetium-99m pertechnetate uptake

    Energy Technology Data Exchange (ETDEWEB)

    Ikekubo, Katsuji; Hino, Megumu; Ito, Hidetomi; Koh, Toshikiyo; Ishihara, Takashi; Kurahachi, Hiroyuki (Kobe City General Hospital (Japan)); Kasagi, Kanji; Hidaka, Akinari; Mori, Toru

    1990-07-01

    We saw 24 thyrotoxic Graves' patients with normal thyroidal uptake of technetium-99m pertechnetate ({sup 99m}Tc) out of 201 untreated thyrotoxic Graves' patients seen over 4 years. The clinical and laboratory findings for these patients were studied and analyzed. Thyroid uptake and scintigraphic examinations by means of {sup 99m}Tc, TBII and TSab activity measurement clearly distinguished these patients from other thyrotoxic disorders (destruction-induced thyrotoxicosis and autonomously functioning thyroid lesions). Different from other disorders, these patients had not lower but normal thyroid uptake and also showed diffuse and discrete trapping into the enlarged glands. These patients had significantly smaller goiters, a lower serum thyroid hormone level, and lower TBII and TSab activity, when compared with other high {sup 99m}Tc uptake groups with Graves' disease, and their condition could be easily controlled with small amounts of antithyroid drugs. Our study indicates that thyrotoxic Graves' disease with normal {sup 99m}Tc uptake exists and {sup 99m}Tc uptake study and TBII activity measurement is very useful for the diagnosis. The normal {sup 99m}Tc uptake thyrotoxic Graves' patient might be early stage patients with general Graves' disease and their early discrimination from general Graves' patients is very advantageous for treatment and prognosis. (author).

  2. First reported case of unilateral Graves' disease in the left lobe of a bilobar thyroid gland.

    Science.gov (United States)

    Chen, Louis C; Green, Jennifer B

    2011-06-01

    Unilateral Graves' disease is a rare disease variant that can occur in a bilobar thyroid gland. We report the first documented case of unilateral Graves' disease in the left lobe of a bilobar thyroid gland and review the pertinent literature. A 48-year-old man presented in June 2010 with thyrotoxicosis. I-131 radioisotope uptake was elevated at 33.4%, and scintigraphy revealed that uptake of the radioisotope was uniformly increased in the left lobe of the thyroid gland. Ultrasonography of the thyroid gland revealed a non-nodular, enlarged, and heterogeneous left lobe; Doppler investigation of the lobe showed hypervascularity classically seen in Graves' disease. The right lobe of the thyroid, on the other hand, appeared homogeneous and hypovascular on ultrasonography. Thyroid-stimulating immunoglobulin was significantly elevated at 191% (reference range disease was the most likely diagnosis. As has occasionally been described in the literature, unilateral involvement of the thyroid gland is a rare presentation of Graves' disease. Pre-existing functional or structural differences (either congenital or acquired) between the two lobes may contribute to this rare presentation. To our knowledge, this is the first reported case of unilateral Graves' disease presenting in the left lobe of a bilobar thyroid gland. Although the pathophysiology of unilateral Graves's disease has not been clearly elucidated, clinicians should be aware that Graves' disease can present unilaterally in either lobe of the thyroid gland.

  3. Graves' disease associated with infectious mononucleosis due to primary Epstein-Barr virus infection: report of 3 cases.

    Science.gov (United States)

    Akahori, Hiroshi; Takeshita, Yumie; Saito, Reina; Kaneko, Shuichi; Takamura, Toshinari

    2010-01-01

    Although the etiology of Graves' disease is still not clear, it is generally suggested that environmental factors such as infections contribute to the development of Graves' disease. We report here three cases of Graves' disease which presented simultaneously with infectious mononucleosis due to primary EBV infection. Acute EBV infection might play an important role in the onset of Graves' disease. These three women complained of a sore throat or neck pain, resembling subacute thyroiditis. In the case of thyrotoxicosis accompanied by sore throat or neck pain, Graves' disease must be distinguished from subacute thyroiditis.

  4. p27kip1 expression distinguishes papillary hyperplasia in Graves' disease from papillary thyroid carcinoma.

    Science.gov (United States)

    Erickson, L A; Yousef, O M; Jin, L; Lohse, C M; Pankratz, V S; Lloyd, R V

    2000-09-01

    In most cases, the histopathologic and cytologic distinction between Graves' disease and papillary thyroid carcinoma is relatively easy, but on occasion Graves' disease may simulate a thyroid papillary carcinoma. For example, papillary fronds with fibrovascular cores may be present in both Graves' disease and papillary carcinoma. p27kip1 (p27) is a cyclin-dependent kinase inhibitory protein that has been shown to be an independent prognostic factor in a variety of human tumors. Our previous studies of p27 expression in hyperplastic and neoplastic endocrine lesions showed that the level of p27 was quite different in these two conditions. To determine if this distinction could also be made between Graves' disease and papillary carcinoma, we analyzed expression of p27 and other cell cycle proteins in a series of cases of Graves' disease with papillary hyperplasia and a series of papillary thyroid carcinomas. Formalin-fixed paraffin-embedded tissues from 61 randomly selected patients with thyroid disease, including 29 cases of Graves' disease with papillary architectural features and 32 cases of papillary carcinoma, were analyzed for expression of p27, Ki-67, and DNA topoisomerase II alpha (topo II alpha) by immunostaining. The distribution of immunoreactivity was analyzed by quantifying the percentage of positive nuclei that was expressed as the labeling index (LI) plus or minus the standard error of the mean. The papillary hyperplasia of Graves' disease had a p27 LI of 68.2 +/- 3.1 (range, 24 to 88), whereas papillary carcinomas had a LI of 25.6 +/- 2.5 (range, 12 to 70) (P hyperplasia in Graves' disease and papillary carcinoma. These results indicate that p27 protein expression is significantly higher in papillary hyperplasia of Graves' disease compared to papillary carcinoma, which may be diagnostically useful in difficult cases.

