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Sample records for limbal grave mediante

  1. Tratamento da miastenia grave mediante imunossupressão medicamentosa não esteróide

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    José Lamartine de Assis

    1986-06-01

    Full Text Available São estudados 14 pacientes (doze dos quais eram mulheres com miastenia grave severa e resistente aos procedimentos terapêuticos habituais. Em um paciente a prednisona foi substituída pela imunossupressão com citotóxicos e em outro o emprego destes permitiu redução da dose do esferóide, que passou a ser bem tolerado. Nos dois casos o emprego dos citostáticos foi decorrência de complicações da prednisona. São empregadas azatioprina e ciclosfosfamida em programas em que estão associadas, na maioria dos casos, prednisona e plasmaférese. Todos os pacientes mantiveram o uso de anticolinesterásicos. A azatioprina é administrada pela via oral nas doses de 100-200mg/dia por período de 20 meses, enquanto a ciclofosfamida é empregada pela via oral nas doses de 100-200mg/dia por 6 meses ou lg pela via intravenosa a intervalos de 15-30 dias durante 6 meses. O período mais longo de observação até o momento é de 32 meses. Ocorreram melhoras importantes em 71,4% dos pacientes, sendo que em 8 (57% as melhoras começaram entre um e 6 meses após o início do tratamento. Efeitos colaterais foram infreqüentes e de pouca monta, não tendo ocorrido complicações graves dependentes diretamente das drogas até o momento.

  2. Predicción de amputación mediante MESS (Mangled Extremity Severity Score) en pacientes con lesión traumática vascular grave

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    Delgado Martínez, Antonio D.; Rodríguez Merchan, E. C.; A. Hernández Díaz; Ballesteros Massó, Rafael

    1995-01-01

    En este estudio retrospectivo y ciego se analizan las historias clínicas de 60 pacientes (63 miembros inferiores), que ingresaron en nuestro hospital desde 1978 a 1992 a causa de una lesión traumática vascular grave; en este grupo no se incluyeron los pacientes con traumatismo vascular localizado por encima de la cadera o debajo del tobillo. El objetivo del estudio ha sido investigar si el MESS (Mangled extremity severity score) es un sistema útil para decidir entre la amputaci...

  3. Presence of bilateral limbal dermoids and choroidal osteomas in a family with inherited limbal dermoids.

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    Magli, A; De Marco, R; Capasso, L

    1999-06-01

    We report a case of bilateral limbal dermoids and bilateral choroidal osteomas in a 14-year-old girl with no extraocular anomalies. Histopathological examination of a limbal lesion confirmed the clinical diagnosis of dermoid. Computerized tomography and ultrasonography were compatible with a diagnosis of choroidal osteoma. Limbal dermoids were present in the patient's mother, in a brother with Down syndrome, and in an aunt with no choroidal osteoma. The present pedigree is compatible with autosomal dominant inheritance of bilateral limbal dermoids. The same gene may be involved in the pathogenesis of ocular choristomas in same patients.

  4. Limbal melanocytes support limbal epithelial stem cells in 2D and 3D microenvironments.

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    Dziasko, Marc A; Tuft, Stephen J; Daniels, Julie T

    2015-09-01

    Human limbal epithelial stem cells (LESCs) are essential for the maintenance of the corneal epithelium of the ocular surface. LESCs are located within limbal crypts between the palisades of Vogt in the limbus; the interface between the peripheral cornea and conjunctiva. The limbal crypts have been proposed as a LESC niche owing to their support of epithelial cells, which can form holoclone colonies in vitro. Closely associated with the limbal crypts is a concentrated population of melanocytes. The anatomical location and close proximity to putative LESC suggests that melanocytes might play a role in maintenance of these stem cells in the niche. The aim of this study was to assess the ability of human limbal melanocytes (hLM) to support the expansion of human limbal epithelial cells (LECs) in vitro as an indicator of functional cell-cell interaction. After observing that hLM co-localize with clusters of compact epithelial cells in the native limbal crypts, hLM were isolated from crypt-rich cadaveric limbal biopsies and used as feeders for the culture of LECs. Interestingly, LECs grown on mitotically active hLM were able to generate large epithelial colonies that contained small and compact cells with morphological stem cell characteristics. Immunocytochemistry revealed that LECs expanded on hLM were positive for the expression of the putative stem cell markers CK15, Bmi-1 and p63α and negative for the marker of terminal cell differentiation CK3. LECs and hLM were finally co-cultured on RAFT (real architecture for 3D tissue) collagen tissue equivalents. In 3D co-cultures, hLM promoted multi-layering of the epithelial sheet in which basal cells were maintained in an undifferentiated state. Taken together, these observations suggest melanocytes could play an important role in the maintenance of LESCs in the native human limbal stem cell niche.

  5. Unilateral partial limbal stem cell deficiency: contralateral versus ipsilateral autologous cultivated limbal epithelial transplantation.

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    Vazirani, Jayesh; Basu, Sayan; Kenia, Hemal; Ali, Md Hasnat; Kacham, Santhosh; Mariappan, Indumathi; Sangwan, Virender

    2014-03-01

    To report the outcomes of autologous cultivated limbal epithelial transplantation using the healthy part of the affected eye or the fellow eye as a source of limbal stem cells in patients with unilateral, partial limbal stem cell deficiency (LSCD). Retrospective, nonrandomized, interventional case series. setting: L. V. Prasad Eye Institute, Hyderabad, India. study population: Patients with unilateral, partial LSCD who underwent autologous cultivated limbal epithelial transplantation between 2001 and 2011. intervention: The limbal biopsy was taken either from the healthy part of the limbus of the same eye (ipsilateral group) or from the healthy fellow eye (contralateral group). Cells were cultivated using a xeno-free explant culture technique, and cultivated cells were transplanted onto the affected surface. primary outcome measure: Success of cultivated limbal epithelial transplantation, defined as a completely epithelialized, avascular, and clinically stable corneal surface. Seventy eyes of 70 patients were studied. The mean follow up was 17.5 ± 7 months. In 34 eyes the limbal biopsy was taken from the ipsilateral eye and in the remaining 36 eyes from the contralateral eye. Clinical success was achieved in 70.59% of eyes in the ipsilateral group and 75% of eyes in the contralateral group (P = .79). Limbal transplant survival rates at the final follow-up visit were 65.1% ± 0.09% in the ipsilateral group and 53.6% ± 0.12% in the contralateral group (P = .74). Ocular surface restoration in partial LSCD is possible with cell-based therapy. Outcomes are similar irrespective of whether the limbal biopsy is taken from the healthy part of the ipsilateral eye or the contralateral eye. Copyright © 2014 Elsevier Inc. All rights reserved.

  6. [Graves' ophthalmopathy].

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    Badelon, Isabelle; Morax, Serge

    2005-01-31

    Graves' ophthalmopathy (GO) is a chronic autoimmune process that affects the retrobulbar tissue and has strong etiological links with graves' disease. Pathogenesis is incompletely understood. Symptoms include proptosis, extraocular muscle dysfunction, eyelid swelling and retraction. In its severe expression, it is a disfiguring and potentially sight threatening disease that profoundly influences and impairs the quality of life of affected individuals. Only a minority of patients develop severe expressions of the disease, requiring aggressive treatments. Glucocorticoids, orbital radiotherapy and decompressive orbital surgery represent a mainstay and a well established treatment for severe and active GO.

  7. Limbal stem cell transplantation: current perspectives

    Directory of Open Access Journals (Sweden)

    Atallah MR

    2016-04-01

    Full Text Available Marwan Raymond Atallah, Sotiria Palioura, Victor L Perez, Guillermo Amescua Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA Abstract: Regeneration of the corneal surface after an epithelial insult involves division, migration, and maturation of a specialized group of stem cells located in the limbus. Several insults, both intrinsic and extrinsic, can precipitate destruction of the delicate microenvironment of these cells, resulting in limbal stem cell deficiency (LSCD. In such cases, reepithelialization fails and conjunctival epithelium extends across the limbus, leading to vascularization, persistent epithelial defects, and chronic inflammation. In partial LSCD, conjunctival epitheliectomy, coupled with amniotic membrane transplantation, could be sufficient to restore a healthy surface. In more severe cases and in total LSCD, stem cell transplantation is currently the best curative option. Before any attempts are considered to perform a limbal stem cell transplantation procedure, the ocular surface must be optimized by controlling causative factors and comorbid conditions. These factors include adequate eyelid function or exposure, control of the ocular surface inflammatory status, and a well-lubricated ocular surface. In cases of unilateral LSCD, stem cells can be obtained from the contralateral eye. Newer techniques aim at expanding cells in vitro or in vivo in order to decrease the need for large limbal resection that may jeopardize the “healthy” eye. Patients with bilateral disease can be treated using allogeneic tissue in combination with systemic immunosuppressive therapy. Another emerging option for this subset of patients is the use of noncorneal cells such as mucosal grafts. Finally, the use of keratoprosthesis is reserved for patients who are not candidates for any of the aforementioned options, wherein the choice of the type of keratoprosthesis depends on

  8. [Graves' ophthalmopathy].

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

    2016-04-01

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

  9. Cytological features of live limbal tissue donor eyes for autograft or allograft limbal stem cell transplantation

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    Jeison de Nadai Barros

    2011-08-01

    Full Text Available PURPOSE: To evaluate by impression cytology (IC the corneal surface of live limbal tissue donor eyes for autograft or allograft limbal stem cell transplantation (LSCT. METHODS: Twenty limbal donors were enrolled (17 for autograft LSCT and 3 for allograft. Impression cytology was performed before transplantation of superior and inferior limbal grafts and after the third postoperative month. RESULTS: Impression cytology analysis showed sheets of corneal epithelial cells and goblet cell absence beyond the edge of the keratectomy sites in all patients, suggesting that conjunctival invasion towards the center did not occur in any eye. Partial conjunctivalization within 2 to 3 clock hours, confirmed by the presence of goblet cells, was limited to the keratectomy site in 10% of the cases. CONCLUSION: A clear central corneal surface was demonstrated in all eyes following surgery leading to the conclusion that limbal donation was a safe procedure in this group of patients. A small percentage of eyes can have donor sites re-epithelized with conjunctival cells at the periphery of the cornea.

  10. A Human Corneal Epithelial Cell Line Model for Limbal Stem Cell Biology and Limbal Immunobiology.

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    Shaharuddin, Bakiah; Ahmad, Sajjad; Md Latar, Nani; Ali, Simi; Meeson, Annette

    2016-10-14

    : Limbal stem cell (LSC) deficiency is a visually debilitating condition caused by abnormal maintenance of LSCs. It is treated by transplantation of donor-derived limbal epithelial cells (LECs), the success of which depends on the presence and quality of LSCs within the transplant. Understanding the immunobiological responses of these cells within the transplants could improve cell engraftment and survival. However, human corneal rings used as a source of LSCs are not always readily available for research purposes. As an alternative, we hypothesized that a human telomerase-immortalized corneal epithelial cell (HTCEC) line could be used as a model for studying LSC immunobiology. HTCEC constitutively expressed human leukocyte antigen (HLA) class I but not class II molecules. However, when stimulated by interferon-γ, HTCECs then expressed HLA class II antigens. Some HTCECs were also migratory in response to CXCL12 and expressed stem cell markers, Nanog, Oct4, and Sox2. In addition because both HTCECs and LECs contain side population (SP) cells, which are an enriched LSC population, we used these SP cells to show that some HTCEC SP cells coexpressed ABCG2 and ABCB5. HTCEC SP and non-side population (NSP) cells also expressed CXCR4, but the SP cells expressed higher levels. Both were capable of colony formation, but the NSP colonies were smaller and contained fewer cells. In addition, HTCECs expressed ΔNp63α. These results suggest the HTCEC line is a useful model for further understanding LSC biology by using an in vitro approach without reliance on a supply of human tissue. Limbal stem cell deficiency is a painful eye condition caused by abnormal maintenance of limbal stem cells. It is treated by transplantation of limbal epithelial cells derived from human tissue. The success of this treatment depends of the quality of the cells transplanted; however, some transplants fail. Understanding more about the immunobiology of these cells within the transplants could

  11. Bone geometry, biomechanics, and mineral content of the distal radius in uremic patients with severe hyperparathyroidism; Valutazione delle proprieta' geometriche, biomeccaniche e osteodensitometriche del radio ultradistale mediante tomografia computerizzata quantitativa periferica nei pazienti uremici affetti da iperparatiroidismo grave

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    Di Leo, C.; Tarolo, G.L.; Bestetti, A.; Tagliabue, L.; Del Sole, A.; Aliberti, G. [Ospedale S. Paolo, Milan (Italy). Cattedra e Scuola di Specializzazione in Medicina Nucleare. Servizio di Medicina Nucleare; Ardemagni, A.; Gallieni, M.; Brancaccio, M.; Froehlich, W. [L' Accessorio nucleare (ACN). Laboratori scientifici, Cerro Maggiore, MI (Italy)

    1999-04-01

    Bone integrity and mineral status were studied with a noninvasive method in uremic patients with severe secondary hyperparathyroidism undergoing maintenance hemodialysis. [Italian] Gli autori propongono un metodo non invasivo per studiare la densita' minerale e le caratteristiche geometriche e biomeccaniche dell'osso nei pazienti uremici affetti da iperparatiroidismo secondario grave.

  12. Preliminary Evidence that the Limbal Ring Influences Facial Attractiveness

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    Darren Peshek

    2011-04-01

    Full Text Available The limbal ring of the eye appears as a dark annulus where the iris meets the sclera. Both width and opacity of the limbal ring are influenced by iris pigmentation and optical properties of the region. With age the limbal ring becomes less prominent, making it a probabilistic indicator of youth and health. This raises the question: Are judgments of facial attractiveness sensitive to this signal in a potentially adaptive way? Here we show that the answer is yes. For male and female observers, both male and female faces with a dark and distinct limbal ring are rated as more attractive than otherwise identical faces with no limbal ring. This result is observed not just for upright faces but also for inverted faces, suggesting that the limbal ring is processed primarily as a local feature rather than as a configural feature in the analysis of facial beauty. We also discuss directions for future research that can clarify the role of the limbal ring in the visual perception of facial attractiveness.

  13. Variations in the technique for autologous limbal transplantation.

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    Mataix, B; Alcántara, A; Caro, M; Montero, J; Ponte, B; Rodríguez de la Rúa, E

    2016-10-01

    To present the results on the use of a single block limbal autograft, combined with amniotic membrane transplantation and sectoral sequential postoperative epitheliectomy of the conjunctiva in 2 patients with unilateral total limbal stem cell deficiency. A single block limbal autograft combined with amniotic membrane transplantation may be sufficient to restore a stable corneal surface, but sometimes sequential sectoral conjunctival epitheliectomy may be required to treat anomalous epithelial remnants. Copyright © 2016 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.

  14. Chronic inflammatory cells and damaged limbal cells in pterygium

    African Journals Online (AJOL)

    EB

    2013-09-03

    Sep 3, 2013 ... Background: Chronic inflammation in pterygium occurrence has not been explained. ... Methods: Chronic inflammatory changes and damaged limbal basal epithelial cells were assessed in 59 samples. ..... Acute and chronic.

  15. Limbal Stem Cell Deficiency: Current Treatment Options and Emerging Therapies

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    Michel Haagdorens

    2016-01-01

    Full Text Available Severe ocular surface disease can result in limbal stem cell deficiency (LSCD, a condition leading to decreased visual acuity, photophobia, and ocular pain. To restore the ocular surface in advanced stem cell deficient corneas, an autologous or allogenic limbal stem cell transplantation is performed. In recent years, the risk of secondary LSCD due to removal of large limbal grafts has been significantly reduced by the optimization of cultivated limbal epithelial transplantation (CLET. Despite the great successes of CLET, there still is room for improvement as overall success rate is 70% and visual acuity often remains suboptimal after successful transplantation. Simple limbal epithelial transplantation reports higher success rates but has not been performed in as many patients yet. This review focuses on limbal epithelial stem cells and the pathophysiology of LSCD. State-of-the-art therapeutic management of LSCD is described, and new and evolving techniques in ocular surface regeneration are being discussed, in particular, advantages and disadvantages of alternative cell scaffolds and cell sources for cell based ocular surface reconstruction.

  16. Limbal and corneal calcification in patients with chronic renal failure.

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    Klaassen-Broekema, N; van Bijsterveld, O P

    1993-09-01

    In patients with chronic renal failure on regular dialysis treatment, limboconjunctival degenerations and calcifications are commonly observed. In this study three groups of patients were followed over a period of 6 years. The first group consisted of 47 patients with renal failure, the second group of 17 patients with renal failure and hyperparathyroidism not controlled by drugs, and the third group seven patients with primary hyperparathyroidism without renal failure. The aim of this study was to determine the progression of the limboconjunctival changes over time. The hypothesis that an increase in serum calcium and phosphorus concentrations, as a result of tertiary hyperparathyroidism, could possibly add a corneal component to the limbal calcification was also tested. All patients with renal failure (in as much as the degenerative limbal features were not obscured by deposits of lime salts), had a type II white limbus girdle of Vogt. This limbal degeneration was observed in only 45% of controls. In all 47 patients with renal failure conjunctival calcification was observed; 26 of them also had limbal calcification. After 6 years 41 patients had developed limbal calcification. This progression was statistically significant. In 15 out of 17 patients with tertiary hyperparathyroidism a band-shaped keratopathy developed in addition to the limboconjunctival calcification.