  5. OTITIS MEDIA AGUDA. DIAGNÓSTICO Y MANEJO PRÁCTICO

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    Dr. Francisco J. Krause

    2016-11-01

    Full Text Available La otitis media aguda es una patología infecciosa del oído medio muy frecuente. El diagnóstico es clínico, por lo que es fundamental un acucioso examen físico y una neumootoscopía para evaluar la movilidad timpánica. Hay dos tendencias respecto al manejo, tratamiento antibiótico inmediato u observación estricta (dependiendo de las características del paciente y del cuadro clínico. Los gérmenes más frecuentes son los virus, Neumococo, Haemophilus influenza y Moraxella catarrhalis. La prevalencia de cada uno de ellos varía según región geográfica y según la presencia de vacunación. La resistencia a antibióticos ha ido en aumento en estos años, pero aún puede considerarse sensible a amoxicilina por lo que se recomienda su uso como primera línea. En el caso de fracaso a tratamiento pueden utilizarse asociaciones con B-lactámicos y/o cefalosporinas, dejando en forma excepcional clindamicina o quinolonas. Aquellos niños con OMA recurrente requerirán evaluación por especialidad para mayor estudio y tratamiento.

  6. Insuficiência renal aguda em paciente tratada com ATRA e anfotericina B: relato de caso

    Directory of Open Access Journals (Sweden)

    Gelcimar Moresco

    2011-06-01

    Full Text Available O presente relato apresenta o caso clínico de uma paciente com leucemia promie-locítica aguda tratada com ácido todo-transretinoico (ATRA, que apresentou suspeita de síndrome do ácido transreti-noico (síndrome de ATRA. Com a ocor-rência de leucopenia febril inespecífica, foram associados ao tratamento antimi-crobianos e antifúngicos. A diminuição da função renal, observada inicialmente, contribuiu para a suspeita de síndrome de ATRA, que foi agravada pelos antifúngi-cos. Assim, o uso de ATRA foi suspenso, mas somente 8 dias depois foi caracteriza-da pneumonia e descartada a hipótese de síndrome de ATRA. Nesse contexto, foi discutida a nefrotoxicidade do ATRA e a potencialização desse efeito adverso pelo uso de antifúngicos nefrotóxicos, em par-ticular da anfotericina B, assim como a im-portância do diagnóstico diferencial entre síndrome de ATRA e doença infecciosa.

  7. Subtipos moleculares de PML/RARα en pacientes con leucemia promielocítica aguda

    Directory of Open Access Journals (Sweden)

    María del Carmen Castro-Mujica

    2013-03-01

    Full Text Available El objetivo fue describir la frecuencia de los subtipos moleculares de PML/RARα en pacientes con leucemia promielocítica aguda (LPA y su distribución según grupo de riesgo de recaída y citomorfología. Se realizó una serie de casos que incluyó a cincuenta pacientes registrados en el Instituto Nacional de Enfermedades Neoplásicas (INEN, durante el periodo 2010-2012, con diagnóstico molecular de LPA PML/RARα y subtipos bcr1, bcr2 y bcr3 por reacción en cadena de la polimerasa con transcriptasa reversa (RT-PCR. El subtipo bcr1 fue el más frecuente (62%. Los pacientes con riesgo de recaída intermedio y morfología hipergranular fueron, en su mayoría, bcr1 (70% y todos los que poseían riesgo de recaída alto y morfología hipogranular fueron bcr3. Se concluye que en la población estudiada hay un predomino del subtipo bcr1 y que existen diferencias en la distribución de los subtipos bcr1 y bcr3 según el grupo de riesgo de recaída y citomorfología

  8. Leucemias agudas en ancianos de la provincia de Santiago de Cuba

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    Lidia Clara Suárez Beyríes

    2015-04-01

    Full Text Available Se realizó un estudio descriptivo y retrospectivo de 64 pacientes mayores de 60 años con leucemia aguda, atendidos en el Servicio de Hematología del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, durante el quinquenio 2006-2011, para determinar las principales características clínicas y hematológicas en el momento del diagnóstico, así como la supervivencia global de los afectados, aunque los tratamientos administrados no tenían criterio curativo. La edad promedio de los ancianos fue de 70 años, en un rango etario de 60 a 90; en tanto, la variedad no linfoblástica representó 98,4 %, y todos los pacientes presentaron anemia y trombocitopenia como alteraciones hematológicas, con incremento en los requerimientos transfusionales. De igual forma, la presencia de blastos en la sangre periférica se demostró en 50 % y la hiperleucocitosis en 59,4 %, mientras las principales causas de muerte estuvieron relacionadas con la hemorragia cerebral y la progresión de la enfermedad con la infiltración multiorgánica, lo cual condujo a una supervivencia muy corta de los integrantes de la serie