  17. Limbal dermoid in Nager acrofacial dysostosis: A rare case report

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    Rohit Malik

    2014-01-01

    Full Text Available Nager syndrome, also called preaxial acrofacial dysostosis, comprises two groups of defects involving the limbs and craniofacial region, respectively. This syndrome is rare and only 70 cases have been reported in the literature. The exact cause of this syndrome is unknown, but there is indication that it is genetically based. Ocular manifestations of this syndrome include widely separated downward slanting eyes, absence of eyelashes, ptosis of upper eyelids and colobomas on the inner aspect of lower eyelids. We report limbal dermoid in a patient with Nager syndrome. We did not find such an association of "Limbal dermoid in Nager acrofacial dysostosis syndrome" on PubMed using Nager acrofacial dysostosis, limbal dermoid and ocular manifestations as the keywords.

  18. Limbal stem cells: Central concepts of corneal epithelial homeostasis

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    Jinny; J; Yoon; Salim; Ismail; Trevor; Sherwin

    2014-01-01

    A strong cohort of evidence exists that supports the localisation of corneal stem cells at the limbus. The distinguishing characteristics of limbal cells as stem cells include slow cycling properties, high proliferative potential when required, clonogenicity, absence of differentiation marker expression coupled with positive expression of progenitor markers, multipotency, centripetal migration, requirement for a distinct niche environment and the ability of transplanted limbal cells to regenerate the entire corneal epithelium. The existence of limbal stem cells supports the prevailing theory of corneal homeostasis, known as the XYZ hypothesis where X represents proliferation and stratification of limbal basal cells, Y centripetal migration of basal cells and Z desquamation of superficial cells. To maintain the mass of cornea, the sum of X and Y must equal Z and very elegant cell tracking experiments provide strong evidence in support of this theory. However, several recent stud-ies have suggested the existence of oligopotent stem cells capable of corneal maintenance outside of the limbus. This review presents a summary of data which led to the current concepts of corneal epithelial homeostasis and discusses areas of controversy surrounding the existence of a secondary stem cell reservoir on the corneal surface

  19. Graves disease (image)

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

  20. Graves' ophthalmopathy: interdisciplinary approach

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    O I Vinogradskaya

    2010-12-01

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

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

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

    2015-09-01

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

  2. Early Results of Autologous Cultivated Limbal Stem Cell Transplantation in Total Limbal Stem Cell Deficiency

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    Mohammad Ali Javadi

    2008-12-01

    Full Text Available

    PURPOSE: To report the early results of transplantation of autologous limbal stem cells cultivated on amniotic membrane (AM in patients with total unilateral limbal stem cell deficiency (LSCD. METHODS: Four eyes of 4 patients with total unilateral LSCD confirmed with impression cytology underwent transplantation of autologous limbal stem cell cultivated on AM. At each follow up visit, a complete eye examination with special attention to recurrence or regression of vascularization, corneal opacification, and epithelial defect healing was performed. Digital imaging was performed at each follow up visit. Impression cytology was repeated in all cases after surgery. RESULTS: The patients were followed for 5-13 months. Visual acuity improved in all cases. Decrease in corneal opacification and vascularization was obvious in 3 cases with coverage of the cornea with corneal epithelium. Sectoral conjunctivalization was evident in these 3 cases, however the corneas were ready for transplantation. The procedure failed in one case with total corneal conjunctivalization. CONCLUSION: Transplantation of autologous stem cells cultivated on AM seems to be an effective way for total LSCD. More definite judgment needs longer follow up together with long-term results of corneal transplantation in these patients.

  1. Chitosan-gelatin biopolymers as carrier substrata for limbal epithelial stem cells.

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    de la Mata, Ana; Nieto-Miguel, Teresa; López-Paniagua, Marina; Galindo, Sara; Aguilar, María Rosa; García-Fernández, Luis; Gonzalo, Sandra; Vázquez, Blanca; Román, Julio San; Corrales, Rosa María; Calonge, Margarita

    2013-12-01

    The aim of this work was to evaluate semi-synthetic biopolymers based on chitosan (CH) and gelatin (G) as potential in vitro carrier substrata for human limbal epithelial cells (hLECs). To that end, human corneal epithelial cells (HCE) were cultured onto different CH-G membranes. None of the polymers were cytotoxic and cell proliferation was higher when CH was functionalized with G. Expression levels of corneal epithelial markers (K3, K12, E-caherin, desmoplakin, and zonula occludens (ZO)-1) were better maintained in HCE cells grown on CH-G 20:80 membranes than other proportions. Consequently, CH-G 20:80 was chosen for the subsequent expansion of hLECs. Cells derived from limbal explants were successfully expanded on CH-G 20:80 membranes using a culture medium lacking components of non-human animal origin. The expression levels found for corneal (K3 and K12) and limbal epithelial stem cells (K15) specific markers were similar to or higher than those found in limbal cells grown onto the control substratum. Our results demonstrate that CH-G 20:80 membranes are suitable for the expansion and maintenance of stem cells derived from the limbal niche. These results strongly support the use of polymers as alternative substrata for the transplantation of cultivated limbal cells onto the ocular surface.

  2. [Radiotherapy for Graves' ophthalmopathy].

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    Kuhnt, T; Müller, A C; Janich, M; Gerlach, R; Hädecke, J; Duncker, G I W; Dunst, J

    2004-11-01

    Graves' ophthalmopathy (GO) is the most frequent extrathyroidal manifestation of Graves' disease, an autoimmune disorder of the thyroid, whereas the precise pathogenesis still remains unclear. In Hashimoto's thyroiditis the occurrence of proptosis is an extremely rare event. The therapy for middle and severe courses of GO shows in partly disappointing results, although several therapy modalities are possible (glucocorticoid therapy, radiotherapy, antithyroid drug treatment, surgery). All these therapies lead in only 40 - 70 % to an improvement of the pathogenic symptoms. An intensive interdisciplinary cooperation is necessary to satisfy the requirements for the treatment of Graves' ophthalmopathy. As a consequence of the very different results of the few of clinical studies that were accomplished with reference to this topic, treatment by radiotherapy in the management of the disease is presently controversially discussed. In the German-speaking countries the radiotherapy is, however, firmly established as a therapy option in the treatment of the moderate disease classes (class 2-5 according to NO SPECS), especially if diplopia is present. This article describes the sequences, dosages and fractionation schemes as well as the risks and side effects of the radiotherapy. Altogether, radiotherapy is assessed as an effective and sure method. The administration of glucocorticoids can take place before the beginning of or during the radiotherapy. For the success of treatment the correct selection of patients who may possibly profit from a radiotherapy is absolutely essential. By realising that GO proceeds normally over a period of 2-5 years, which is followed by a period of fibrotic alteration, the application of the radiotherapy in the early, active phase is indispensable. A precise explanation for the effects of radiotherapy in treatment of the GO does not exist at present. The determination of the most effective irradiation doses was made from retrospectively evaluated

  3. Fisiopatologia da asma grave

    OpenAIRE

    Todo-Bom, Ana; Mota-Pinto, Anabela

    2006-01-01

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

  4. Epidemiology of Graves' orbitopathy.

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    Putta-Manohar, Sudeep; Perros, Petros

    2010-03-01

    Thyroid orbitopathy is a relatively rare disease. Prevalence data are lacking and can only be estimated. The incidence of thyroid orbitopathy has been documented in one American study (16 cases per 100,000 population per year for females and 2.9 cases per 100,000 population for males). Thyroid orbitopathy can affect every race and age group. The majority of patients present in middle age with concurrent thyrotoxicosis due to Graves' disease. The onset of orbitopathy usually coincides with the hyperthyroidism, though the two may be asynchronous by months or sometimes years. A small proportion of patients with thyroid orbitopathy have primary hypothyroidism or are euthyroid. Female patients outnumber males by 2-5 to 1. Smoking increases the risk of thyroid orbitopathy up to 8-fold.

  5. Hashimoto's thyroiditis following Graves' disease.

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    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.

  6. A CLINICAL STUDY OF LIMBAL STEM CELL TRANSPLANTATION IN VARIOUS OCULAR SURFACE DISORDERS

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    Rashmi

    2015-10-01

    Full Text Available AIMS: The purpose of this study is to evaluate the various causes of limbal stem cell deficiency, to assess signs and symptoms in ocular surface disorder and improvement following stem cell transplantation, to carry out limbal stem cell transplantation in various ocular surface disorders and to assess various intraoperative and postoperative complications following stem cell transplantation. METHODS: This study included 40 cases of ocular surface disorders treated with limbal autograft transplantation. Patients were recorded in a predesigned proforma, including the detailed history and complete ophthalmological examination. All cases of ocular surface disorders were treated with conjunctivo-limbal autograft transplantation under peribulbar and facial anaesthesia. RESULT: Maximum number of patients belong to age group 30-40 years. Males were more commonly affected by ocular surface disorders than females. (1.8:1. various causes of limbal stem cell deficiency were reviewed. The most common etiology associated with limbal stem cell deficiency was pterygia (60% followed by vascularised leucomatous corneal opacity (20%, chemical burns (15% and epitheliopathy (5%. Most common symptoms reported by patients were redness (100%, foreign body sensation (90%, watering (85% and photophobia (50%. Most common signs found were conjunctival congestion (90%, corneal vascularization (70%, conjunctivalisation (70% and epithelial defects (30%. 72.5% of patients reported increased ocular comfort. Postoperative incidence of redness was reduced from 90% to 20%, watering from 85% to 15% and photophobia from 50% to 25%. Improvement in signs was noted as decrease in conjunctival congestion from 90% to 22.2%, vascularisation from 70% to 35%, conjunctivalisation from 70% to 21.5% and epithelial defects from 30% to 16.6%. CONCLUSIONS: Use of autologous limbal transplantation with corneal and conjunctival tissue as a vehicle was useful for ocular surface reconstruction in

  7. Graves opthalmopathy and psychoendocrinopathies

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    Ghanem Asaad

    2010-01-01

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

  8. Mass Graves, Landscapes of Terror

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    Ferrándiz, Francisco

    2009-01-01

    The recent exhumation of mass graves from the Spanish Civil War and the Post-War years, mostly involving the largely abandoned graves of the Francoist rearguard, have become a central element in contemporary debates about the conflict and the regime following it. In this paper, the complexity and dynamism of this process is analysed, including from political and legal initiatives of great social and media impact to local actions on the ground, at times failed, ephemeral or almost imperceptibl...

  9. Limbal Stem Cell-Sparing Corneoscleroplasty with Peripheral Intralamellar Tuck: A New Surgical Technique for Keratoglobus

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    Elias Jarade

    2017-04-01

    Full Text Available Purpose: To describe the technique of limbal stem cell-sparing corneoscleroplasty for the management of advanced keratoglobus. Methods: A patient with bilateral advanced keratoglobus, with best-corrected visual acuity of 20/400 in the right eye and 20/200 in the left eye, underwent limbal stem cell-sparing corneoscleroplasty of the right eye. Initially, a 360-degree limbal incision with 200-μm depth was created, followed by a sublimbal tunnel dissection into the sclera, in order to conserve stem cells. Next, a limbus-to-limbus lamellar keratectomy at 200-μm depth was performed. Meanwhile, a donor corneoscleral button with preserved endothelium of the central 8 mm was fashioned. Prior to suturing the donor corneoscleral graft using a modified suturing technique to cover its scleral component, a full-thickness trephination of 8-mm diameter was completed in the central host cornea. Results: Reepithelialization occurred within the first week. No episodes of rejection, intraocular pressure spikes, or epithelial breakdown were observed postoperatively. At the 6-month follow-up, the patient had 20/70 best-corrected vision and a smooth cornea with regular astigmatism on topography. Conclusion: Limbal stem cell-sparing corneoscleroplasty is a single-step technique for restoring the structural integrity of the cornea in advanced keratoglobus while preserving the host limbal stem cells.

  10. Evaluation of a new disposable silicon limbal relaxing incision knife by experienced users

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    Parvu Valentin

    2009-12-01

    Full Text Available Abstract Background Previous research has suggested that the silicon BD Atomic Edge™ knife has superior performance characteristics when compared to a metal knife and performance similar to diamond knife when making various incisions. This study was designed to determine whether a silicon accurate depth knife has equivalent performance characteristics when compared to a diamond limbal relaxing incision (LRI knife and superior performance characteristics when compared to a steel accurate depth knife when creating limbal relaxing incision. Methods Sixty-five ophthalmic surgeons with limbal relaxing incision experience created limbal relaxing incisions in ex-vivo porcine eyes with silicon and steel accurate depth knives and diamond LRI knives. The ophthalmic surgeons rated multiple performance characteristics of the knives on Visual Analog Scales. Results The observed differences between the silicon knife and diamond knife were found to be insignificant. The mean ratio between the performance of the silicon knife and the diamond knife was shown to be greater than 90% (with 95% confidence. The silicon knife's mean performance was significantly higher than the performance of the steel knife for all characteristics. (p-value Conclusions For experienced users, the silicon accurate depth knife was found to be equivalent in performance to the diamond LRI knife and superior to the steel accurate depth knife when making limbal relaxing incisions in ex vivo porcine eyes. Disposable silicon LRI knives may be an alternative to diamond LRI knives.

  11. Transplantation of human limbal cells cultivated on amniotic membrane for reconstruction of rat corneal epithelium after alkaline burn

    Institute of Scientific and Technical Information of China (English)

    SONG E; YANG Wei; CUI Zhi-hua; DONG Yu; SUI Dong-ming; GUAN Xiao-kang; MA Yang-ling

    2005-01-01

    Background The transplantation of limbal epithelial cells cultivated on amniotic membrane is a newly developed treatment for limbal stem cell deficiency. The purpose of our study was to investigate the biological characteristics of limbal epithelial cells and evaluate the effect of transplantation of cultivated human limbal epithelial cells on ocular surface reconstruction in limbal stem cell deficiency rat model. Methods Human limbal cells were isolated and cultivated in vitro. Cytokertins 3, 12, and 19 (K3, K12 and K19) and p63 were detected by immunofluorescent staining or RT-PCR. BrdU labelling test was used to identify the slow cycling cells in the cultures. Limbal stem cell deficiency was established in rat cornea by alkali burn. Two weeks after injury, the rats received transplants of human limbal stem cells cultivated on amniotic membrane carrier. The therapeutic effect was evaluated by slit lamp observation, Hemotoxin and Eosin (HE) staining and immunofluorescent staining.Results On day 7 in primary culture, p63 and K19 were strongly expressed by most cells but only a few cells expressed K3. On days 14 and 21, p63 and K19 were still expressed by a majority of cells, but the expressive intensity of p63 decreased in a number of cells, while the proportion of K3 positive cells increased slightly and some cells coexpressed p63 and K3. RT-PCR showed that gene expression of both p63 and K12 were positive in cultivated limbal cells, but in mature superficial epithelial cells, only K12 was detected. BrdU labelling test showed that most cells were labelled with BrdU after 7 days' labelling and BrdU label retaining cells were observed after chasing for 21 days with BrdU free medium. For in vivo test, slit lamp observation, HE staining and immunofluorescent staining showed that the rats receiving transplant of human limbal stem cells cultivated on amniotic membrane grew reconstructed corneas with intact epithelium, improved transparency and slight or no

  12. Safety of Cultivated Limbal Epithelial Stem Cell Transplantation for Human Corneal Regeneration

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    J. Behaegel

    2017-01-01

    Full Text Available Ex vivo cultivated limbal stem cell transplantation is a promising technique for the treatment of limbal stem cell deficiency. While the results of the clinical trials have been extensively reported since the introduction of the technique in 1997, little has been reported regarding the potential health risks associated with production processes and transplantation techniques. Culture procedures require the use of animal and/or human-derived products, which carry the potential of introducing toxic or infectious agents through contamination with known or unknown additives. Protocols vary widely, and the risks depend on the local institutional methods. Good manufacturing practice and xeno-free culture protocols could reduce potential health risks but are not yet a common practice worldwide. In this review, we focus on the safety of both autologous- and allogeneic-cultivated limbal stem cell transplantation, with respect to culture processes, surgical approaches, and postoperative strategies.

  13. Technique of cultivating limbal derived corneal epithelium on human amniotic membrane for clinical transplantation

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    Fatima A

    2006-01-01

    Full Text Available Background : The technique of transplantation of cultivated limbal epithelium rather than direct limbal tissue isa novel method of "cell therapy" involved in reconstructing the ocular surface in severe limbal stem celldeficiency [LSCD], caused by chemical burns. Aim : To describe a simple feeder-cell free technique of cultivating limbal epithelium on human amniotic membrane[HAM]. Materials and Methods : The limbal tissues (2 mm were harvested from patients with LSCD. These tissueswere proliferated in vitro on HAM supplemented by human corneal epithelial cell medium and autologousserum. Cultures covering more ?50% area of 2.5x5 cm HAM were considered adequate for clinical use. Thecultured epithelium was characterized by histopathology and immunophenotyping.Results: A total of 542 cultures out of 250 limbal tissues were cultivated in the laboratory from January 2001through July 2005. The culture explants showed that clusters of cells emerging from the edge of the explantsin one-three days formed a complete monolayer within 10-14 days. In 86% of cultures (464 of 542, thegrowth was observed within one-two days. Successful explant cultures were observed in 98.5% (534 of 542cultures with 91% explant cultures showing an area of ?6.25 cm2 (6.25 - 12.5 cm2 range. The cultivatedepithelium was terminated between 10-14 days for clinical transplantation. The problems encountered wereinadequate growth (2 of 542 and contamination (2 of 542. Conclusions : We demonstrate a simple technique of generating a sheet of corneal epithelium from a limbalbiopsy. This new technique could pave the way for a novel form of cell therapy.

  14. Short-term uvb-irradiation leads to putative limbal stem cell damage and niche cell-mediated upregulation of macrophage recruiting cytokines

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    Maria Notara

    2015-11-01

    Full Text Available Ultraviolet light B (UVB-irradiation is linked to various ocular pathologies such as limbal stem cell defects in pterygium. Despite the large circumstantial evidence linking UVB irradiation and limbal epithelial stem cell damage, the precise molecular responses of limbal stem cells to UVB irradiation are unclear. Here the effect of UVB irradiation on the putative stem cell phenotype, limbal niche cells and the subsequent effects on corneal (lymphangiogenic privilege were investigated. Primary human limbal epithelial stem cells and fibroblasts were irradiated with 0.02 J/cm2 of UVB, a low dose corresponding to 3 min of solar irradiation. UVB irradiation caused significant reduction of limbal epithelial and limbal fibroblast proliferation for 24 h, but apoptosis of limbal epithelial stem cells only. Moreover, UVB induced stem-like character loss of limbal epithelial cells, as their colony forming efficiency and putative stem cell marker expression significantly decreased. Interestingly, limbal epithelial cells co-cultured with UVB-irradiated limbal fibroblasts also exhibited loss of stem cell character and decrease of colony forming efficiency. Conditioned media from limbal epithelial cells inhibited lymphatic endothelial cell proliferation and tube network complexity; however this effect diminished following UVB irradiation. In contrast, pro-inflammatory and macrophage-recruiting cytokines such as TNFα, IFNγ and MCP1 were significantly upregulated following cell irradiation of limbal fibroblasts. These data demonstrate the key role of the limbal stem cell niche in response to UVB and subsequent (lymphangiogenic and inflammatory events. These data suggest that the known pro(lymphangiogenic effect of UVB irradiation in pterygium is not linked to a direct up-regulation of pro-angiogenic cytokines, but rather to indirect macrophage-recruiting cytokines being upregulated after UVB irradiation.

  15. Immunological aspects of Graves' disease

    NARCIS (Netherlands)

    B.M. van Ouwerkerk (Marcel)

    1986-01-01

    textabstractAssuming an autoimmune interested to know whether apart from restoring the immunologic parameters. Freshly diagnosed hyperthyroid patients with Graves' disease were all similarly treated with MMI 10 mg t.i.d. and when euthyroidism was achieved, with substitution of thyroid hormone. At

  16. Clinical evaluation of Graves ophthalmopathy

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    Janićijević-Petrović Mirjana A.

    2012-01-01

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

  17. Culture of Oral Mucosal Epithelial Cells for the Purpose of Treating Limbal Stem Cell Deficiency

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    Tor Paaske Utheim

    2016-03-01

    Full Text Available The cornea is critical for normal vision as it allows allowing light transmission to the retina. The corneal epithelium is renewed by limbal epithelial cells (LEC, which are located in the periphery of the cornea, the limbus. Damage or disease involving LEC may lead to various clinical presentations of limbal stem cell deficiency (LSCD. Both severe pain and blindness may result. Transplantation of cultured autologous oral mucosal epithelial cell sheet (CAOMECS represents the first use of a cultured non-limbal autologous cell type to treat this disease. Among non-limbal cell types, CAOMECS and conjunctival epithelial cells are the only laboratory cultured cell sources that have been explored in humans. Thus far, the expression of p63 is the only predictor of clinical outcome following transplantation to correct LSCD. The optimal culture method and substrate for CAOMECS is not established. The present review focuses on cell culture methods, with particular emphasis on substrates. Most culture protocols for CAOMECS used amniotic membrane as a substrate and included the xenogeneic components fetal bovine serum and murine 3T3 fibroblasts. However, it has been demonstrated that tissue-engineered epithelial cell sheet grafts can be successfully fabricated using temperature-responsive culture surfaces and autologous serum. In the studies using different substrates for culture of CAOMECS, the quantitative expression of p63 was generally poorly reported; thus, more research is warranted with quantification of phenotypic data. Further research is required to develop a culture system for CAOMECS that mimics the natural environment of oral/limbal/corneal epithelial cells without the need for undefined foreign materials such as serum and feeder cells.

  18. Spatial distribution of niche and stem cells in ex vivo human limbal cultures.

    Science.gov (United States)

    Mariappan, Indumathi; Kacham, Santhosh; Purushotham, Jyothi; Maddileti, Savitri; Siamwala, Jamila; Sangwan, Virender Singh

    2014-11-01

    Stem cells at the limbus mediate corneal epithelial regeneration and regulate normal tissue homeostasis. Ex vivo cultured limbal epithelial transplantations are being widely practiced in the treatment of limbal stem cell deficiency. In this report, we examined whether the limbal niche cells that nurture and regulate epithelial stem cells coexist in ex vivo limbal cultures. We also compared the inherent differences between explant and suspension culture systems in terms of spatial distribution of niche cells and their effect on epithelial stem cell proliferation, migration, and differentiation in vitro. We report that the stem cell content of both culture systems was similar, explaining the comparable clinical outcomes reported using these two methods. We also showed that the niche cells get expanded in culture and the nestin-positive cells migrate at the leading edges to direct epithelial cell migration in suspension cultures, whereas they are limited to the intact niche in explant cultures. We provide evidence that C/EBPδ-positive, p15-positive, and quiescent, label-retaining, early activated stem cells migrate at the leading edges to regulate epithelial cell proliferation in explant cultures, and this position effect is lost in early suspension cultures. However, in confluent suspension cultures, the stem cells and niche cells interact with each another, migrate in spiraling patterns, and self-organize to form three-dimensional niche-like compartments resembling the limbal crypts and thereby reestablish the position effect. These 3D-sphere clusters are enriched with nestin-, vimentin-, S100-, and p27-positive niche cells and p15-, p21-, p63α-, C/EBPδ-, ABCG2-, and Pax6-positive quiescent epithelial stem cells.

  19. Culture of Oral Mucosal Epithelial Cells for the Purpose of Treating Limbal Stem Cell Deficiency.

    Science.gov (United States)

    Utheim, Tor Paaske; Utheim, Øygunn Aass; Khan, Qalb-E-Saleem; Sehic, Amer

    2016-03-01

    The cornea is critical for normal vision as it allows allowing light transmission to the retina. The corneal epithelium is renewed by limbal epithelial cells (LEC), which are located in the periphery of the cornea, the limbus. Damage or disease involving LEC may lead to various clinical presentations of limbal stem cell deficiency (LSCD). Both severe pain and blindness may result. Transplantation of cultured autologous oral mucosal epithelial cell sheet (CAOMECS) represents the first use of a cultured non-limbal autologous cell type to treat this disease. Among non-limbal cell types, CAOMECS and conjunctival epithelial cells are the only laboratory cultured cell sources that have been explored in humans. Thus far, the expression of p63 is the only predictor of clinical outcome following transplantation to correct LSCD. The optimal culture method and substrate for CAOMECS is not established. The present review focuses on cell culture methods, with particular emphasis on substrates. Most culture protocols for CAOMECS used amniotic membrane as a substrate and included the xenogeneic components fetal bovine serum and murine 3T3 fibroblasts. However, it has been demonstrated that tissue-engineered epithelial cell sheet grafts can be successfully fabricated using temperature-responsive culture surfaces and autologous serum. In the studies using different substrates for culture of CAOMECS, the quantitative expression of p63 was generally poorly reported; thus, more research is warranted with quantification of phenotypic data. Further research is required to develop a culture system for CAOMECS that mimics the natural environment of oral/limbal/corneal epithelial cells without the need for undefined foreign materials such as serum and feeder cells.

  20. Graves' disease associated with histologic Hashimoto's thyroiditis.

    Science.gov (United States)

    Falk, S A; Birken, E A; Ronquillo, A H

    1985-02-01

    The microscopic slides of 16 patients who underwent bilateral subtotal thyroidectomy for hyperthyroid Graves' disease were reviewed and classified into three groups: I, Hashimoto's thyroiditis; II, Graves' disease; and III, both Hashimoto's thyroiditis and Graves' disease. Three patients were classified as group I, 10 as group II, and three as group III. In 38% of the patients with clinical Graves' disease the histologic evidence of Hashimoto's thyroiditis could be found either alone or in combination with histologic evidence of Graves' disease (groups I and III). One patient in group I, four in group II, and three in group III had infiltrative ophthalmopathy (50% of total). Hyperthyroid Graves' disease, Graves' ophthalmopathy, and Hashimoto's thyroiditis can occur all together, in duads, or individually at a specific time in a patient's life.

  1. An investigation of donor and culture parameters which influence epithelial outgrowths from cultured human cadaveric limbal explants.

    Science.gov (United States)

    Baylis, Oliver; Rooney, Paul; Figueiredo, Francisco; Lako, Majlinda; Ahmad, Sajjad

    2013-05-01

    Limbal stem cell deficiency is a blinding disease which affects the cornea at the front of the eye. The definitive cure involves replacing the corneal epithelial (limbal) stem cells, for example by transplanting cultured limbal epithelial cells. One method of performing cultures is to grow a sheet of epithelial cells from a limbal explant on human amniotic membrane. The growth of limbal tissue can be variable. The aim of this study is to investigate how different donor and culture factors influence the ex vivo growth of cadaveric limbal explants. Limbal explant cultures were established from 10 different cadaveric organ cultured corneo-scleral discs. The growth rate and the time taken for growth to be established were determined. Statistical analysis was performed to assess correlation between these factors and donor variables including donor age, sex, time from donor death to enucleation, time from enucleation to organ culture storage and duration in organ culture. Growth curves consistently showed a lag phase followed by a steeper linear growth phase. Donor age, time between death and enucleation, and time between enucleation and organ culture were not correlated to the lag time or the growth rate. Time in organ culture had a significant correlation with the duration of lag time (P = 0.003), but no relationship with the linear growth rate. This study shows that an important factor correlating with growth variation is the duration of corneo-scleral tissue in organ culture. Interestingly, donor age was not correlated with limbal explant growth. Copyright © 2012 Wiley Periodicals, Inc.

  2. Comparison between Limbal and Pars Plana Approaches Using Microincision Vitrectomy for Removal of Congenital Cataracts with Primary Intraocular Lens Implantation

    Science.gov (United States)

    Liu, Xin; Zheng, Tianyu; Zhou, Xingtao; Lu, Yi; Zhou, Peng; Fan, Fan; Luo, Yi

    2016-01-01

    Purpose. To compare the surgical outcomes of limbal versus pars plana vitrectomy using the 23-gauge microincision system for removal of congenital cataracts with primary intraocular lens implantation. Methods. We retrospectively reviewed all eyes that underwent cataract removal through limbal or pars plana incision. Main outcome measures included visual outcomes and complications. Results. We included 40 eyes (26 patients) in the limbal group and 41 eyes (30 patients) in the pars plana group. The mean age was 46 months. There was no significant difference in best-corrected visual acuity between the two groups (P = 0.64). Significantly, more eyes had at least one intraoperative complication in the limbal group than in the pars plana group (P = 0.03) that were mainly distributed at 1.5–3 years of age (P = 0.01). The most common intraoperative complications were iris aspiration, iris prolapse, and iris injury. More eyes in the limbal group had postoperative complications and required additional intraocular surgery, but the difference was not significant (P = 0.19). Conclusions. The visual results were encouraging in both approaches. We recommend the pars plana approach for lower incidence of complications. The limbal approach should be reserved for children older than 3 years of age and caution should be exercised to minimize iris disturbance. PMID:27313872

  3. Concise review: hurdles in a successful example of limbal stem cell-based regenerative medicine.

    Science.gov (United States)

    Pellegrini, Graziella; Rama, Paolo; Di Rocco, Antonio; Panaras, Athanasios; De Luca, Michele

    2014-01-01

    Recent breakthroughs in regenerative medicine have generated enthusiasm and many efforts to explore new therapeutic potentials of both somatic and pluripotent stem cells. About 30 years passed since a discovery of a method of producing a great number of human epidermal keratinocytes by cultivation from a small skin biopsy, many possibilities are now envisaged for therapeutic application of different cultured cell types. The importance of stem cell content was proven for many tissues or organs in different pathologies. Ocular burns cause depletion of limbal stem cells, which lead to corneal opacification and visual loss. Most of available treatments are palliative and focused on the relief of the devastating clinical picture. This review is focused on recent developments in cell-based therapy of limbal stem cell deficiency. All findings can provide support for improvement and standardization of the cure for this disabling disease.

  4. Ex-vivo Potential of Cadaveric and Fresh Limbal Tissues to Regenerate Cultured Epithelium

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    Vemuganti Geeta

    2004-01-01

    Full Text Available Purpose: To evaluate and compare the ex-vivo growth potential and formation of cultured corneal epithelium from residual corneo-limbal rings obtained from the operating room after penetrating keratoplasty, and fresh limbal tissues from patients undergoing routine cataract surgery. Methods: With the approval of the Institutional Review Board and informed consent from patients, 1-2mm of limbal tissues from 15 patients and 31 tissues from the cadaveric limbal ring preserved in MK medium (16 tissues and Optisol (15 tissues were used for the study. Donor data included age, time lapse between death and collection, collection and preservation and preservation and culture. Tiny bits of the limbal tissue were explanted on the de-epithelialised human amniotic membrane prepared following standard guidelines, and cultured using Human Corneal Epithelial cell medium. Radial growth from the explant was observed and measured by phase contrast microscopy over 2-4 weeks. After adequate confluent growth, whole mount preparation of the membrane was made and stained with haematoxylin and eosin. Part of the membrane was fixed in formalin and processed for routine histologic examination. The sections were stained with haematoxylin and eosin. Results: Forty-six tissues were evaluated from 42 eyes (15 from patients, 31 from cadaveric eyes with a mean age of 55.3 years ± 21.23 years (range 18 years - 110 years. The growth pattern observed was similar in all the positive cases with clusters of cells budding from the explant over 24- 72 hours, and subsequent formation of a monolayer over the next 2-3 weeks. The stained whole mount preparation showed a radial growth of cells around explants with diameter ranging from 5 to 16mm. Histologic evaluation of the membrane confirmed the growth of 2-3 cell-layered epithelium over the amniotic membrane. Cultivated epithelium around explant cell cultures was observed in 100% (15/15 of limbal tissue obtained from patients, as against

  5. Impression cytology and in vivo confocal microscopy in corneas with total limbal stem cell deficiency

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    Aline Lütz de Araújo

    2013-10-01

    Full Text Available PURPOSES: To describe corneal changes seen on in vivo confocal microscopy in patients with total limbal stem cell deficiency and to correlate them with cytological findings. METHODS: A prospective case series including 13 eyes (8 patients with total limbal deficiency was carried out. Stem cell deficiency was diagnosed clinically and by corneal impression cytology. Confocal images of the central cornea were taken with the Heidelberg Retina Tomograph II, Rostock Corneal Module (Heidelberg Engineering, Heidelberg, Germany. RESULTS: Impression cytology of the cornea revealed conjunctival epithelial cells and goblet cells in all cases. In vivo confocal microscopy showed disruption of normal layers of the corneal epithelium in all eyes. Confocal images showed cells with characteristics of conjunctival epithelium at the cornea in 76.9% of the total. These findings on confocal microscopy were compatible to limbal stem cell deficiency. Additionally, goblet cells, squamous metaplasia, inflammatory cells and dendritic cells were observed. The sub-basal nerve plexus was not identified in any of the corneas. Corneal neovessels were observed at the epithelium and stroma. All cases showed diffuse hyper-reflective images of the stroma corresponding to opacity of the tissue. CONCLUSIONS: Limbal stem cell deficiency had been confirmed by impression cytology in all cases, and 76.9% of the cases could also be diagnosed by in vivo confocal microscopy through the conjunctival epithelial cell visualization on the corneal surface. Frequent confocal microscopy findings were abnormal cells at the cornea (conjunctival epithelial, goblet and inflammatory cells, corneal neovessels and diffuse hyper-reflection of the stroma.

  6. Evaluation of a new disposable silicon limbal relaxing incision knife by experienced users

    OpenAIRE

    Parvu Valentin; Dugue Geoffrey; Albanese John; Bajart Ann M; Lee Edwin

    2009-01-01

    Abstract Background Previous research has suggested that the silicon BD Atomic Edge™ knife has superior performance characteristics when compared to a metal knife and performance similar to diamond knife when making various incisions. This study was designed to determine whether a silicon accurate depth knife has equivalent performance characteristics when compared to a diamond limbal relaxing incision (LRI) knife and superior performance characteristics when compared to a steel accurate dept...

  7. Optimal isolation and xeno-free culture conditions for limbal stem cell function.

    Science.gov (United States)

    Stasi, Kalliopi; Goings, DaVida; Huang, Jiayan; Herman, Lindsay; Pinto, Filipa; Addis, Russell C; Klein, Dahlia; Massaro-Giordano, Giacomina; Gearhart, John D

    2014-01-20

    To preserve limbal stem cell (LSC) function in vitro with xenobiotic-free culture conditions. Limbal epithelial cells were isolated from 139 donors using 15 variations of three dissociation solutions. All culture conditions were compared to the baseline condition of murine 3T3-J3 feeders with xenobiotic (Xeno) keratinocyte growth medium at 20% O2. Five Xeno and Xeno-free media with increasing concentrations of calcium and epidermal growth factor (EGF) were evaluated at 5%, 14%, and 20% O2. Human MRC-5, dermal (fetal, neonatal, or adult), and limbal stromal fibroblasts were compared. Statistical analysis was performed on the number of maximum serial weekly passages, percentage of aborted colonies, colony-forming efficiency (CFE), p63α(bright) cells, and RT-PCR ratio of p63α/K12. Immunocytochemistry and RT-PCR for p63α, ABCG2, Bmi1, C/EBPδ , K12, and MUC1 were performed to evaluate phenotype. Dispase/TrypLE was the isolation method that consistently showed the best yield, viability, and CFE. On 3T3-J2 feeders, Xeno-free medium with calcium 0.1 mM and EGF 10 ng/mL at 20% O2 supported more passages with equivalent percentage of aborted colonies, p63α(bright) cells, and p63α/K12 RT-PCR ratio compared to baseline Xeno-media. With this Xeno-free medium, MRC-5 feeders showed the best performance, followed by fetal, neonatal, adult HDF, and limbal fibroblasts. MRC-5 feeders supported serial passages with sustained high expression of progenitor cell markers at levels as robust as the baseline condition without significant difference between 20% and 5% O2. The LSC function can be maintained in vitro under appropriate Xeno-free conditions.