  9. Consumo alimentar e estresse em pacientes com síndrome coronariana aguda

    Directory of Open Access Journals (Sweden)

    Evelise Helena Fadini Reis Brunori

    2015-10-01

    Full Text Available RESUMOObjetivo:Avaliar se o consumo alimentar de pacientes com síndrome coronariana aguda (SCA segue as recomendações nacionais e internacionais e se existe relação com níveis de estresseMétodo:Estudo transversal com 150 pacientes com SCA que foram entrevistados utilizando-se os Questionários de Frequência Alimentar e Escala de Estresse Percebido-10.Resultados:Consumo diário acima das recomendações: colesterol (92%, fi bras (42,7% e proteínas (68%; consumo abaixo das recomendações: potássio (88% e carboidratos (68,7%; consumo conforme recomendações: sódio (53,3% e lípides (53,3%. A maioria (54% com consumo alimentar inadequado era estressada ou altamente estressada. Houve associação estatisticamente signifi cante entre menor nível de estresse e maior consumo de fibras.Conclusão:Em pacientes com SCA, o consumo alimentar esteve fora do recomendado pelas diretrizes e o menor consumo de fibras ocorre concomitantemente com maior estresse. Esforços educativos podem instrumentalizar os pacientes na adequação do consumo alimentar e no controle do estresse.

  10. Toxicidad aguda de las hojas de Xanthium spinosum en ratones BALB/C

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    Arturo Silvero-Isidre

    2016-01-01

    Full Text Available Las hojas de la planta Xanthium spinosum se utilizan culturalmente en Paraguay por sus propiedades medicinales. Se evaluó la toxicidad aguda del extracto de hojas maduras; para el estudio se seleccionaron 35 ratones BALB/C machos que fueron distribuidos en 7 grupos, 6 de ensayo y 1 de control. El extracto fue preparado en concentraciones de 6 y 9% (g/dL; se administró la solución 6% a tres grupos y la solución 9% a los otros tres grupos, con dosis entre 200 y 1000 mg/kg. Al final de 14 días de observación, se extrajeron muestras de sangre para estudios laboratoriales de urea y transaminasas, además de órganos para estudios anatomopatológicos. Se determinaron aumentos en los niveles de GOT y urea en comparación al grupo control. Se concluye que el consumo del extracto de hojas maduras de Xanthium spinosum puede causar daño hepático.

  11. Actuación de enfermería en la leucemia mieloide aguda.

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    Melchor Pino, Pilar

    2012-08-01

    Full Text Available La leucemia mieloide aguda (LMA es una proliferación neoplásica de células inmaduras de estirpe mieloide que se produce por una alteración en el crecimiento y diferenciación de las células hematopoyéticas.En este trabajo se presenta un caso clínico sobre un paciente de 37 años diagnosticado de LMA. Se hace una valoración de las necesidades básicas siguiendo el modelo de Virginia Henderson al ingreso del paciente, mediante una entrevista dirigida y la obtención de datos mediante la observación.El objetivo general es elaborar un plan individualizado de cuidados a dicho paciente, mediante la aplicación del Proceso Enfermero y la utilización de la taxonomía NANDA-NOC-NIC que nos permitirá aplicar unos cuidados de calidad a este paciente.Cuando el paciente abandone el hospital, la enfermera le entregará un informe de alta, que asegurará la continuidad de sus cuidados.

  12. Reacciones adversas e interacciones medicamentosas en el tratamiento de las enfermedades respiratorias agudas

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    Oneyda Clapé Laffita

    2000-12-01

    Full Text Available Como continuación de los estudios de farmacovigilancia en la Unidad de Cuidados Intensivos e Intermedios del Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora", se evaluaron las reacciones adversas e interacciones medicamentosas detectadas en el tratamiento de las enfermedades respiratorias agudas, para lo cual se aplicó el método de vigilancia intensiva del paciente hospitalizado, a fin de validar los datos obtenidos farmacológica y estadísticamente. Se encontraron 96 reacciones adversas y 47 interacciones medicamentosas, valores estos que fueron relacionados con aspectos clínicos y demográficos. Los posibles riesgos quedaron atenuados por las medidas propuestas en cada plan terapéutico y la orientación farmacológica al enfermo.As part of the pharmacovigilance studies conducted at the Intensive and Intermediate Care Unit of the "Saturnino Lora" Provincial Clinical and Surgical Teaching Hospital, the adverse reactions and drug interactions detected in the treatment of acute respiratory diseases were evaluated. The method of intensive surveillance of the hospitalized patient was used to validate the data obtained from the pharmacological and statistical point of view. 96 adverse reactions and 47 drug interactions were found. These values were related to clinical and demographic aspects. The possible risks were attenuated by the measures proposed in each therapeutic plan and the pharmacological advice given to the patient.

  13. Histological Changes in Autoimmune Hepatitis with Graves' Disease: A Child Case Report.

    Science.gov (United States)

    Yamada, Mamiko; Shibata, Hironori; Masugi, Yohei; Ishi, Tomohiro; Kameyama, Kaori; Ebinuma, Hirotoshi; Hasegawa, Tomonobu

    2017-08-15

    We herein report a child case of autoimmune hepatitis (AIH) accompanied with Graves' disease. Elevated aminotransferase levels were found in a 12-year-old Japanese girl with Graves' disease. In her first liver biopsy, necrosis and inflammation was limited to the centrilobular area, while the second biopsy showed different findings. Namely, portal injury newly appeared, including interface hepatitis, which represents the histological characteristics of AIH. As the histological findings at the onset of AIH do not always show typical findings, a re-biopsy is considered to be important in individuals suspected to have AIH. AIH should be included in the differential diagnosis of liver dysfunction in Graves' disease, even in children.