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

    OpenAIRE

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

    2013-01-01

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

  9. System for tracking transplanted limbal epithelial stem cells in the treatment of corneal stem cell deficiency

    Science.gov (United States)

    Boadi, J.; Sangwal, V.; MacNeil, S.; Matcher, S. J.

    2015-03-01

    The prevailing hypothesis for the existence and healing of the avascular corneal epithelium is that this layer of cells is continually produced by stem cells in the limbus and transported onto the cornea to mature into corneal epithelium. Limbal Stem Cell Deficiency (LSCD), in which the stem cell population is depleted, can lead to blindness. LSCD can be caused by chemical and thermal burns to the eye. A popular treatment, especially in emerging economies such as India, is the transplantation of limbal stem cells onto damaged limbus with hope of repopulating the region. Hence regenerating the corneal epithelium. In order to gain insights into the success rates of this treatment, new imaging technologies are needed in order to track the transplanted cells. Optical Coherence Tomography (OCT) is well known for its high resolution in vivo images of the retina. A custom OCT system has been built to image the corneal surface, to investigate the fate of transplanted limbal stem cells. We evaluate two methods to label and track transplanted cells: melanin labelling and magneto-labelling. To evaluate melanin labelling, stem cells are loaded with melanin and then transplanted onto a rabbit cornea denuded of its epithelium. The melanin displays strongly enhanced backscatter relative to normal cells. To evaluate magneto-labelling the stem cells are loaded with magnetic nanoparticles (20-30nm in size) and then imaged with a custom-built, magneto-motive OCT system.

  10. Limbal Stem Cell Transplantation for Gelatinous Drop-like Corneal Dystrophy

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    Hossein Movahedan

    2013-01-01

    Full Text Available Purpose: To report the outcomes of allograft limbal stem cell transplantation for recurrent gelatinous drop-like corneal dystrophy (GDLD. Methods: In this non-comparative interventional case series, 4 eyes of 3 consecutive patients with recurrent GDLD underwent allograft limbal stem cell transplantation. Two eyes underwent concomitant penetrating keratoplasty while the other two underwent simultaneous superficial keratectomy. Main outcome measures were best spectacle corrected visual acuity, intraocular pressure and corneal clarity. Results: Patient age ranged from 28 to 63 years. Mean follow-up after surgery was 23±10 (median, 22; range, 12-36 months. Mean visual acuity improved from 2.70±0.61 logMAR preoperatively to 1.05±0.06 logMAR at final postoperative visit (P=0.066. Intraocular pressure was normal in all eyes at baseline and remained within normal limits at all postoperative visits. All corneas remained smooth and clear during the follow-up period with no episode of rejection or recurrence. All patients maintained ambulatory vision until final follow-up. Conclusion: The present study provides further evidence that limbal stem cell transplantation may be an effective therapeutic alternative in patients with GDLD.

  11. Surgical procedure for limbal dermoid and palpebral coloboma-dermoid in English bulldog puppy

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    Božinović Stanko

    2009-01-01

    Full Text Available A dermoid is a malformation, a congenital choristoma, in fact an ectopic part of the skin. This malformation can be located on the eyelids (palpebral, on the palpebral or bulbar part of the conjunctive, on the third eyelid or on the cornea, the limbus edge of the eyelid. Ocular dermoids consist of a cornified squamous-stratified epithelium that can be pigmented to various degrees, located on irregular dermis in which there are hair follicles, sweat and fat glands, and, in rare cases, cartilage and bone can also be observed. Corneal dermoids can be classified into three types: limbal or epibulbar dermoid, a dermoid which covers the greater part or the entire cornea, a dermoid that covers the entire front segment of the eye. Coloboma presents a congenital malformation that is characterized by the absence of an eyelid and it can be located on the upper or on the lower lid. This paper presents the case of an English bulldog puppy in which a limbal dermoid and a palpebral coloboma-dermoid were observed at the same time. In this case, superficial keratectomy was selected for the treatment of the limbal dermoid, while the palpebral colobomadermoid was treated using excision with a plastic reconstruction procedure. A microscopic examination of sample tissue of the corneal demoid showed, on the surface, cornified squamous-stratified epithelium lying on the dermis. The dermis was observed to contain hair follicles, as well as sweat and fat glands.

  12. Clinical observation of pterygium excision combined with limbal stem cell transplantation and drug therapy

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    Hai-Jia Xu

    2013-09-01

    Full Text Available AIM: To investigate the effect of pterygium excision combined with autologous limbal stem cell transplantation and drug treatment after the operation.METHODS: A total of 980 eyes of 760 cases underwent pterygium excision, the conjunctival graft with stem cells was interrupted sutured in the limbal sclera planting beds and bulbar conjunctiva. One hundred and sixty-two eyes which relapse again were divided into 2 groups, group A: 1g/L mitomycin C+norfloxacin eye drops for 1-3 months; Group B: dexamethasone eye drops and diclofenac sodium eye drops for 1-3 months or more.RESULTS: One hundred and sixty-two eyes which relapse again were divided into the A and B groups use different medication treatment, Group A: 67 eyes(81.7%were curd, 12 eyes(14.6%relapse again, 3 eyes(3.7%recurrence. Group B: 35 eyes(43.8%were cured, 29 eyes(36.3%relapse again, 16 eyes(20.0%recurrence. The recurrence rate of group A was significantly lower than that of group B(PCONCLUSION: Pterygium excision combined with limbal stem cell transplantation without rejection, safe and effective, with low recurrence rate, postoperative eye drops is particularly important, which could effectively inhibit and reduce the recurrence rate and significantly improve the therapeutic effect.

  13. Dermopathy of Graves' disease: Clinico-pathological correlation.

    Science.gov (United States)

    Reddy, Sagili Vijaya Bhaskar; Gupta, Sushil Kumar; Jain, Manoj

    2012-05-01

    Dermopathy of Graves' disease is a classical, but uncommon extrathyroidal manifestation of Graves' disease. The images of a typical case of dermopathy of Graves' disease are presented along with clinico-pathological correlation.

  14. 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...

  15. Biventricular Takotsubo cardiomyopathy in Graves hyperthyroidism.

    Science.gov (United States)

    Perkins, Matthew J; Schachter, David T

    2014-03-01

    Graves hyperthyroidism is commonly seen in clinical practice and Takotsubo stress cardiomyopathy is an increasingly recognized cardiac complication of physical or emotional stress. We report the rare case of a patient with Graves hyperthyroidism that was complicated by severe biventricular takotsubo cardiomyopathy, which was demonstrated on heart catheterization. After appropriate pharmacologic treatment of her hyperthyroidism, she had complete resolution of her cardiomyopathy.

  16. 91. Reducción de infecciones graves por estafilococo s. aureus meticilino-resistente tras cirugía cardíaca

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    A. Pérez Murillo

    2010-01-01

    Conclusiones: La detección de portadores mediante frotis nasal de SARM es una estrategia barata, segura y efectiva y se traduce no sólo en un menor número de infecciones graves en los portadores, sino también en una reducción en las del resto de pacientes (infecciones cruzadas.

  17. MMSC-LIKE LIMBAL CELLS COTRANSPLANTATION PROMOTES LOCAL IMMUNOCORRECTION AND CORNEAL GRAFT TRANSPARENT RETENTION IN HIGH RISK KERATOPLASTY

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    S. A. Borzenok

    2014-01-01

    Full Text Available Aim was to evaluate clinical results of donor corneal graft survival in high-risk recipients in co-transplantation of preserved allogenic limbal grafts. Materials and methods. Two types of penetrative keratoplasties were carried out in patients with corneal graft opacities and high risk of rejection (n = 69. Co-transplantation of donor cornea and allogenic MMSC-like limbal cells in the form of limbal transplants was carried out in the 1st group (n = 36; in the 2nd group (n = 33 only the cornea was transplanted. Results. Observation of the patients during one year after surgery showed that the rate of transparent cornea engraftment increased in the 1st group (86,1 against 69,7% in the 2nd group. The density of endothelial cells was also higher in the 1st group (85,9 against 76,2% in the 2nd group. At the same time, progressive decreasing of pro-inflammatory cytokines (IL-6, IFNγ, TNFα and increasing of anti-inflammatory cytokines (IL-10, IL-1RA, TGFβ along with higher level of HLA-G5 were revealed in the recipients’ tear fluid in the 1st group in comparison to the 2nd group. Conclusion. Simultaneous transplantation of preserved limbal grafts with corneal graft in high-risk keratoplasty favors the transparent cornea engraftment, obviously, this is due to immunoregulatory activity of the MMSC-like limbal cells. 

  18. Response of human limbal epithelial cells to wounding on 3D RAFT tissue equivalents: effect of airlifting and human limbal fibroblasts.

    Science.gov (United States)

    Massie, Isobel; Levis, Hannah J; Daniels, Julie T

    2014-10-01

    Limbal epithelial stem cell deficiency can cause blindness but may be treated by human limbal epithelial cell (hLE) transplantation, normally on human amniotic membrane. Clinical outcomes using amnion can be unreliable and so we have developed an alternative tissue equivalent (TE), RAFT (Real Architecture for 3D Tissue), which supports hLE expansion, and stratification when airlifted. Human limbal fibroblasts (hLF) may be incorporated into RAFT TEs, where they support overlying hLE and improve phenotype. However, the impact of neither airlifting nor hLF on hLE function has been investigated. hLE on RAFT TEs (±hLF and airlifting) were wounded using heptanol and re-epithelialisation (fluorescein diacetate staining), and percentage putative stem cell marker p63α and proliferative marker Ki67 expression (wholemount immunohistochemistry), measured. Airlifted, hLF- RAFT TEs were unable to close the wound and p63α expression was 7 ± 0.2% after wounding. Conversely, non-airlifted, hLF- RAFT TEs closed the wound within 9 days and p63α expression was higher at 22 ± 5% (p < 0.01). hLE on both hLF- and hLF+ RAFT TEs (non-airlifted) closed the wound and p63α expression was 26 ± 8% and 36 ± 3% respectively (ns). Ki67 expression by hLE increased from 1.3 ± 0.5% before wounding to 7.89 ± 2.53% post-wounding for hLF- RAFT TEs (p < 0.01), and 0.8 ± 0.08% to 17.68 ± 10.88% for hLF+ RAFT TEs (p < 0.05), suggesting that re-epithelialisation was a result of proliferation. These data suggest that neither airlifting nor hLF are necessarily required to maintain a functional epithelium on RAFT TEs, thus simplifying and shortening the production process. This is important when working towards clinical application of regenerative medicine products.

  19. Cytokeratin patterns in corneal, limbal, and conjunctival epithelium. An immunofluorescence study with PKK-1, 8.12, 8.60, and 4.62 anticytokeratin antibodies.

    Science.gov (United States)

    Ryder, M I; Weinreb, R N

    1990-11-01

    The authors examined immunofluorescently the specific cytokeratin staining patterns of corneal, limbal, and conjunctival epithelium with PKK-1, 8.12, 4.62, and 8.60 monoclonal anticytokeratin antibodies. Observations were made on unfixed frozen postmortem human tissue. The PKK-1 antibody stain was observed in all layers of corneal epithelium but only in suprabasal layers of limbal and conjunctival epithelium. By contrast, the 8.12 antibody stain was observed only in the superficial layer of corneal epithelium but through all layers of limbal and conjunctival epithelium. The 4.60 antibody stain was seen in focal areas of corneal and limbal epithelium and through all layers of conjunctival epithelium. The 8.60 antibody stain was not present in the three epithelia. These immunofluorescence studies showed unique cytokeratin patterns among layers in corneal, limbal, and conjunctival epithelium.

  20. Coculture of autologous limbal and conjunctival epithelial cells to treat severe ocular surface disorders: Long-term survival analysis

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    Sandhya V Subramaniam

    2013-01-01

    Full Text Available Background: Cultivated limbal epithelium for reconstruction of corneal surface is a well-established procedure; however, it is not adequate for damage which also extensively involves the conjunctiva. In severe cases of ocular surface damage that warrant additional conjunctival transplantation apart from cultivated limbal stem cell transplantation, we describe the long-term survival of a novel method of cocultivating autologous limbal and conjunctival epithelium on a single substrate. Materials and Methods: Forty eyes of 39 patients with severe limbal stem cell deficiency and conjunctival scarring or symblepharon underwent transplantation of autologous cocultivated epithelium on human amniotic membrane. A ring barrier was used to segregate the central limbal and peripheral conjunctival epithelia in vitro. Patients were followed up at regular intervals to assess stability of the ocular surface, defined by absence of conjunctivalization into the central 4 mm of the cornea and absence of diffuse fluorescein staining. Penetrating keratoplasty (PKP was subsequently performed, where indicated, in patients with surface stability. Results: The cumulative survival probability was 60% at 1 year and 45% at 4 years by Kaplan-Meier analysis (mean follow-up duration: 33 ± 29 months, range: 1-87 months. Best-corrected visual acuity improved to greater than 20/200 in 38% eyes at the last follow-up, compared with 5% eyes before surgery. Immunohistochemistry in five of the corneal buttons excised for PKP showed an epithelial phenotype similar to cornea in all five. Conclusions: Synchronous use of cultured limbal and conjunctival epithelium offers a feasible alternative and a simpler one-step surgical approach to treat severe ocular surface disorders involving limbus and conjunctiva.

  1. System for tracking transplanted limbal epithelial stem cells in the treatment of corneal stem cell deficiency (Conference Presentation)

    Science.gov (United States)

    Boadi, Joseph; Matcher, Stephen; MacNeil, Sheila; Sangwan, Virender S.

    2016-04-01

    The prevailing hypothesis for the existence and healing of the avascular corneal epithelium is that this layer of cells are continually produced by stem cells in the limbus and transported onto the cornea to mature into corneal epithelium. In the event that the cornea is damaged and the limbal stem cell population is severely reduced, this condition known as Limbal Stem Cell Deficiency and can lead to blindness. There are numerous treatments but most have high long term failure rates. Most treatment methods include the transplantation of limbal stem cells into damaged limbus with hope of repopulating the region and regenerating at healthy corneal epithelium. Optical Coherence Tomography (OCT) is well known for its high resolution in vivo images. A bespoke OCT has been built to investigate the trajectories of these limbal stem cells after transplantation to see whether if they do repopulate the damaged limbus or not. In the experimentation magneto-labelling was used to track the limbal stem cells. For the magneto-labelling a mixture of limbal stem cells and cornea epithelium are cultured with super paramagnetic iron (Fe3O4) nanoparticles (20-30nm in size) for 24hours, to allow for uptake. The cells are then transplanted onto the denuded cornea. The transplanted cell mixture with the encapsulated magnetic nanoparticles is actuated with an external magnetic field 0.08T leading to a phase modulation on the signal. A Phase sensitive Magneto-motive OCT is used to locate the transplanted cells. The location of the cells with embed SPIOs were located both in 2D and 3D.

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

    Science.gov (United States)

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

    2016-02-21

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

  3. Human pluripotent stem cell-derived limbal epithelial stem cells on bioengineered matrices for corneal reconstruction.

    Science.gov (United States)

    Mikhailova, Alexandra; Ilmarinen, Tanja; Ratnayake, Anjula; Petrovski, Goran; Uusitalo, Hannu; Skottman, Heli; Rafat, Mehrdad

    2016-05-01

    Corneal epithelium is renewed by limbal epithelial stem cells (LESCs), a type of tissue-specific stem cells located in the limbal palisades of Vogt at the corneo-scleral junction. Acute trauma or inflammatory disorders of the ocular surface can destroy these stem cells, leading to limbal stem cell deficiency (LSCD) - a painful and vision-threatening condition. Treating these disorders is often challenging and complex, especially in bilateral cases with extensive damage. Human pluripotent stem cells (hPSCs) provide new opportunities for corneal reconstruction using cell-based therapy. Here, we investigated the use of hPSC-derived LESC-like cells on bioengineered collagen matrices in serum-free conditions, aiming for clinical applications to reconstruct the corneal epithelium and partially replace the damaged stroma. Differentiation of hPSCs towards LESC-like cells was directed using small-molecule induction followed by maturation in corneal epithelium culture medium. After four to five weeks of culture, differentiated cells were seeded onto bioengineered matrices fabricated as transparent membranes of uniform thickness, using medical-grade porcine collagen type I and a hybrid cross-linking technology. The bioengineered matrices were fully transparent, with high water content and swelling capacity, and parallel lamellar microstructure. Cell proliferation of hPSC-LESCs was significantly higher on bioengineered matrices than on collagen-coated control wells after two weeks of culture, and LESC markers p63 and cytokeratin 15, along with proliferation marker Ki67 were expressed even after 30 days in culture. Overall, hPSC-LESCs retained their capacity to self-renew and proliferate, but were also able to terminally differentiate upon stimulation, as suggested by protein expression of cytokeratins 3 and 12. We propose the use of bioengineered collagen matrices as carriers for the clinically-relevant hPSC-derived LESC-like cells, as a novel tissue engineering approach for

  4. Results of Limbal Conjunctival Autograft Transplantation in Primary and Recurrent Pterygium Surgery

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    Raşit Kılıç

    2014-12-01

    Full Text Available Objectives: To evaluate the results of limbal conjunctival autograft transplantation in cases with primary and recurrent pterygium. Materials and Methods: A total of 54 eyes of 49 patients who were operated for pterygium with limbal conjunctival autograft technique between April 2011-July 2013 with at least 6 months of follow-up were retrospectively assessed. All cases were distributed into 3 groups according to the postoperative therapy and the primary/recurrent nature of pterygium: Recurrent pterygium with postoperative topical cyclosporin A+hydroxypropylmethylcellulose treatment were included in group 1, primary pterygium with postoperative topical cyclosporin A+hydroxypropylmethylcellulose were included in group 2, and primary pterygium without either topical cyclosporin A or hydroxypropylmethylcellulose were included in group 3. Results: Eleven eyes of 9 patients were detected for group 1, 11 eyes of 11 patients for group 2, and 32 eyes of 29 patients were detected for group 3. Follow-up period was 17±9.1 months for group 1, 14.4±6.1 months for group 2, 13.2±7 months for group 3, and 14.2±7.3 months for all groups. Totally, two recurrences (3.7% were observed as one case for both group 1 (9.1% and group 3 (3.1% during the follow-up period. The recurrence rate between the three groups was not statistically significantly different (p=0.653. Conclusion: Limbal conjunctival autograft technique is an effective and safe technique in excision of primary and recurrent pterygium. (Turk J Ophthalmol 2014; 44: 449-53

  5. Photo-cross-linking of amniotic membranes for limbal epithelial cell cultivation

    Energy Technology Data Exchange (ETDEWEB)

    Lai, Jui-Yang, E-mail: jylai@mail.cgu.edu.tw

    2014-12-01

    In the present study, we developed photo-cross-linked amniotic membrane (AM) as a limbal stem cell niche. After ultraviolet (UV) irradiation for varying time periods, the biological tissues were studied by determinations of cross-linking structure, degradability, and nutrient permeation ability. Our results showed that the number of cross-links per unit mass of AM significantly increased with increasing illumination time from 5 to 50 min. However, the cross-link formation was inhibited by longer irradiation time (i.e., 150 min), probably due to the scission of tissue collagen chains through irradiation. The biological stability and matrix permeability of photo-cross-linked AM materials strongly depended on their cross-linking densities affected by the UV irradiation. In vitro biocompatibility studies including cell viability and pro-inflammatory gene expression analyses demonstrated that, irrespective of the irradiation time employed, the physically cross-linked biological tissues exhibited negligible cytotoxicity and similar interleukin-6 (IL-6) mRNA levels. The data clearly indicate that these AM matrices do not cause potential harm to the corneal epithelial cells. After the growth of limbal epithelial cells (LECs) on AM substrates, Western blot analyses were conducted to examine the expression of ABCG2. It was found that the ability of UV-irradiated AM to maintain the undifferentiated precursor cell phenotype was significantly enhanced with increasing extent of photo-cross-linking. In summary, the UV irradiation time may have a profound influence on the fabrication of photo-cross-linked AM matrices for LEC cultivation. - Highlights: • We report the development of photo-cross-linked AM as a limbal stem cell niche. • Cross-linked structure of tissue materials was controlled by UV irradiation time. • Biostability and matrix permeability of AM depended on cross-linking density. • All the studied photo-cross-linked AM showed good in vitro biocompatibility.

  6. Mass Graves, Landscapes of Terror

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    Ferrándiz, Francisco

    2009-06-01

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

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

  7. Pneumonia grave por "Chlamydia psittaci"

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    MOSCHIONI CRISTIANE

    2001-01-01

    Full Text Available A psitacose, também conhecida como ornitose, é causada pela Chlamydia psittaci; caracteriza-se por doença de início insidioso, sintomas brandos e inespecíficos, lembrando infecção de vias aéreas superiores. Acomete principalmente o pulmão, sendo raramente doença sistêmica e fatal. Descreve-se um caso raro de pneumonia por Chlamydia psittaci que evoluiu para insuficiência respiratória aguda, necessitando de ventilação mecânica. Destaca-se a importância em considerar o diagnóstico, especialmente em casos de pneumonia comunitária que evolui de modo insatisfatório, que não responde à terapia antimicrobiana e cuja epidemiologia é positiva para exposição às aves. O diagnóstico precoce é fundamental devido à excelente resposta terapêutica. O diagnóstico tardio pode levar a curso grave e fatal da doença.

  8. Orbital Volumetry in Graves' Orbitopathy

    DEFF Research Database (Denmark)

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

    2014-01-01

    .6 cm(3) in controls, 8.7 ± 8.0 cm(3) in GO without DON, and 9.4 ± 3.1 cm(3) in GO with DON. The muscle and fat volumes were higher in patients with GO than in controls (P orbits with and without DON were not significantly different. The volume of the optic nerve were...... similar in the 3 groups. The number of apical, coronal 2 mm thick slices with no fat was 2.9 ± 0.9 in normal orbits, it was 4.1 ± 1.0 in GO orbits without DON and 5.3 ± 0.8 in GO orbits with DON (P = 0.007). Conclusion. Apical muscle enlargement may be more important than orbital fat enlargement......Purpose. We wanted to investigate the relative significance of fat and muscle enlargement in the development of dysthyroid optic neuropathy (DON) in Graves' orbitopathy (GO). Methods. Preoperative coronal CT scans of 13 patients with and without DON who subsequently underwent orbital decompression...

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

    OpenAIRE

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

    2014-01-01

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

  10. Chemical injury treated with autologous limbal epithelial stem cell transplantation and subconjunctival bevacizumab

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    Cavallini GM

    2014-08-01

    Full Text Available Gian Maria Cavallini,1 Graziella Pellegrini,2 Veronica Volante,1 Pietro Ducange,1 Michele De Maria,1 Giulio Torlai,1 Caterina Benatti,1 Matteo Forlini1 1Institute of Ophthalmology, 2Centre for Regenerative Medicine “Stefano Ferrari”, University of Modena e Reggio Emilia, Modena, Italy Background: Limbal stem cell (LSC deficiency leads to corneal opacity due to a conjunctivalization of the corneal surface. LSC transplantation, which can be followed by corneal keratoplasty, is an effective procedure to restore corneal transparency; however, a common cause of failure of this procedure is neovascularization (NV.Methods: A 59-year-old man with a 21-year history of a corneal chemical burn caused by phosphoric acid in his left eye was examined. He presented with unilateral total LSC deficiency with severe conjunctivalization and a corrected distance visual acuity that was limited to hand motion.Results: We reported the short-term in vivo efficacy of subconjunctival bevacizumab for progressive corneal NV in a patient with LSC deficiency that underwent LSC transplantation. Four months after autologous LSC transplantation and 1 month after the second subconjunctival bevacizumab injection, the patient’s corrected distance visual acuity was 1/10.Conclusion: Subconjunctival injection of bevacizumab can reduce the corneal NV, reducing conjunctival inflammation and supporting restoration of a stable ocular surface that is able to counteract graft failure, with no toxicity for the transplanted LSC. Keywords: stem cells, bevacizumab, limbal stem cell deficiency, transplantation

  11. Clinical observation on fibrin glue technique in pterygium surgery performed with limbal autograft transplantation

    Directory of Open Access Journals (Sweden)

    Hui Liu

    2013-07-01

    Full Text Available AIM: To compare the efficiency and safety of fibrin glue to suture technique in pterygium surgery performed with limbal autograft.METHODS: A prospective randomized clinical trial was carried out in 60 eyes of 48 patients operated for primary nasal pterygium. Autologous limbal graft taken from the superotemporal limbus was used to cover the sclera after pterygium excision under local anesthesia with 2% lidocaine. In 22 cases(30 eyes, the transplant was attached to the sclera with a fibrin tissue adhesive(group 1and in 26 cases(30 eyeswith 10-0 Virgin silk sutures(group 2. Patients were followed up at least for 3 months. Time of operation, matching degree of graft and visual analogue scale(VASscore were mainly observed and recorded. RESULTS: Patient symptoms were significantly less and biomicroscopic findings were better in group 1. Pterygium recurrence was seen in 1 case of group 1, and 1 case of group 2. Average surgery time was shorter(PCONCLUSION: Using fibrin glue for graft fixation in pterygium surgery causes significantly less postoperative pain and shortens surgery time significantly.

  12. Proteomic analysis as a means to approach limbal stem cell biology in a search for stem cell markers.

    Science.gov (United States)

    Honoré, Bent; Vorum, Henrik

    2014-04-01

    The cornea consists of three main layers: an outer surface epithelium, the stroma, and the endothelium. A clear cornea is necessary for optimal vision and is maintained and repaired from limbal epithelial stem cells located in the limbus between the cornea and the sclera. Diseases and injury may result in deficiency of the stem cells impairing their ability to renew the corneal epithelium. Patients with limbal stem cell deficiency experience chronic pain and ultimately blindness. Attempts to treat the disease are based on replacement of the stem cells by transplantation or by culturing the stem cells. We here review the proteomic techniques that so far have been used to approach characterization of limbal stem cells and markers to identify them. It is apparent that the field is in a rather inchoate state due to the scarcity and relative inaccessibility of the stem cells. However, the importance of revealing limbal stem cell biology and identifying stem cell biomarkers calls for greater use of emerging methodology. Strategies for future studies are discussed. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  13. Concise review: transplantation of cultured oral mucosal epithelial cells for treating limbal stem cell deficiency-current status and future perspectives.

    Science.gov (United States)

    Utheim, Tor Paaske

    2015-06-01

    A number of diseases and external factors can deplete limbal stem cells, causing pain and visual loss. Ten years have passed since the first transplantation of cultured oral mucosal epithelial cells in humans, representing the first autologous cell-based therapy for severe bilateral limbal stem cell deficiency. Its steady increase in popularity since then can be attributed to the accumulating evidence of its efficacy in reverting limbal stem cell deficiency. In this review, the focus is on clinical, and to a lesser degree laboratory, features of cultured oral mucosal epithelial transplants over the past 10 years. Comparisons with other available technologies are made. Avenues for research to stimulate further improvements in clinical results and allow worldwide distribution of limbal stem cell therapy based on oral mucosal cells are discussed. These include storage and transportation of cultured oral mucosal epithelial sheets and in vivo culture of oral mucosal epithelial cells.

  14. [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.

  15. γδ T Cells Are Necessary for Platelet and Neutrophil Accumulation in Limbal Vessels and Efficient Epithelial Repair after Corneal Abrasion

    OpenAIRE

    Li, Zhijie; Burns, Alan R.; Rumbaut, Rolando E.; Smith, C. Wayne

    2007-01-01

    Corneal epithelial abrasion in C57BL/6 mice induces an inflammatory response with peak accumulation of neutrophils in the corneal stroma within 12 hours. Platelets localize in the limbal vessels throughout the same time course as neutrophils and contribute to wound healing because antibody-dependent depletion of platelets retards epithelial division and wound closure. In the present study, T cells in the limbal epithelium were found to predominantly express the γδ T-cell receptor (TCR). Corne...

  16. Culture of human limbal epithelial stem cells on tenon's fibroblast feeder-layers: a translational approach.

    Science.gov (United States)

    Scafetta, Gaia; Siciliano, Camilla; Frati, Giacomo; De Falco, Elena

    2015-01-01

    The coculture technique is the standard method to expand ex vivo limbal stem cells (LSCs) by using inactivated embryonic murine feeder layers (3T3). Although alternative techniques such as amniotic membranes or scaffolds have been proposed, feeder layers are still considered to be the best method, due to their ability to preserve some critical properties of LSCs such as cell growth and viability, stemness phenotype, and clonogenic potential. Furthermore, clinical applications of LSCs cultured on 3T3 have taken place. Nevertheless, for an improved Good Manufacturing Practice (GMP) compliance, the use of human feeder-layers as well as a fine standardization of the process is strictly encouraged. Here, we describe a translational approach in accordance with GMP regulations to culture LSCs onto human Tenon's fibroblasts (TFs). In this chapter, based on our experience we identify and analyze issues that often are encountered by researchers and discuss solutions to common problems.

  17. Short-term outcome of Boston Type 1 keratoprosthesis for bilateral limbal stem cell deficiency

    Directory of Open Access Journals (Sweden)

    Sayan Basu

    2012-01-01

    Full Text Available This study reports the short-term functional and anatomical outcome of Boston Type 1 keratoprosthesis (Boston Kpro implantation for bilateral limbal stem cell deficiency (LCSD. Retrospective analysis was done on eight eyes of eight patients who underwent Boston Kpro implantation between July 2009 and October 2009. The best corrected visual acuity (BCVA and slit-lamp biomicroscopy findings were assessed at 1, 3 and 6 months postoperatively. All eight eyes retained the prosthesis. BCVA of 20/40 or better was achieved in 8, 6, and 5 eyes at 1, 3, and 6 months, respectively, postoperatively. One patient each developed epithelial defect, sterile stromal melt and fungal keratitis in the late postoperative period associated with antecedent loss of the soft contact lens from the eye. Boston Kpro has good short-term visual and anatomical outcome in patients with bilateral LSCD, provided compliance with postoperative care can be ensured.

  18. The Sclerotic Scatter Limbal Arc Is More Easily Elicited under Mesopic Rather Than Photopic Conditions.

    Directory of Open Access Journals (Sweden)

    Eric Denion

    Full Text Available We aimed to determine the limbal lighting illuminance thresholds (LLITs required to trigger perception of sclerotic scatter at the opposite non-illuminated limbus (i.e. perception of a light limbal scleral arc under different levels of ambient lighting illuminance (ALI.Twenty healthy volunteers were enrolled. The iris shade (light or dark was graded by retrieving the median value of the pixels of a pre-determined zone of a gray-level iris photograph. Mean keratometry and central corneal pachymetry were recorded. Each subject was asked to lie down, and the ALI at eye level was set to mesopic values (10, 20, 40 lux, then photopic values (60, 80, 100, 150, 200 lux. For each ALI level, a light beam of gradually increasing illuminance was applied to the right temporal limbus until the LLIT was reached, i.e. the level required to produce the faint light arc that is characteristic of sclerotic scatter at the nasal limbus.After log-log transformation, a linear relationship between the logarithm of ALI and the logarithm of the LLIT was found (p<0.001, a 10% increase in ALI being associated with an average increase in the LLIT of 28.9%. Higher keratometry values were associated with higher LLIT values (p = 0.008 under low ALI levels, but the coefficient of the interaction was very small, representing a very limited effect. Iris shade and central corneal thickness values were not significantly associated with the LLIT. We also developed a censored linear model for ALI values ≤ 40 lux, showing a linear relationship between ALI and the LLIT, in which the LLIT value was 34.4 times greater than the ALI value.Sclerotic scatter is more easily elicited under mesopic conditions than under photopic conditions and requires the LLIT value to be much higher than the ALI value, i.e. it requires extreme contrast.

  19. Effects of flow-induced shear stress on limbal epithelial stem cell growth and enrichment.

    Directory of Open Access Journals (Sweden)

    Yun Gyeong Kang

    Full Text Available The roles of limbal epithelial stem cells (LESCs are widely recognized, but for these cells to be utilized in basic research and potential clinical applications, researchers must be able to efficiently isolate them and subsequently maintain their stemness in vitro. We aimed to develop a biomimetic environment for LESCs involving cells from their in vivo niche and the principle of flow-induced shear stress, and to subsequently demonstrate the potential of this novel paradigm. LESCs, together with neighboring cells, were isolated from the minced limbal tissues of rabbits. At days 8 and 9 of culture, the cells were exposed to a steady flow or intermittent flow for 2 h per day in a custom-designed bioreactor. The responses of LESCs and epithelial cells were assessed at days 12 and 14. LESCs and epithelial cells responded to both types of flow. Proliferation of LESCs, as assessed using a BrdU assay, was increased to a greater extent under steady flow conditions. Holoclones were found under intermittent flow, indicating that differentiation into transient amplifying cells had occurred. Immunofluorescent staining of Bmi-1 suggested that steady flow has a positive effect on the maintenance of stemness. This finding was confirmed by real-time PCR. Notch-1 and p63 were more sensitive to intermittent flow, but this effect was transient. K3 and K12 expression, indicative of differentiation of LESCs into epithelial cells, was induced by flow and lasted longer under intermittent flow conditions. In summary, culture of LESCs in a bioreactor under a steady flow paradigm, rather than one of intermittent flow, is beneficial for both increasing proliferation and maintaining stemness. Conversely, intermittent flow appears to induce differentiation of LESCs. This novel experimental method introduces micro-mechanical stimuli to traditional culture techniques, and has potential for regulating the proliferation and differentiation of LESCs in vitro, thereby

  20. Bilateral carpal tunnel syndrome in Graves' disease.

    Science.gov (United States)

    Manganelli, P; Pavesi, G; Salaffi, F

    1987-01-01

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

  1. Diagnosis and treatment of Graves disease.

    Science.gov (United States)