  14. Chylothorax Associated with Substernal Goiter in Graves' Disease Treated with Radioactive Iodine.

    Science.gov (United States)

    Young Oh, Seo; Hyun Kim, Bo; Young Kim, Do; Min Lee, Kyu; Jin Lee, Min; Su Kim, Sung; Ho Kim, Jong; Kyung Jeon, Yun; Soo Kim, Sang; Ki Kim, Yong; Joo Kim, In

    2017-04-01

    We present a rare case of chylothorax associated with an intrathoracic goiter in Graves' disease that was treated with radioactive iodine. A 23-year-old woman with Graves' disease was referred to our clinic with a pleural effusion, dyspnea, characteristic bilateral proptosis, and a diffuse goiter. The pleural fluid biochemistry was consistent with chylothorax. However, the chylothorax did not decrease with conservative therapy. Therefore, RAI was administered. Subsequently, the chylothorax and goiter improved more quickly than expected. This case illustrates that chylothorax associated with a substernal goiter in Graves' disease can be treated successfully with radioactive iodine instead of surgery.

  15. Mortality in Graves' orbitopathy is increased and influenced by gender, age and pre-existing morbidity

    DEFF Research Database (Denmark)

    Schwensen, Charlotte F; Hjelm Brandt Kristensen, Frans; Hegedüs, Laszlo

    2017-01-01

    INTRODUCTION: It is unclear whether the excess mortality associated with Graves' disease differs between individuals with Graves' orbitopathy (GO) or without (GD). SUBJECTS AND METHODS: A nationwide, register-based cohort study in which all adult Danes diagnosed with GD (n = 28 461) and GO (n......-existing morbidity using the Charlson score. RESULTS: Adjusted mortality in Graves' disease overall (GD + GO) was significantly increased compared to that in the background population (HR = 1.18 (95% confidence interval: 1.15-1.21)). In GD and GO separately, adjusted mortality was also significantly higher than...

  16. The curative effect analysis of 131I-therapy on patients with Graves' disease

    International Nuclear Information System (INIS)

    Cui Qin; Lu Shujun; Lu Tianhe

    2002-01-01

    To investigate the curative effect of 131 I-therapy on Graves' disease, the authors analyse conditions of patients who have received 131 I-therapy (n -674). These results showed that the incidence of fully recover, improve, Graves' disease and invalid is 80.11%, 7.28%, 11.87% and 0.74% respectively. Therefore, 131 I-therapy on Graves' disease is convenient. It has little side effect, low cost and better curative effect, it is one of the best therapeutic methods to treat hyperthyroidism

  17. Radioiodine treatment of Graves' disease. An assessment of its potential risks

    International Nuclear Information System (INIS)

    Graham, G.D.; Burman, K.D.

    1986-01-01

    Concern about the side effects of radiation exposure has deterred physicians from using radioiodine treatment for Graves' disease, although the efficacy and safety of this treatment have been established in the 35 years since its introduction. In that time, no significant side effects have been discovered. We believe iodine-131 should be considered the treatment of choice in most patients with Graves' disease. This article reviews the current understanding of the risks in radioiodine treatment of Graves' disease, including the risks for teratogenicity, genetic damage, carcinogenesis, and cellular dysfunction

  18. The experience of gasless endoscopic-assisted thyroidectomy via the anterior chest approach for Graves' disease.

    Science.gov (United States)

    Hong, Yun; Yu, Shi-Tong; Cai, Qian; Liang, Fa-Ya; Han, Ping; Huang, Xiao-Ming

    2016-10-01

    The aim of this study was to evaluate the safety, feasibility, effectiveness, and cosmesis of a gasless endoscopic-assisted thyroidectomy via the anterior chest in patients with Graves' disease. We retrospectively reviewed 38 patients with Graves' disease treated with thyroidectomy from November 2007 to June 2015. We analyzed clinical characteristics of patients, type of operation, operative indications, operative duration, length of postoperative hospital stay, and postoperative complications. The thyroidectomies were classified as total thyroidectomy (n = 12) or near-total thyroidectomy with a remnant of Graves' disease is a safe, feasible, and effective and provides an excellent cosmetic outcome procedure. It is a valid option in appropriately selected patients.

  19. Activation of latent Graves' disease in children. Review of possible psychosomatic mechanisms.

    Science.gov (United States)

    Morillo, E; Gardner, L I

    1980-03-01

    In some children, psychological events have appeared to be important in the triggering of Graves' disease. This report examines the case histories of three children in whom the appearance of symptomatology of Graves' disease was associated with depression following the death of a loved one. An analysis of neuroendocrine and immunologie pathways suggests that depression, set off by bereavement, causes low levels of norepinephrine in the brain. The latter in turn may mediate an increase in ACTH and cortisol, leading to reductions in immune surveillance and resultant production of thyroid-stimulating immunoglobulins, hence the development of Graves' disease.