    Streetman, Darcie D; Khanderia, Ujjaini

    2003-01-01

    To review the etiology, diagnosis, and clinical presentation of Graves disease and provide an overview of the standard and adjunctive treatments. Specifically, antithyroid drugs, beta-blockers, inorganic iodide, lithium, and radioactive iodine are discussed, focusing on current controversies. Primary articles were identified through a MEDLINE search (1966-July 2000). Key word searches included beta-blockers, Graves disease, inorganic iodide, lithium, methimazole, and propylthiouracil. Additional articles from these sources and endocrinology textbooks were also identified. We agreed to include articles that would highlight the most relevant points, as well as current areas of controversy. Graves disease is the most common cause of hyperthyroidism. The 3 main treatment options for patients with Graves hyperthyroidism include antithyroid drugs, radioactive iodine, and surgery. Although the antithyroid drugs propylthiouracil (PTU) and methimazole (MMI) have similar efficacy, there are situations when 1 agent is preferred. MMI has a longer half-life than PTU, allowing once-daily dosing that can improve patient adherence to treatment. PTU has historically been the drug of choice for treating pregnant and breast-feeding women because of its limited transfer into the placenta and breast milk. Adjuvant therapies for Graves disease include beta-blockers, inorganic iodide, and lithium. beta-Blockers are used to decrease the symptoms of hyperthyroidism. Inorganic iodide is primarily used to prepare patients for thyroid surgery because of its ability to decrease the vascularity of the thyroid gland. Lithium, which acts in a manner similar to iodine, is not routinely used due to its transient effect and the risk of potentially serious adverse effects. In the US, radioiodine therapy has become the preferred treatment for adults with Graves disease. It is easy to administer, safe, effective, and more affordable than long-term treatment with antithyroid drugs. Hypothyroidism is an

  2. Graves-Basedow disease and potential risk factors

    Directory of Open Access Journals (Sweden)

    Živanović Dušica

    2008-01-01

    Full Text Available Background/Aim. Graves-Basedow disease is a common multifactorial genetic syndrome, which is determined by several genes and environmental factors. The aim of the present study was to investigate the presence of risk factors for developing Graves-Basedow disease between the groups of individuals with and without Graves-Basedow disease, and to compare the presence of risk factors between the affected individuals with or without positive family history for Graves- Basedow disease. Methods. This cross-sectional study was conducted in Ćuprija (central Serbia during a period from December 2001 to April 2002. The case group comprised 132 individuals diagnosed with Graves-Basedow disease. The control group comprised 130 subjects without any of endocrine diseases. All participants were interviewed at the Medical Center Ćuprija using structural questionnaire. Data were collected on basic demographic characteristics, exposure to various chemical and physical agents, stress, smoking and family history of Graves-Basedow disease. In statistical analysis chi-square test was used. Results. The individuals with Graves-Basedow disease were statistically significantly older (above 50 (p = 0.020, exposed to stress (p = 0.024 and to physical agents (p = 0.031, and had significantly (p = 0.000 more relatives with Graves-Basedow disease than those without the disease. Among the affected individuals with positive family history of Graves-Basedow disease the number of women was significantly higher (p = 0.000, than the affected individuals without positive family history of Graves- Basedow disease. Conclusion. In our study, as in many other, gender, age, positive family history of Graves-Basedow disease and exposure to physical agents were identified as potential risk factors for the increased incidence of Graves- Basedow disease. Different risk factors are probably responsible for developing Graves-Basedow disease among the affected individuals with or without

  3. Tratamiento de la enfermedad de Graves Basedow

    Directory of Open Access Journals (Sweden)

    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.

  4. Diagnosis and classification of Graves' disease.

    Science.gov (United States)

    Menconi, Francesca; Marcocci, Claudio; Marinò, Michele

    2014-01-01

    Graves' disease (GD) is an autoimmune disorder involving the thyroid gland, typically characterized by the presence of circulating autoantibodies that bind to and stimulate the thyroid hormone receptor (TSHR), resulting in hyperthyroidism and goiter. Organs other than the thyroid can also be affected, leading to the extrathyroidal manifestations of GD, namely Graves' ophthalmopathy, which is observed in ~50% of patients, and Graves' dermopathy and acropachy, which are quite rare. Presumably, the extrathyroidal manifestations of GD are due to autoimmunity against antigens common to the thyroid and other affected organs. Although its exact etiology remains to be completely understood, GD is believed to result from a complex interaction between genetic susceptibility and environmental factors. Clinically, GD is characterized by the manifestations of thyrotoxicosis as well as by its extrathyroidal features when present, the latter making the diagnosis almost unmistakable. In the absence of ophthalmopathy, the diagnosis is generally based on the association of hyperthyroidism and usually diffuse goiter confirmed with serum anti-TSHR autoantibodies (TRAbs). Hyperthyroidism is generally treated with anti-thyroid drugs, but a common long term treatment strategy in patients relapsing after a course of anti-thyroid drugs (60-70%), implies the use of radioactive iodine or surgery.

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

    OpenAIRE

    2016-01-01

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

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

    OpenAIRE

    2007-01-01

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

  7. Preservation of Ocular Epithelial Limbal Stem Cells: The New Frontier in Regenerative Medicine.

    Science.gov (United States)

    Lužnik, Zala; Bertolin, Marina; Breda, Claudia; Ferrari, Barbara; Barbaro, Vanessa; Schollmayer, Petra; Ferrari, Stefano

    2016-01-01

    Significant advances have been made in the field of ocular regenerative medicine. Promising stem cell-based therapeutic strategies have been translated into the clinical practice over the last few decades. These new stem cell-based therapies offer the possibility of permanently restoring corneal epithelium in patients with severe disabling and blinding ocular surface disease. The European Union has already classified stem cell-based therapies as "medicinal products". Therefore, manipulation is strictly regulated according to the defined conditions of good manufacturing practice, with the production of stem cell therapeutics at only accredited production sites authorized by the national regulatory agencies. In this regard, as first medical products are licensed for commercial use in Europe enabling a more widespread access to a stem cell-based therapy, the need for safe, validated and reproducible techniques for ex vivo cultured tissue preservation and distribution are coming to the forefront of research. However, these provide various new challenges for biobanking industry such as the retention of viability, good functionality of stem cells and sterility issues. This chapter provides an overview of the current advances in the field of corneal/limbal epithelial stem cell culture preservation techniques using either hypothermic storage or cryopreservation methods, that were used in different culturing steps (from stem cell isolation to the ex vivo epithelial graft preparation), with the reported impact on the post-thawing product recovery.

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

    Directory of Open Access Journals (Sweden)

    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%

  9. Combined HLA matched limbal stem cells allograft with amniotic membrane transplantation as a prophylactic surgical procedure to prevent corneal graft rejection after penetrating keratoplasty: case report

    Directory of Open Access Journals (Sweden)

    Paolo Capozzi

    2014-09-01

    Full Text Available Purpose. To determine if the use of combined HLA matched limbal stem cells allograft with amniotic membrane transplantation (AMT is a safe and effective prophylactic surgical procedure to prevent corneal graft after penetrating keratoplasty (PK. Methods. We report the case of a 17 years old patient with a history of congenital glaucoma, trabeculectomy and multiple corneal graft rejections, presenting total limbal cell deficiency. To reduce the possibility of graft rejection in the left eye after a new PK, a two step procedure was performed. At first the patient underwent a combined HLA matched limbal stem cells allograft (LAT and AMT and then, 10 months later, a new PK. Results. During 12 months of follow-up, the corneal graft remained stable and smooth, with no sign of graft rejection. Conclusions. In our patient, the prophylactic use of LAT from HLA-matched donors and AMT before PK, may result in a better prognosis of corneal graft survival.

  10. Corneal Differentiation Following HSC70 and HSP72 Expression in Air-Exposed Limbal Stem Cells Cultured on Denuded Amniotic Membrane

    Directory of Open Access Journals (Sweden)

    Parvaneh Mohammadi

    2010-01-01

    Full Text Available Objective: The aim of this study is to create an ex vivo model to examine the expressionof two heat shock protein 70 (HSP70 family members, heat shock protein 72 (HSP72and heat shock constitute protein 70 (HSC70, at the mRNA and protein levels in differentiatingcorneal cells from air exposed limbal stem cells.Materials and Methods: Limbal biopsies were cultured as explants on a cellular amnioticmembrane for 14 days. The cells were then exposed to air for 16 extra additional days.The proposed expression of limbal stem cell markers (p63, ABCG2, corneal markers(K3/12, connexin 43, as well as HSP72 and HSC70 were analyzed by reverse transcription-polymerase chain reaction (RT-PCR at the mRNA level, and by immunocytochemistryand flowcytometry at the protein level both pre and post air exposure. Fresh limbal andcorneal tissues were used as control group.Results: Air exposure decreased expression of p63 and increased expression of K3/K12 indicating an increase in the number of corneal cells. Our data showed that HSP72and HSC70 were expressed at the mRNA level before and after air exposure while theirexpression significantly increased post air exposure at the protein level.Conclusion: We assume HSC70 expression may be related to early and terminal stagesof differentiation in cultured limbal stem cells. In addition, limbal stem cells were protectedduring normal development against oxidative stress thru increased HSP72 expression.These findings may have broader implications in development of therapeutic strategiesfor treating wound healing disorders by induction of HSPs.

  11. Graves' disease associated with alopecia areata developing after Hashimoto's thyroiditis.

    Science.gov (United States)

    Aşık, Mehmet; Binnetoğlu, Emine; Şen, Hacer; Tekeli, Zeliha; Uysal, Fatma; Ukinç, Kubilay

    2013-01-01

    Graves' disease and Hashimoto's thyroiditis are the most common autoimmune thyroid diseases. Hypothyroidism can develop in patients with Graves' disease, either spontaneously or as a result of radioactive iodine therapy or surgery. However, it is rare for patients with Hashimoto's thyroiditis to subsequently develop Graves' disease. We report a case of alopecia areata associated with Graves' disease in a 41-year-old woman who had previously been diagnosed with Hashimoto's disease. Alopecia areata is an autoimmune disease associated with other autoimmune diseases such as thyroid disorders, anemia, and other skin disorders.

  12. Tratamiento de la osteoporosis grave con teriparatide

    Directory of Open Access Journals (Sweden)

    Marcelo A. Sarli

    2013-10-01

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

  13. 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...

  14. Factores genéticos en casos graves de gripe (H1N1 2009

    Directory of Open Access Journals (Sweden)

    Francesc Calafell i Majó

    2011-01-01

    Full Text Available La pandemia de gripe (H1N1 2009 generó una serie de cuestiones, entre las cuales estuvo que entre un 25 y un 30% de los casos graves de gripe no presentaron ningún factor de riesgo obvio. Hipotetizamos que un elemento que puede contribuir a la respuesta son factores de riesgo gené ticos del huésped involucrados en la mala progresió n de la enfermedad. Varios indicios nos llevaron a esta hipótesis: estudios de agregación familiar en islandeses y mormones de Utah muestran una cierta heredabilidad de la mortalidad por gripe; se conocen casi 300 genes humanos necesarios para la replicació n del virus de la gripe; y los pacientes más graves de gripe (H1N12009 mostraron una desregulació n del sistema inmune adaptativo. Estamos abordando este problema mediante un diseñ o caso-control (casos hospitalizados de gripe (H1N12009 confirmados contra casos ambulatorios, tambié n confirmados para (H1N12009, en el que se genotiparán más de un milló n de polimorfismos de cambios de nucleó tido (SNPs y de variació n de número de copia (CNVs en casos y controles.

  15. Derivation of neurons with functional properties from adult limbal epithelium: implications in autologous cell therapy for photoreceptor degeneration.

    Science.gov (United States)

    Zhao, Xing; Das, Ani V; Bhattacharya, Sumitra; Thoreson, Wallace B; Sierra, Jorge Rodriguez; Mallya, Kavita B; Ahmad, Iqbal

    2008-04-01

    The limbal epithelium (LE), a circular and narrow epithelium that separates cornea from conjunctiva, harbors stem cells/progenitors in its basal layer that regenerate cornea. We have previously demonstrated that cells in the basal LE, when removed from their niche and cultured in reduced bond morphogenetic protein signaling, acquire properties of neural progenitors. Here, we demonstrate that LE-derived neural progenitors generate neurons with functional properties and can be directly differentiated along rod photoreceptor lineage in vitro and in vivo. These observations posit the LE as a potential source of neural progenitors for autologous cell therapy to treat photoreceptor degeneration in age-related macular degeneration and retinitis pigmentosa.

  16. 75 FR 65030 - Native American Graves Protection and Repatriation Review Committee: Nomination Solicitation

    Science.gov (United States)

    2010-10-21

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

  17. 75 FR 13140 - Native American Graves Protection and Repatriation Review Committee: Nomination Solicitation

    Science.gov (United States)

    2010-03-18

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

  18. Graves' orbitopathy as a rare disease in Europe

    DEFF Research Database (Denmark)

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

    2017-01-01

    qualify as rare. Recent published data on the incidence of GO and Graves' hyperthyroidism in Europe were used to estimate the prevalence of GO. The position statement was developed by a series of reviews of drafts and electronic discussions by members of the European Group on Graves' Orbitopathy...

  19. 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.

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

    Science.gov (United States)

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

    2013-08-01

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

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

    NARCIS (Netherlands)

    L. Elbers; M. Mourits; W. Wiersinga

    2011-01-01

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

  2. 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).

  3. Radiotherapy in the management of Graves` ophthalmopathy

    Energy Technology Data Exchange (ETDEWEB)

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

    1998-06-01

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

  4. Long-term outcomes of limbal relaxing incisions during cataract surgery: aberrometric analysis

    Directory of Open Access Journals (Sweden)

    Monaco G

    2015-08-01

    Full Text Available Gaspare Monaco, Antonio ScialdoneDepartment of Ophthalmology, Ospedale Fatebenefratelli e Oftalmico, Milan, ItalyPurpose: To compare the final changes in corneal wavefront aberration by limbal relaxing incisions (LRIs after cataract surgery.Methods: This prospective cumulative interventional nonrandomized case study included cataract and astigmatic patients undergoing LRIs and phaco with intraocular lens implantation. LRIs were planned using Donnenfeld nomogram. The root mean square of corneal wave aberration for total Z(n,i(1≤n≤8, astigmatism Z(2,±1, coma Z(3–5–7,±1, trefoil Z(3–5–7,±2, spherical Z(4–6–8,0, and higher-order aberration (HOA Z(3≤n≤8 was examined before and 3 years after surgery (optical path difference-Scan II [OPD-Scan II]. Uncorrected distance visual acuity and best-corrected distance visual acuity (CDVA for distance, keratometric cylinder, and variations in average corneal power were also analyzed.Results: Sixty-four eyes of 48 patients were included in the study. Age ranged from 42 to 92 years (70.6±8.4 years. After LRIs, uncorrected distance visual acuity and best-corrected distance visual acuity improved statistically (P<0.01. The keratometric cylinder value decreased by 40.1%, but analysis of KP90 and KP135 polar values did not show any decrease that could be statistically confirmed (P=0.22 and P=0.24. No significant changes were detected in root mean square of total (P=0.61 and HOAs (P=0.13 aberrations. LRIs did not induce alteration in central corneal power confirming a 1:1 coupling ratio.Conclusion: LRIs determined a nonsignificant alteration of corneal HOA. Therefore, LRIs can be still considered a qualitatively viable mean in those cases where toric intraocular lenses are contraindicated or not available. Yet, the authors raise the question of nonpersonalized nomograms, as in the present study, LRIs did not reach the preset target cylinder. Keywords: astigmatism, ocular wavefront, intraocular

  5. 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.

  6. 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.

  7. 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.

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

    Science.gov (United States)

    Jamieson, A; Semple, C G

    2000-02-01

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

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

    Data.gov (United States)

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

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

    Institute of Scientific and Technical Information of China (English)

    Jianhua Yan; Zhongyao Wu

    2003-01-01

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

  11. Anaesthetic Challenges In An Untreated Grave's Disease Parturient ...

    African Journals Online (AJOL)

    Alasia Datonye

    hyperthyroidism in pregnancy is challenging to perioperative care ... associated with untreated Graves ' disease in pregnancy. Method: .... pregnancy, symptoms of fatigue, heat intolerance, and. 7 ... Magnesium produces a dose-dependent.

  12. 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.

  13. 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.

  14. Orbital metastases from neuroendocrine carcinoma, masquerading as graves orbitopathy.

    Science.gov (United States)

    Sira, Mano; Clauss, Ralf P; Maclean, Chris; Rose, Geoffrey E

    2010-04-01

    We describe a patient with metastases from neuroendocrine carcinoma masquerading as Graves ophthalmopathy. This rare tumour possibly has a propensity for orbital spread, and we postulate a mechanism evoking the 'seed and soil' hypothesis.

  15. Orbital dissection defatting technique for Graves disease.

    Science.gov (United States)

    Hecht, S D; Guibor, P; Wolfley, D; Wiggs, E O

    1984-04-01

    Five patients with Graves disease and bilateral proptosis were treated with different incisional approaches. They all underwent orbital decompression by removal of the anterior medial orbital walls, the anterior ethmoidal sinuses, the orbital floors, and multiple incisions of the orbital periosteums . The defatting technique, which consists of applying manual anterior orbital pressure with alternate removing of small lobules of fat, was added when it was intraoperatively decided by Hertel exophthalmometer measurement that more decompression was needed. It is estimated that one-third more reduction in proptosis resulted. An average total decrease in proptosis of 9 mm per orbit occurred. Both visual accuities and visual fields returned to normal. The only important complication was the development of hypertropia in down gaze in one patient. A potential value of this technique is its use with orbital floor decompression alone. It may be possible to avoid removing the medial and lateral walls of the orbit, thereby decreasing complications. Defatting may also be a valuable addition in those rare cases where all decompression techniques available are needed to affect an adequate decompression.

  16. Miastenia grave distal: relato de caso

    Directory of Open Access Journals (Sweden)

    Scola Rosana Herminia

    2003-01-01

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

  17. ENFERMEDADES GRAVES CON DIAGNÓSTICO PRENATAL

    Directory of Open Access Journals (Sweden)

    Carmen María Samaniego Fernández

    2012-01-01

    Full Text Available El objetivo de este artículo es presentar la información publicada hasta el momento sobre la supervivencia, las secuelas y la calidad de vida de las enfermedades mencionadas por la declaración de la Comisión de Bioética de la Sociedad Española de Ginecología y Obstetricia (SEGO como extremadamente graves e incurables, subsidiarias de interrupción voluntaria del embarazo más allá de las veintidós semanas de edad gestacional, según lo contemplado por la Ley Orgánica 2/2010 de Salud Sexual y Reproductiva y de la Interrupción Voluntaria del Embarazo. Los profesionales sanitarios deben conocer los aspectos médicos, los avances terapéuticos y el pronóstico de dichas enfermedades, siendo un deber ético transmitir dicha información a los progenitores.

  18. 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 < 0.05) and control group (262 ± 95 × 10 cells/µL; P < 0.05). In GD group, more platelet-bound lymphocytes (332 ± 91 /µL) were found than that in 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.

  19. 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.

  20. Tratamiento quirúrgico de las complicaciones del shock meningocóccico grave Surgical treatment of the severe meningococcal septic shock complications

    OpenAIRE

    P. Casteleiro Roca; J. Midón Miguez; J. García Barreiro; F. Martelo Villar

    2010-01-01

    El shock meningocóccico es una entidad relativamente frecuente y de pronóstico muy grave, que provoca fallo multiorgánico con una alta mortalidad y que precisa ingreso en Unidad de Cuidados Intensivos. En los casos grandes puede provocar necrosis de tejidos mediante una fisiopatología poco clara. En los últimos años la supervivencia de estos pacientes ha aumentado debido al diagnóstico precoz y a medidas de reanimación más agresivas. Como consecuencia encontramos un aumento del número de paci...

  1. A new rat model of glaucoma induced by intracameral injection of silicone oil and electrocoagulation of limbal vessels

    Institute of Scientific and Technical Information of China (English)

    GUO Xue-qian; TIAN Bei; LIU Zhi-cheng; WEI Wen-bin; TAO Yong; SUN Shi-jie; ZHANG Yu

    2011-01-01

    Background A satisfied glaucoma model is absent now.The aim of this study was to evaluate the effect of a combination of intracameral injection of silicone oil and electrocoagulation of corneal limbal vessels and episcleral veins in the rats to establish glaucoma model.Methods Operation was performed in each of the left eyes of 90 adult male rats.Right eyes were used as controls.Measurement of intraocular pressure (IOP) was performed with an applanation tonometer (Tong-Pen).Retinal ganglion cells (RGCs) were retrogradely labeled by applying FluoroGold onto the bilateral superior colliculus.Results During the follow-up (24 weeks),the lOP of the study eyes was significantly higher (P<0.05) than the control eyes (at final examination,IOP of control eyes was (13.4±1.0) mmHg and lOP of study eyes was (16.1±1.8) mmHg).Correspondingly,at 24 weeks after operation,the RGCs density of the study eyes (2286.11±290.45/mm2) was significantly lower than the control eyes (2626.46±164.85/mm2,P<0.01).In the operated eyes,histological examination showed excavation of optic disc and increased neuroglial cells in the optic nerve,reduced thickness of retina and diminution of retinal ganglion cells,and atrophy of ciliary body and iris.Notably,the anterior chamber angle of the operated eye remained open.Conclusions A combination of intracameral injection of silicone oil and electrocoagulation of comeal limbal vessels and episcleral veins may establish a reliable glaucoma model for further research.

  2. Comparative analysis of different feeder layers with 3T3 fibroblasts for culturing rabbits limbal stem cells

    Directory of Open Access Journals (Sweden)

    Hui-Xian Wang

    2017-07-01

    Full Text Available AIM: To explore the possibility of human umbilical cord mesenchymal stem cells (hUCMSCs, human umbilical vein endothelial cells (hUVECs, human dental pulp stem cells (hDPSCs and human periodontal ligament stem cells (hPDLSCs serving as feeder cells in co-culture systems for the cultivation of limbal stem cells. METHODS: Different feeder layers were cultured in Dulbecco’s modified Eagle’s medium (DMEM/F12 and were treated with mitomycin C. Rabbits limbal stem cells (LSCs were co-cultured on hUCMSCs, hUVECs, hDPSCs, hPDLSCs and NIH-3T3, and then comparative analysis were made between each group to see their respective colony-forming efficiency (CFE assay and immunofluorescence (IPO13,CK3/12. RESULTS: The efficiency of the four type cells in supporting the LSCs morphology and its cellular differentiation was similar to that of NIH-3T3 fibroblasts as demonstrated by the immunostaining properties analysis, with each group exhibiting a similar strong expression pattern of IPO13, but lacking CK3 and CK12 expression in terms of immunostaining. But hUCMSCs, hDPSCs and hPDLSCs feeder layers were superior in promoting colony formation potential of cells when compared to hUVECs and feeder-cell-free culture. CONCLUSION: hUCMSCs, hDPSCs and hPDLSCs can be a suitable alternative to conventional mouse NIH-3T3 feeder cells, so that risk of zoonotic infection can be diminished.

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

    Science.gov (United States)

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

    2015-01-01

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

  4. Human lymphocyte antigens (HLA) and Graves' disease in Turkey.

    Science.gov (United States)

    Orhan, Y; Azezli, A; Carin, M; Aral, F; Sencer, E; Molvalilar, S

    1993-09-01

    To evaluate the association of HLA types with Turkish patients with Graves' disease, HLA typing, clinical findings, and thyroid antibodies were correlated. The HLA types, clinical findings (ophthalmopathy and age at onset), and thyroid stimulating hormone (TSH) receptor (TRAb) and antithyroid microsomal antibodies (MAb) were analyzed. Seventy Turkish patients with Graves' disease and 306 control subjects were assessed. Serological HLA typing was performed in HLA A, B, C, DR, and DQ loci. There was a significantly increased prevalence of HLA B8, B49, DR3, DR4, and DR10 in Graves' disease. The association of Graves' disease with HLA DR3 was found to be less strong than previously described. The HLA DR4 antigen may contribute to the predisposition of Graves' disease in Turkey. The results suggest that HLA B7, B13, DR7, DQw2, and DQw3 may confer a protective effect for Graves' disease in Turkey. Patients carrying HLA B12, B18, and B44 haplotypes had a tendency to develop the disease at a later age. The difference from the other studies may be the result of the selection of the controls; in part, of the variability in serological typing reagents; and, also, of the rather weak HLA associations with the disease.

  5. Il trattamento di pazienti con sepsi grave mediante drotrecogin alfa: una valutazione economica con riferimento all’Italia

    Directory of Open Access Journals (Sweden)

    Carlo Lucioni

    2002-09-01

    Full Text Available Sepsis can be defined as a spectrum of clinical conditions caused by the immune response of a host to infection or trauma and characterized by systemic inflammation and coagulation. Particularly in elderly, immunocompromised and critically ill patients, sepsis is a major cause of morbidity and mortality in intensive care units (ICUs worldwide. In the US, sepsis is the leading cause of death in noncoronary ICU patients. Drotrecogin alfa, or recombinant human activated protein C, has antithrombotic, antiinflammatory, and profibrinolytic properties. Recently in a phase III trial (PROWESS, Drotrecogin alfa demonstrated significantly reduced mortality in severe sepsis patients at 28 days. In this trial important value factors for the assessment of costs and outcomes of severe sepsis were also considered. The purpose of the present study is to determine the economic burden of the treatment with Drotrecogin alfa, according to a cost-effectiveness analysis based on the data of the PROWESS trial. The study has been adapted to the italian health environment. As regards to the costs per surviving patient and costs per QALY (Quality Adjusted Life Year, the predicted cost-effectiveness ratio of drotrecogin alfa in severe sepsis patients is much lower than the standard values considered as acceptable in the international litterature.

  6. 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

  7. La nutrición enteral precoz en el enfermo grave

    Directory of Open Access Journals (Sweden)

    B. García Vila

    Full Text Available La nutrición enteral se ha demostrado como un método eficaz y seguro de nutrir a los enfermos graves ingresados en una Unidad de Cuidados Intensivos. Aunque se desconoce cuánto tiempo puede estar un enfermo grave sin nutrición, el catabolismo acelerado y el ayuno pueden ser deletéreos en el enfermo grave y la recomendación más frecuente es la de empezar la nutrición artificial cuando se prevea un período de ayuno superior a los siete días. Las ventajas de la nutrición enteral sobre la nutrición parenteral son evidentes a nivel experimental inmune tanto local como sistémica y mantiene las funciones de barrera del intestino. Estudios clínicos han demostrado que la nutrición enteral precoz, administrada en las primeras 48 horas de ingreso, disminuye la incidencia de infecciones nosocomiales en estos enfermos aunque no la mortalidad, salvo en grupos concretos de pacientes, especialmente en enfermos quirúrgicos. El mayor inconveniente de la nutrición enteral es su intolerancia digestiva y el abordaje trans-pilórico, necesario cuando se produce gastroparesia. También existen dudas de su eficacia cuando el enfermo está en situación de isquemia tisular. Para que la nutrición enteral precoz sea eficaz hace falta instaurar una estrategia terapéutica que incluye tanto medidas sencillas como la elevación del cabecero de la cama, a medidas más sofisticadas como el abordaje trans-pilórico o el uso de nutrientes con capacidad inmunomoduladora. El uso de nutrición enteral precoz es, hoy por hoy, el mejor método de soporte nutricional en estos enfermos si se individualiza su uso en función de la situación clínica de cada paciente y se realiza mediante una estrategia terapéutica adecuada.

  8. Plasma polymer-coated contact lenses for the culture and transfer of corneal epithelial cells in the treatment of limbal stem cell deficiency.

    Science.gov (United States)

    Brown, Karl David; Low, Suet; Mariappan, Indumathi; Abberton, Keren Maree; Short, Robert; Zhang, Hong; Maddileti, Savitri; Sangwan, Virender; Steele, David; Daniell, Mark

    2014-02-01

    Extensive damage to the limbal region of the cornea leads to a severe form of corneal blindness termed as limbal stem cell deficiency (LSCD). Whereas most cases of corneal opacity can be treated with full thickness corneal transplants, LSCD requires stem cell transplantation for successful ocular surface reconstruction. Current treatments for LSCD using limbal stem cell transplantation involve the use of murine NIH 3T3 cells and human amniotic membranes as culture substrates, which pose the threat of transmission of animal-derived pathogens and donor tissue-derived cryptic infections. In this study, we aimed to produce surface modified therapeutic contact lenses for the culture and delivery of corneal epithelial cells for the treatment of LSCD. This approach avoids the possibility of suture-related complications and is completely synthetic. We used plasma polymerization to deposit acid functional groups onto the lenses at various concentrations. Each surface was tested for its suitability to promote corneal epithelial cell adhesion, proliferation, retention of stem cells, and differentiation and found that acid-based chemistries promoted better cell adhesion and proliferation. We also found that the lenses coated with a higher percentage of acid functional groups resulted in a higher number of cells transferred onto the corneal wound bed in rabbit models of LSCD. Immunohistochemistry of the recipient cornea confirmed the presence of autologous, transplanted 5-bromo-2'-deoxyuridine (BrdU)-labeled cells. Hematoxylin staining has also revealed the presence of a stratified epithelium at 26 days post-transplantation. This study provides the first evidence for in vivo transfer and survival of cells transplanted from a contact lens to the wounded corneal surface. It also proposes the possibility of using plasma polymer-coated contact lenses with high acid functional groups as substrates for the culture and transfer of limbal cells in the treatment of LSCD.

  9. Long-Term Cultures of Human Cornea Limbal Explants Form 3D Structures Ex Vivo - Implications for Tissue Engineering and Clinical Applications.

    Science.gov (United States)

    Szabó, Dóra Júlia; Noer, Agate; Nagymihály, Richárd; Josifovska, Natasha; Andjelic, Sofija; Veréb, Zoltán; Facskó, Andrea; Moe, Morten C; Petrovski, Goran

    2015-01-01

    Long-term cultures of cornea limbal epithelial stem cells (LESCs) were developed and characterized for future tissue engineering and clinical applications. The limbal tissue explants were cultivated and expanded for more than 3 months in medium containing serum as the only growth supplement and without use of scaffolds. Viable 3D cell outgrowth from the explants was observed within 4 weeks of cultivation. The outgrowing cells were examined by immunofluorescent staining for putative markers of stemness (ABCG2, CK15, CK19 and Vimentin), proliferation (p63α, Ki-67), limbal basal epithelial cells (CK8/18) and differentiated cornea epithelial cells (CK3 and CK12). Morphological and immunostaining analyses revealed that long-term culturing can form stratified 3D tissue layers with a clear extracellular matrix deposition and organization (collagen I, IV and V). The LESCs showed robust expression of p63α, ABCG2, and their surface marker fingerprint (CD117/c-kit, CXCR4, CD146/MCAM, CD166/ALCAM) changed over time compared to short-term LESC cultures. Overall, we provide a model for generating stem cell-rich, long-standing 3D cultures from LESCs which can be used for further research purposes and clinical transplantation.

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

    Science.gov (United States)

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

    1988-04-01

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

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

    Directory of Open Access Journals (Sweden)

    Maribel Rodríguez Matos

    2013-09-01

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

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

    Directory of Open Access Journals (Sweden)

    Maribel Rodríguez Matos

    2013-09-01

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

  13. Tratamiento del hombro doloroso mediante terapia manual

    OpenAIRE

    Gabucio López, Pedro

    2008-01-01

    Introducción: Las disfunciones de hombro son un problema de salud común en las sociedades occidentales. Algunos protocolos de tratamiento han sido desarrollados mediante ensayos clínicos con pacientes que presentan dolor de hombro. Sin embargo, no hay evidencias que sustenten que un protocolo es mejor que otros. El principal objetivo de este trabajo es presentar un caso clínico en el que mediante terapia manual y la prescripción de ejercicios físicos se consigue la resolución del ...

  14. Tratamiento del hombro doloroso mediante terapia manual

    OpenAIRE

    Gabucio López, Pedro

    2008-01-01

    Introducción: Las disfunciones de hombro son un problema de salud común en las sociedades occidentales. Algunos protocolos de tratamiento han sido desarrollados mediante ensayos clínicos con pacientes que presentan dolor de hombro. Sin embargo, no hay evidencias que sustenten que un protocolo es mejor que otros. El principal objetivo de este trabajo es presentar un caso clínico en el que mediante terapia manual y la prescripción de ejercicios físicos se consigue la resolución del ...

  15. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  17. 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)

  18. 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.

  19. Comparative evaluation of oculometric variables in graves' ophthalmopathy

    Directory of Open Access Journals (Sweden)

    Hélio Amante Miot

    2009-01-01

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

  20. Hipertrigliceridemia familiar grave durante a gestação

    OpenAIRE

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

    2001-01-01

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

  1. Peripartum cardiomyopathy in a patient with Graves' disease.

    Science.gov (United States)

    Kajiya, Takashi; Lee, Souki; Yamashita, Makoto; Sasaki, Yuichi; Kamizono, Yusuke; Imamura, Masakazu; Toyonaga, Koichi; Toda, Hitoshi; Koriyama, Nobuyuki; Tei, Chuwa

    2010-11-05

    Peripartum cardiomyopathy (PPCM) is a rare life-threatening cardiomyopathy of unknown etiology that occurs during the peripartum period in previously healthy women. Autoimmune and viral factors have been suggested to be involved in PPCM. Here we describe a patient with Graves' disease, which is one of the organ-specific autoimmune diseases, who developed acute heart failure due to PPCM at 2 weeks after her first delivery. The patient recovered completely with conservative treatment for heart failure. An association between PPCM and Graves' disease has not been reported before. PPCM may be an organ-specific autoimmune disease, so the coexistence of other autoimmune diseases should be considered in PPCM patients.

  2. 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.

  3. Thymic Hyperplasia Presenting as a Neck Mass in Graves Disease

    Directory of Open Access Journals (Sweden)

    Serkan Yener

    2009-06-01

    Full Text Available We describe a female patient who presented with Graves disease and a neck mass. Radiological characteristics of the mass suggested thymic hyperplasia. She was treated with methimazole, and because the mass did not regress after six months of therapy, the patient had total thyroidectomy and thymectomy. Pathological examination was consistent with chronic lymphocytic thyroiditis and thymic hyperplasia. Microscopic changes in the thymus can be detected in one third of patients with Graves disease, but massive enlargement is rare. It has been reported that regression occurs in most patients after a euthyroid state has been achieved; however, in some patients, thymectomy may be indicated. Turk Jem 2009; 13: 11-2

  4. Hipertrigliceridemia familiar grave durante a gestação

    OpenAIRE

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

    2001-01-01

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

  5. 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...

  6. 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.

  7. Características de los casos graves hospitalizados por gripe pandémica (H1N1 2009 en Cataluña

    Directory of Open Access Journals (Sweden)

    Pere Godoy

    2011-01-01

    Full Text Available Fundamentos. Las pandemias de gripe pueden comportar una mayor gravedad. El objetivo fue determinar las características de los casos graves hospitalizados de gripe pandémica en Cataluña y estudiar factores de riesgo de ingreso en CI. Métodos: e realizó un estudio epidemiológico observacional y prospectivo de los casos nuevos de gripe pandémica hospitalizados por su gravedad en el período: junio del 2009 hasta mayo del 2010. e solicitó a los centros sanitarios la declaración de los casos que cumplieron la definición de caso grave y en los que se confirmó la presencia del virus pandémico. Mediante una encuesta epidemiológica se recogió información sobre variables demográficas, clínica, factores de riesgo, tratamiento y evolución clínica. Las diferencias entre los casos en CI respecto al resto de casos graves se estudiaron con la odds ratio ajustada (ORa mediante un modelo de regresión logística no condicional. Resultados: e detectaron 773 casos graves de gripe pandémica; 465 (60,2% presentaron al menos un factor de riesgo y los más prevalentes fueron: embarazo 19 (13%, asma 87 (12%; enfermedad pulmonar obstructiva crónica 87 (11,4% y cardiopatías 80 (10,5%. Precisaron ingreso en una unidad de cuidados intensivos 293 pacientes (37,9%. Los factores asociados al ingreso en CI fueron la obesidad IMC>40 (ORa=2,5; IC 95% 1,4-4,5 y la enfermedad hepática crónica (ORa=2,3; IC 95% 1,1-4,8. Conclusiones: e confirma la alta prevalencia de embarazo, enfermedades respiratorias crónicas, diabetes y obesidad entre los casos graves. La obesidad mórbida se comporta como un factor de riesgo de ingreso en CI y por ello debe ser un indicador de vacunación antigripal.