  20. Remission of aplastic anemia induced by treatment for Graves disease in a pediatric patient.

    Science.gov (United States)

    Das, Prabodh Kumar; Wherrett, Diane; Dror, Yigal

    2007-08-01

    Aplastic anemia (AA) is mediated by T-cell autoimmunity in the majority of cases; it is rare and mostly idiopathic in children. We describe a child, who developed AA following Graves' disease which could not be attributed to antithyroid drugs. We hypothesized that both diseases were caused by similar autoimmune process. We monitored the blood counts and did not administer any conventional treatment for AA assuming that the existing anti- hematopoietic stem cell humoral and cellular immunity might subside with induction of remission of Grave's disease. The child went into complete remission with the treatment of the Graves' disease.

  1. Resposta circulatória à caminhada de 50 m na unidade coronariana, na síndrome coronariana aguda Respuesta circulatoria a la caminata de 50m en la unidad coronaria, en la síndrome coronaria aguda Circulatory response to a 50-m walk in the coronary care unit in acute coronary syndrome

    Directory of Open Access Journals (Sweden)

    Cristiane Maria Carvalho Costa Dias

    2009-02-01

    Full Text Available FUNDAMENTO: Ausência de técnica padronizada e monitorada para iniciar a reabilitação de pacientes com síndrome coronariana aguda (SCA, na unidade coronariana. OBJETIVO: Descrever a técnica e a resposta circulatória à caminhada de 50 m (C50m. MÉTODOS: Estudo experimental, transversal, com 65 pacientes com SCA; destes 36 (54% com infarto agudo do miocárdio (IAM, Killip I; 29 (45,2% com angina instável (AI; 61,5% do sexo masculino, idade 62,8 ± 12,7 anos. Caminhada com início 45 ± 23 horas pós-internamento. Mensuraram-se pressão arterial sistólica (PAS mmHg e diastólica (PAD mmHg, freqüência cardíaca (FC bpm, duplo produto (PAS mmHg X FC bpm, saturação periférica de oxigênio (SpO2%, tempo de caminhada e percepção do esforço pela escala de Borg (EB. Obtiveram-se medições nas posições supina, sentada e ortostase (fase 1 - estresse gravitacional, no final da caminhada e pós-repouso de 5 minutos (fase 2 - estresse físico. RESULTADOS: Observou-se aumento da FC ao estresse gravitacional sentado (Δ = 4,18 e em ortostase (Δ = 2,69, (p 142 mmHg ao sentar associou-se com aumento significativo (p = 0,031 de 11 mmHg ao exercício em 13 pacientes com sobrepeso/obesidade e 85% com hipertensão. Verificaram-se efeitos adversos em 19 (29,2% pacientes, tonturas em 23,1%, com impedimento da caminhada em três deles. CONCLUSÃO: Nesta amostra, após 24 horas do evento coronariano, não se verificaram efeitos colaterais graves à C50m.FUNDAMENTO: Ausencia de técnica estandarizada y de monitoreo para iniciarse la rehabilitación de pacientes con síndrome coronaria aguda (SCA, en la unidad coronaria. OBJETIVO: Describir la técnica y la respuesta circulatoria a la caminata de 50m (C50m./ MÉTODOS: Estudio experimental, transversal, con 65 pacientes con SCA; el número de 36 (54% de ellos con infarto agudo de miocardio (IAM, Killip I; un total de 29 (45,2% con angina instable (AI; el 61,5% del sexo masculino, edad 62,8 ± 12,7 a

  2. Síndrome de ativação macrofágica secundária à infecção aguda pelo vírus Epstein-Barr Macrophage activation syndrome triggered by Epstein-Barr virus

    Directory of Open Access Journals (Sweden)

    Adolpho X. de Carvalho Filho

    2008-06-01

    Full Text Available A síndrome de ativação macrofágica (SAM ou síndrome hemofagocítica secundária (reativa consiste de uma rara, grave e potencialmente fatal complicação das doenças reumáticas crônicas, particularmente da artrite idiopática juvenil de início sistêmico, doença de Still do adulto e lúpus eritematoso sistêmico. É caracterizada pela excessiva ativação dos macrófagos, resultando febre, hepatoesplenomegalia, linfadenomegalia, envolvimento neurológico, graus variáveis de citopenias, hiperferritinemia, distúrbio hepático, coagulação intravascular e freqüente falência de múltiplos órgãos. Também ocorre em associação com neoplasias, imunodeficiências e variedade de agentes infecciosos virais (sobretudo do grupo do herpes, bacterianos e fúngicos. Relatamos um caso de SAM decorrente de infecção viral aguda pelo vírus Epstein-Barr tratado com corticóide oral

  3. Mortalidad asociada a hemorragia digestiva alta por enfermedad ácido péptica en pacientes operados Mortality associated with upper gastrointestinal bleeding due to peptic acid disease in patients operated

    Directory of Open Access Journals (Sweden)

    Lucas García Orozco

    2013-04-01

    Full Text Available Introducción: existen diversos criterios en cuanto a la identificación de los pacientes con sangrado digestivo alto que requieren tratamiento quirúrgico de urgencia, dada la alta tasa de letalidad y mortalidad que presentan. Objetivo: valorar la mortalidad por hemorragia digestiva alta asociada a enfermedad ácido péptica. Métodos: se realizó una investigación descriptiva de 38 pacientes que habían sido operados por hemorragia digestiva asociada a enfermedad ácido péptica, que fallecieron en el Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" durante el decenio 2002-2011. Resultados: en la casuística se encontró un predominio del sexo masculino y del grupo etario de 60 y más años. Los sangrados masivo y persistente constituyeron las situaciones más comunes para decidir el tratamiento quirúrgico urgente. La vagotomía troncular más piloroplastia fue la técnica más empleada, en tanto la infección respiratoria y el choque séptico resultaron ser las principales complicaciones posoperatorias; este último y la disfunción multiorgánica fueron las causas directas de muerte más representativas. Conclusiones: para seleccionar la técnica quirúrgica en cada paciente debe tenerse en cuenta la causa del sangrado, la localización, el estado clínico y la edad. La vagotomía troncular asociada a algún procedimiento de drenaje resultó la más utilizada porque es menos laboriosa y el efecto antiácido más efectivo.Introduction: there are several criteria regarding the identification of patients with upper gastrointestinal bleeding who require emergency surgical treatment because of their high lethality and mortality rate. Objective: to value the mortality due to high gastrointestinal bleeding associated with acid peptic disease. Methods: a descriptive study was carried out in 38 patients who were operated due to gastrointestinal bleeding associated with acid peptic disease and who died in "Saturnino Lora

  4. Upper gastrointestinal bleeding: risk factors for mortality in two urban centers in Latin America Hemorragia digestiva alta: factores de riesgo para mortalidad en dos centros urbanos de América Latina

    Directory of Open Access Journals (Sweden)

    C. H. Morales Uribe

    2011-01-01

    Full Text Available Objective: to describe the experience with upper gastrointestinal bleeding (UGIB in two major Latin American hospitals; its main cuses, treatment and prognosis, while exploring some risk factors associated with death. Design: prospective cohort study. Patients and methods: We included 464 patients older than 15 years of age from two reference centers. We studied some demographic variables, history, clinical presentation, treatment and mortality. We explored the association betwen those variables and death. Results: The mean age was 57.9 years, and the male: female ratio was 1.4:1. Three hundred and fifty nine patients (77.4% were seen for gastrointestinal bleeding (outpatients bleeding and 105 patients (22.6% were inpatients seen for UGIB. A total of 71.6% of patients admitted with the diagnosis of upper GI bleeding underwent upper GI emdoscopy (EGD within 24 hours. The main causes of bleeding were peptic ulcer (190 patients, 40.9%, erosive disease (162 patients, 34.9% and variceal bleeding (47 patients, 10.1%. Forty four patients died (9.5%. Patient who presented with bleeding due to other causes during hospitalization has a higher mortality risk than those whose complaints were related to gastrointestinal bleeding (RR 2.4, 95% CI 1.2-4.6. An increasing number of comorbidities such as those described in the Rockall Score, were also associated with a higher risk of mortality (RR 2.5 95% CI 1.1-5.4. Conclusion: Intrahospital upper GI bleeding and the presence of comorbilities ares risk factors for a fatal outcome. Identifying patients with a higher risk would help improve the management of patients with UGIB.Objetivo: presentar la experiencia con la hemorragia de vías digestivas alta (HDA en dos hospitales centros de referencia de un país latinoamericano, las principales causas, tratamiento, pronóstico y explorar algunos factores de riesgo asociados con la mortalidad. Diseño: estudio de cohortes prospectivo. Pacientes y métodos: se

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

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    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).

  6. The observation of the therapeutic effectiveness of 131I on 260 youngster with Grave's hyperthyroidism

    International Nuclear Information System (INIS)

    Liu Binwen; Gao Xiusheng; Zhang Yahua; Pu Dongli

    2003-01-01

    Objective: To study the therapeutic effect and find new ways on treatment of Grave's hyperthyroidism in youngsters. Methods: 260 Grave's hyperthyroidism patients (age under 21 years) treated with 131 I were followed up 1-16 years later. Results: 118 of all patients were cured and 55 cases improved, failed treatment 2 cases, subclinical hypothyroidism 9 cases, clinical hypothyroidism 6 cases. 35 cases were treated with 131 I two or three times. All the patients with subclinical hypothyroidism and clinical hypothyroidism caused by 131 I were cured with medicine. 131 I treatment had no effect on growth and mentality and didn't cause leukemia nor thyroid cancer. Conclusions: The therapy of youngsters with Grave's hyperthyroidism with 131 I has the same effectiveness as adult. To the youngster Grave's patients who failed medical treatment, therapy with 131 I is safe and effective. It leads to temporary hypothyroidism which can be cured with medicine, no delayed hypothyroidism has been found

  7. A questionnaire survey on the management of Graves' orbitopathy in Europe

    NARCIS (Netherlands)

    Perros, P.; Baldeschi, L.; Boboridis, K.; Dickinson, A. J.; Hullo, A.; Kahaly, G. J.; Kendall-Taylor, P.; Krassas, G. E.; Lane, C. M.; Lazarus, J. H.; Marcocci, C.; Marino, M.; Mourits, M. P.; Nardi, M.; Orgiazzi, J.; Pinchera, A.; Pitz, S.; Prummel, M. F.; Wiersinga, W. M.

    2006-01-01

    OBJECTIVE: To determine management patterns among clinicians who treat patients with Graves' orbitopathy (GO) in Europe. DESIGN AND METHODS: Questionnaire survey including a case scenario of members of professional organisations representing endocrinologists, ophthalmologists and nuclear medicine

  8. Important considerations in the management of Graves' disease in pregnant women.

    Science.gov (United States)

    Okosieme, Onyebuchi E; Lazarus, John H

    2015-01-01

    Graves' disease is an autoimmune disorder in which autoantibodies to the thyroid-stimulating hormone receptor cause hyperthyroidism through unregulated stimulation of the thyroid-stimulating hormone receptor. Effective management of Graves' disease in pregnancy must address the competing fetal and maternal priorities of controlling hyperthyroidism in the mother on the one hand, and on the other, minimizing the impact of maternal disease and antithyroid drugs on the well-being of the fetus. Optimal strategies for achieving this intricate balance are currently a source of continued debate among thyroid experts and studies in recent decades are now providing greater clarity into the risk posed to the unborn baby by the combination of biochemical, immunological and pharmacological hazards arising from Graves' disease and its therapy. This review summarizes the current best practice and highlights important considerations and areas of uncertainty in the management of Graves' disease in pregnant women.

  9. Comparison of curative effect of 131I and antithyroid drugs in Graves' disease: a meta analysis.

    Science.gov (United States)

    Yuan, Ju; Lu, Xiuqing; Yue, Yan

    2017-03-01

    Radioactive 131I is currently reported to be a potential effective intervention for Graves' Disease treatment in China. Whether 131I treatment was associated with effective outcome or reduced risk of side effects, reccurence rate remained unknown. Eligible studies were selected from Chinese VIP, Wangfang, CNKI databases using the keywords "Iodine" and "Graves Disease". Finally, 13 clinical trials met the inclusion criterion and were included this meta-analysis. Our meta-analysis included 1355 patients diagnosed of Graves' Disease with regular anti-thyroid drugs oral administration and 1320 patients with 131I therapy. The results showed that there was significant symptom improvement with radioactive iodine intervention (Odd Ratio (OR)=4.50, 95% CI [3.55, 5.71], PGraves' Disease. Treatment with 131I was associated with better clinical outcome; it reduced side effects and reccurence rate but increased hypothyroidism in Graves' Disease.

  10. 131I-therapy of graves' disease and non-immunogenic thyrotoxicosis

    International Nuclear Information System (INIS)

    Hoeschel, M.; Heinze, H.G.

    1984-01-01

    From 1977 to 1982, 315 patients suffering from thyrotoxicosis with diffuse and/or nodular goitre or Graves' disease were treated with 131 I. In 246 patients, the results of treatment after 7 months to 5 1/2 years could be evaluated. After a single treatment with 131 I, 72% of the patients with hyperthyroid nodular goitre and 61% of those with diffuse goitre, but only 36% of the patients with Graves' disease showed normal thyroid function. By repeated 131 I treatments - as many as 5 for those with Graves' disease - normal thyroid function could be achieved in nearly all patients examined. Patients with immune thyrotoxicosis, type Graves' disease, showed a high resistance to therapy. A dependence was found between the results of these treatments and previous antithyroidal drug therapy or surgery. The rate of hypothyroidism varied between 4 and 15%. The highest rate of hypothyroidism was observed in operated patients with persistent or recurring thyrotoxicosis. (orig.) [de

  11. The observation on plasma endothelin levels in patients with graves' disease

    International Nuclear Information System (INIS)

    Hao Xiaojun; Liu Changshan; Yang Lianrong; Zhang Qiliang; Wang Honggang; Liu Xudong

    2002-01-01

    Observing the plasma endothelin levels in patients with Graves' disease to probe its clinical significance, plasma endothelin levels were measured in 55 cases of Graves' disease before and after treatment respectively, and these were compared with that of 23 health subjects. Results: plasma endothelin levels in patients with Graves' disease significantly increase, compared with heath subjects (150.4 +- 29.31 ng/L vs 42.80 +- 7.58 ng/L, P < 0.01); post-treatment endothelin levels apparently decrease (97.61 +- 15.99 ng/L vs 150.4 +- 29.31 ng/L, P < 0.01). Plasma endothelin levels in patients with Graves' disease significantly increase, and after treatment the endothelin levels decrease following decreasing of thyroid hormone level and high hemodynamics

  12. Modified lateral orbital wall decompression in Graves' orbitopathy using computer-assisted planning.

    Science.gov (United States)

    Spalthoff, S; Jehn, P; Zimmerer, R; Rana, M; Gellrich, N-C; Dittmann, J

    2018-02-01

    Graves' orbitopathy, a condition seen in the autoimmune syndrome Graves' disease, affects the fatty tissue and muscles inside the orbit. Graves' orbitopathy is associated with increasing exophthalmos and sometimes leads to compressive dysthyroid optic neuropathy, resulting in progressive vision loss. Dysthyroid compressive optic neuropathy, functional problems, and cosmetic problems are the main indications for surgical decompression of the orbit, especially if conservative treatment has not led to a reduction in symptoms. Many surgical techniques are described in the literature. This article presents a modification of the lateral orbital wall osteotomy, involving the rotation and reduction of the osteotomized bone segment using preoperative planning, intraoperative computed navigation, and piezoelectric surgery. This new method combines the advantages of different techniques and appears to be a valid approach to the treatment of severe cases of Graves' orbitopathy. Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  13. Cradle to Grave: an Analysis of Female Oppression in Nawal El ...

    African Journals Online (AJOL)

    Cradle to Grave: an Analysis of Female Oppression in Nawal El Saadawi.s Woman ... An International Journal of Language, Literature and Gender Studies ... Women are subjected to male oppression and suppression at various stages of life.

  14. A 27-year-old woman diagnosed as polycystic ovary syndrome associated with Graves' disease.

    Science.gov (United States)

    Jung, Jung Hwa; Hahm, Jong Ryeal; Jung, Tae Sik; Kim, Hee Jin; Kim, Ho Soo; Kim, Sungsu; Kim, Soo Kyoung; Lee, Sang Min; Kim, Deok Ryong; Choi, Won Jun; Seo, Yeong Mi; Chung, Soon Il

    2011-01-01

    Polycystic ovary syndrome (PCOS) and Graves' disease are the common causes of menstrual irregularity leading to infertility in women of child-bearing age. A 21-year-old female patient visited us with complaints of oligomenorrhea and hand tremor. She was diagnosed as having PCOS and hyperthyroid Graves' disease, simultaneously. She had low body weight (BMI: 16.4 kg/m(2)), mild hirsutism, and thyrotoxicosis. The patient was treated with anti-thyroid drug and beta-blocker for about two years, and then recovered to normal thyroid function. Although some studies have suggested a connection between PCOS and autoimmune thyroiditis, no study indicated that PCOS is associated with Graves' disease until now. Here, we describe the first case report of a lean woman with normal insulin sensitivity presenting PCOS and Graves' disease simultaneously.

  15. The incidence of diplopia following coronal and translid orbital decompression in Graves' orbitopathy

    NARCIS (Netherlands)

    Paridaens, D.; Hans, K.; van Buitenen, S.; Mourits, M. P.

    1998-01-01

    PURPOSE: Firstly, to assess the incidence of induced diplopia following orbital decompression in patients with Graves' orbitopathy. Secondly, to assess patient satisfaction after orbital decompression. Thirdly, to determine the factors that contribute to the variable reported incidence of diplopia

  16. Transconjunctival orbital decompression in Graves' ophthalmopathy: lateral wall approach ab interno

    NARCIS (Netherlands)

    A.D.A. Paridaens (Dion); K. Verhoeff; D. Bouwens; W.A. van den Bosch (Willem)

    2000-01-01

    textabstractAIMS: A modified surgical technique is described to perform a one, two, or three wall orbital decompression in patients with Graves' ophthalmopathy. METHODS: The lateral wall was approached ab interno through a "swinging eyelid" approach (lateral canthotomy

  17. Early versus late orbital decompression in Graves' orbitopathy: a retrospective study in 125 patients

    NARCIS (Netherlands)

    Baldeschi, Lelio; Wakelkamp, Iris M. M. J.; Lindeboom, Robert; Prummel, Marc F.; Wiersinga, Wilmar M.

    2006-01-01

    PURPOSE: To determine if early rehabilitative orbital decompression in Graves' orbitopathy (GO) leads to a more effective postoperative outcome than the same intervention performed at a later, more likely, fibrotic stage. DESIGN: Retrospective comparative case series. PARTICIPANTS: The medical

  18. Agranulocitosis inducida por metimazol en pacientes con enfermedad de Graves

    Directory of Open Access Journals (Sweden)

    Helard Manrique-Hurtado

    2013-04-01

    Full Text Available Objetivo: Describir las características clínicas y epidemiológicas de los pacientes con enfermedad de Graves que presentaron agranulocitosis inducida por metimazol. Material y métodos: Estudio retrospectivo, tipo serie de casos. Se revisaron las historias clínicas de todos los pacientes con diagnóstico de agranulocitosis inducida por metimazol, atendidos en el Hospital Nacional Arzobispo Loayza, entre enero 2002 y diciembre 2008. Se buscó asociación entre las variables demográficas y clínicas con la mortalidad y el tiempo de recuperación. Resultados: Treinta (0,60% pacientes con enfermedad de Graves fueron hospitalizados con el diagnóstico de agranulocitosis inducida por metimazol. La mediana de la edad fue 33,5 años y 86,67% fueron mujeres. Al ingreso, todos los pacientes presentaron fiebre y dolor de garganta. El manejo incluyó aislamiento invertido, suspensión del metimazol, administración de antibióticos y glucocorticoides. Doce (40% pacientes recibieron GM-CSF. El número de granulocitos se normalizó después de 10,59 días y cuatro (13,33% pacientes murieron por infecciones bacterianas y sepsis. En todos los casos, el tratamiento definitivo fue yodo radioactivo. No hubo diferencia significativa en la edad, sexo, dosis de metimazol, duración del tratamiento y uso de factor estimulante colonia, entre los pacientes fallecidos y los sobrevivientes. Además, el uso de factor estimulante de colonia no redujo el tiempo de recuperación de la agranulocitosis. Conclusión: La agranulocitosis inducida por metimazol es un evento adverso serio y potencialmente mortal. En este grupo de pacientes, la mortalidad fue elevada y el uso de factor estimulante de colonia no disminuyó el tiempo de recuperación.

  19. Strategies of radioiodine therapy for Graves' disease

    Energy Technology Data Exchange (ETDEWEB)

    Lind, P. [Department of Nuclear Medicine and Endocrinology, PET Center Klagenfurt, LKH Klagenfurt (Austria)

    2002-08-01

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

  20. High-dose radioiodine therapy of Graves disease

    International Nuclear Information System (INIS)

    Solodky, V.; Fomin, D.; Pestritskaya, E.

    2015-01-01

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