  8. 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.

  9. 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

  10. 78 FR 22292 - Native American Graves Protection and Repatriation Review Committee: Notice of Nomination...

    Science.gov (United States)

    2013-04-15

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

  11. 77 FR 65406 - Native American Graves Protection and Repatriation Review Committee: Notice of Nomination...

    Science.gov (United States)

    2012-10-26

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

  12. Amniotic membrane modulates innate immune response inhibiting PRRs expression and NF-κB nuclear translocation on limbal myofibroblasts.

    Science.gov (United States)

    Domínguez-López, Alfredo; Bautista-de Lucio, Victor Manuel; Serafín-López, Janet; Robles-Sánchez, Edson; Garfias, Yonathan

    2014-10-01

    Corneal damage observed in a viral infection such as herpetic stromal keratitis is mainly caused by proinflammatory molecules released by resident cells in the response to viral antigens. There are pattern recognition receptors like MDA5, RIG-1, and TLR3, that recognize viral dsRNA and after activation, the innate immune response is exacerbated inducing the synthesis and secretion of inflammatory cytokines through NF-κB activation. Amniotic membrane (AM) has demonstrated to reduce inflammation by several mechanisms, however the effect of AM on innate immune receptors such as MDA5, RIG-1, and TLR3 has not been reported. In this study, we have determined that the presence of AM significantly inhibited the synthesis and secretion of proinflammatory cytokines on human limbal myofibroblasts (HLM) stimulated with poly I:C. Similarly, the presence of AM reduced the protein expression of MDA5, RIG-1, and TLR3 on poly I:C stimulated HLM. Additionally, the presence of the AM significantly inhibited the NF-κB nuclear translocation when the HLM were poly I:C stimulated, and concomitantly, the AM was able to relocate cadherins affecting the myofibroblastic cellular morphology. These results suggest that AM generates an anti-inflammatory microenvironment, and specific inhibition of NFκB nuclear translocation on infected corneal tissue would reduce the inflammation undesirable effects, explaining in part the beneficial usefulness of transplanting AM on herpetic stromal keratitis.

  13. The three-dimensional organisation of the post-trabecular aqueous outflow pathway and limbal vasculature in the mouse.

    Science.gov (United States)

    van der Merwe, Elizabeth L; Kidson, Susan H

    2014-08-01

    The mouse eye has been used as a model for studies on the microanatomy of the outflow pathways but most of what is known comes from histological sections. These studies have focused mainly on the morphological features of the trabecular meshwork, Schlemm's canal and aqueous channels that link to the superficial episcleral vasculature. However, the anatomical architecture of the aqueous outflow vessels and their relationship to each other and to the general vascular circulation is not well understood. The aim of this study was to provide a detailed description of the microarchitecture of the aqueous outflow vessels and their relationship to the superficial limbal/episcleral vasculature throughout the entire limbus. The aqueous outflow vessels and blood and lymphatic vessels were imaged in PECAM-1 and LYVE-1 immunostained whole anterior segments of adult mice and three-dimensional (3-D) reconstructions of the optical sections were generated to reveal the aqueous, blood and lymphatic architecture. The arterial supply, venous drainage, organisation of perilimbal vasculature, collector channels/aqueous veins and the morphology of Schlemm's canal were revealed in their entirety and the relationships between these structures is described. Schlemm's canal was PECAM-1 positive but there was no affinity for the lymphatic marker LYVE-1. We show that Schlemm's canal is a continuous circular structure and more often seen as a single, broad, varicose vessel with short regions appearing as a plexus. Aqueous veins link Schlemm's canal to the superficial vasculature and there were no direct links seen between the canal and the lymphatic vessels.

  14. Laser scanning confocal microscopy-assisted obtain of limbal tissue for the ex vivo culture of human limbal epithelial stem cells and identification%共焦显微镜引导下取材行人角膜缘上皮干细胞的体外培养及鉴定

    Institute of Scientific and Technical Information of China (English)

    杜连心; 余晓菲; 许中中; 张红敏; 杜晓峰; 王丽娅

    2011-01-01

    Background Human limbal allograft transplantation or limbal autograft transplantation are the primary approaches to the severe corneal-blindness,but their application in clinic were limited because of the defects of donor material.With the development of tissue engineering technology,transplantation of in vitro cultured limbal epithelial stem cells is being an advanced management.Objective The aim of this work was to expand human limbal epithelial stem cells ex vivo under the guidance of confocal microscope and to lay the foundation for fabricating ex vivo cultured cell sheets.Methods Ten eyes of ten patients were examined with the Heidelberg Retina Tomography Ⅲ Rostock Cornea Module(HRT3-RCM)to elucidate the structure of the human corneoscleral limbus and to correlate limbal epithelial dimensions.According to the analysis of the images of limbal epithelia,the limbal tissues provided by Eye Bank of Henan Eye Institute were cut into suitable explants.Then,this study was conducted to expand limbal epithelial stem cells ex vivo on denuded amniotic membrane.The phenotypes of primary cultured cells were evaluated by morphology and immunofluorescent staining with antibodies for limbal epithelial stem cell markers (p63,cytokeratinl9)and differentiation markers(keratin 3,involucrin).This experimental procedure was approved by the Ethic Committee of Henan Provincial People's Hospital.The written informed consent was obtained from subjects before initiation of any examination.Results The palisade morphology of human limbus was imaged clearly on the laser scanning in vivo confocal microscopy and many hyperreflective cells were observed in palisade basal cells.The cell-island phenomenon was seen in the basement membrane under the laser scanning in vivo confocal microscopy.The oblique sections of limbus showed many papilla-like epithelial columns below the superficial limbal epithelia.Throughout the experiment duration,the epithelial cells grew well with the migration rates

  15. 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...

  16. A patient with Graves' disease, thrombocytopenia and chronic hepatitis B.

    OpenAIRE

    Szeto, C C; Chow, C C; Ko, G. T.; K. Y. LI; Yeung, V. T.; Cockram, C S

    1997-01-01

    A 22-year-old Chinese man, a HBsAg carrier, presented with relapse of thyrotoxic Graves' disease complicated by thrombocytopenia and hepatitis. Platelet count and liver enzymes gradually improved following successful treatment of the thyrotoxicosis with radioactive iodine. Possible pathogenetic links and therapeutic implications are discussed.

  17. [Central congenital hypothyroidism due to Graves' disease in the mother

    NARCIS (Netherlands)

    Liebrand, C.A.; Mol, A.C. de; Kempers, M.J.E.; Noordam, C.

    2006-01-01

    Two male twins were born at a gestational age of 30 weeks. Five days after delivery, the mother was diagnosed with Graves' disease. The thyroid function in the neonates was therefore evaluated, which led to the detection of central congenital hypothyroidism (central CHT), even though the neonatal

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

    NARCIS (Netherlands)

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

    2005-01-01

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

  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. 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...

  1. Selenium and the Course of Mild Graves' Orbitopathy

    NARCIS (Netherlands)

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

    2011-01-01

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

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

    NARCIS (Netherlands)

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

    2000-01-01

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

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

    NARCIS (Netherlands)

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

    2005-01-01

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

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

    OpenAIRE

    2010-01-01

    Thyroid disorders are commonly associated with coagulopathy. Patients with hyperthyroidism 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.

  5. Graves' disease: thyroid function and immunologic activity

    Energy Technology Data Exchange (ETDEWEB)

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

    1982-11-01

    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 9/-9..mu..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<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.

  6. Graves' disease: thyroid function and immunologic activity

    Energy Technology Data Exchange (ETDEWEB)

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

    1982-11-01

    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.

  7. 78 FR 21410 - Native American Graves Protection and Repatriation Review Committee: Meetings

    Science.gov (United States)

    2013-04-10

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

  8. 77 FR 23196 - Native American Graves Protection and Repatriation Act Regulations

    Science.gov (United States)

    2012-04-18

    ... Office of the Secretary 43 CFR Part 10 RIN 1024-AD99 Native American Graves Protection and Repatriation... Secretary of the Interior (Secretary) is responsible for implementation of the Native American Graves... implementing the Native American ] Graves Protection and Repatriation Act for purposes of factual accuracy...

  9. 77 FR 65407 - Native American Graves Protection and Repatriation Review Committee: Notice of Nomination...

    Science.gov (United States)

    2012-10-26

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

  10. 77 FR 39406 - Safety Zone; Tom Graves Memorial Fireworks, Port Bay, Wolcott, NY

    Science.gov (United States)

    2012-07-03

    ... SECURITY Coast Guard 33 CFR Part 165 RIN 1625-AA00 Safety Zone; Tom Graves Memorial Fireworks, Port Bay... from a portion of Port Bay during the Tom Graves Memorial Fireworks display. This temporary safety zone... vessels during the Tom Graves Memorial Fireworks. This zone will be effective and enforced from 9:30 p.m...

  11. 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.

  12. Experimental study on the culture and transplantation of limbal epithelium cells of rabbit%兔角膜缘上皮细胞培养与移植的实验研究

    Institute of Scientific and Technical Information of China (English)

    罗廷浩

    2012-01-01

    OBJECTIVE To study the treatment of autotransplantation on rabbit limbal stem cells lack by cultured limbal epithelium cells cultured on gelatin. METHODS Limbal epithelium cells had been cultured on gelatin in DMEM/HamF12 medium for one week, and cultured limbal epithelium cell had been marked with 'HTDR for one day, then limbal epithelium cells and gelatin were transplanted on the limbal and scleral of the rabbit model with lack of corneal stem cells by autotransplantation. The corneal changes were observed by a slillamp every day, the corneal pathological changes and 3HTDR content were examined. RESULTS Rabbit limbal epithelium cells continued to proliferate, differentiate and form multiple cell layers on gelatin. After autotransplantation with cultured epithelium cells and gelatin the rabbit epithelium showed corneal phenotype and progressive decrease of vascularity and stromal infiltration in the limbal and peripheral zone. Pathological examination verified that the limbal and peripheral corneal epithelium was composed of multilayer cells; the neu-vascularization was reduced and stromal inflammatory cells were decreased. The limbal content 3HTDR by isotope radioisotope was examined four weeks after operation. CONCLUSIONS Transplantation with cultured limbal epithelium cells could restore the composition of corneal epithelial cell, decrease neo-vascularization, maintain the function of limbal cellular barrier and provide better condition for later keratoplasty.%目的 观察以明胶为裁体培养的角膜缘上皮细胞移植治疗兔角膜缘干细胞缺乏症的疗效.方法 切除实验兔角膜缘组织并用NaOH处理制作角膜缘干细胞缺乏动物模型,切除的角膜缘上皮细胞在铺有明胶裁体的细胞培养板上培养5d后(角膜上皮细胞移植术前24 h)用3H胸腺嘧啶核苷标记,于模型动物上行角膜缘上皮细胞移植术,术后观察角膜修复情况,并做病理学检查及同位素检测.结果 1.细胞培养:兔角

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

    Science.gov (United States)

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

    2015-09-01

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

  14. Generation of corneal epithelial cells from induced pluripotent stem cells derived from human dermal fibroblast and corneal limbal epithelium.

    Directory of Open Access Journals (Sweden)

    Ryuhei Hayashi

    Full Text Available Induced pluripotent stem (iPS cells can be established from somatic cells. However, there is currently no established strategy to generate corneal epithelial cells from iPS cells. In this study, we investigated whether corneal epithelial cells could be differentiated from iPS cells. We tested 2 distinct sources: human adult dermal fibroblast (HDF-derived iPS cells (253G1 and human adult corneal limbal epithelial cells (HLEC-derived iPS cells (L1B41. We first established iPS cells from HLEC by introducing the Yamanaka 4 factors. Corneal epithelial cells were successfully induced from the iPS cells by the stromal cell-derived inducing activity (SDIA differentiation method, as Pax6(+/K12(+ corneal epithelial colonies were observed after prolonged differentiation culture (12 weeks or later in both the L1B41 and 253G1 iPS cells following retinal pigment epithelial and lens cell induction. Interestingly, the corneal epithelial differentiation efficiency was higher in L1B41 than in 253G1. DNA methylation analysis revealed that a small proportion of differentially methylated regions still existed between L1B41 and 253G1 iPS cells even though no significant difference in methylation status was detected in the specific corneal epithelium-related genes such as K12, K3, and Pax6. The present study is the first to demonstrate a strategy for corneal epithelial cell differentiation from human iPS cells, and further suggests that the epigenomic status is associated with the propensity of iPS cells to differentiate into corneal epithelial cells.

  15. Comparison of clinical outcomes between limbal relaxing incisions and toric intraocular lenses in eyes with astigmatic corneas

    Directory of Open Access Journals (Sweden)

    Giuliano de Oliveira Freitas

    2014-01-01

    Full Text Available Objective: To compare refractive and vectorial outcomes of limbal relaxing incisions (LRI versus toric intraocular lenses (IOL in the treatment of preexisting corneal astigmatism at the time of phacoemulsification. Methods: This longitudinal observational case series assessed 62 eyes of 31 consecutive cataract patients with preoperative corneal astigmatism between 0.75 and 2.50 diopters in both eyes. Patients were randomly assorted in two groups: one assigned to receive AcrySof Toric™ IOL in both eyes, and another one assigned to have AcrySof Natural™ IOL associated with LRI, also in both eyes. All patients were re-evaluated, postoperatively, at 1, 3 and 6 months, when refractive astigmatism analysis was performed using vectorial methods proposed by Thibos. Variability of outcomes within each group and between groups were assessed and compared. Results: Manifest refractive cylinder, in diopters (D, as means ± standard deviation, in the LRI group for 1-month, 3-month and 6-month re-evalutions were respectively -0.66 ± 0.30; -0.70 ± 0.21 and -0.74 ± 0.26 when compared to -0.58 ± 0.24; -0.63 ± 0.20, and -0.62 ± 0.17 in the toric IOL group. (p value ≥ 0.06. Vectorial analysis evidenced greater astigmatism reduction in the toric IOL group in the 6th postoperative month, when postoperative mean astigmatic power vector was 0.31 D, when compared to 0.37 D in the LRI group (p value = 0.00. Conclusions: A trend of slightly better refractive outcomes favoring toric IOL group was seen, although such a trend was not statistically significant. Vectorial analysis, however, suggests that the use of toric IOL may constitute a more advantageous approach in the treatment of pre-existing corneal astigmatism, simultaneously with phacoemulsification.

  16. ES micro-environment enhances stemness and inhibits apoptosis in human limbal stem cells via the maintenance of telomerase activity.

    Directory of Open Access Journals (Sweden)

    Zhiping Liu

    Full Text Available Our previous work had found that telomerase rejuvenated in the cytoplasm of corneal epithelial cells cultured in embryonic stem cell-conditioned medium, the functional properties of stem-like corneal epithelial cells can be enhanced by co-culturing with embryonic stem cells (ESCs via activation of the integrinβ1-FAK-PI3K/Akt signaling pathway. The goal of this study was to explore the potential molecular mechanisms of the ES micro-environment that enhance the stem cell-like phenotype and inhibit apoptosis in human limbal stem cells (LSC. The LSC were cultured in different media, either CnT-20 medium or CnT-20 +20% ES culture supernatant (ESC-CM. We observed that LSC cultured in ESC-CM had an increased proliferative capacity, greater serial passage capacity, higher colony-forming efficiency (CFE and higher levels of stem cell-associated marker than those cultured in CnT-20. Compared with CnT-20, ESC-CM enhanced the undifferentiated status and inhibited apoptosis in the LSC by promoting the maintenance of telomerase activity, which could reduce the generation of reactive oxygen species (ROS, maintain the membrane potential (Δψm at higher levels and reduce the expression of the p21 protein. Our findings indicated that ESC-CM system induced LSC to maintain a stem cell phenotype and inhibit the process of apoptosis. These effects might partially be achieved via the telomerase-p21-mitochondrial axis and the activation of the FAK/Wnt signaling pathways. This study may have high impact and clinic implication on the expansion of LSC in regenerative medicine, especially for ocular surface reconstruction.

  17. 伊朗 Graves 眼病的临床特点%Clinical features of Graves' ophthalmopathy in Iran

    Institute of Scientific and Technical Information of China (English)

    Ali Sadeghi Tari; Mohammad Taher Rajabi; Khalil Hamzedust; Seyed Ziaeddin Tabatabaie; Abolfazl Kasai

    2007-01-01

    AIM:To determine the clinical characteristics of a prospective study of patients with Graves' ophthalmopathy.METHODS:We reviewed clinical manifestations,and medical records of 103 patients in whom Graves' ophthalmopathy WaS diagnosed between 2003 and 2005.RESULTS:Among 103 patients with Graves' ophthalmopathy,48(46.6%)male and 55(53.3%)female(F:M=1.1),with mean age of 45 (range;18-73) years,95 (92.2%)patients had Graves' hyperthyroidism,3(2.9%) had primary hypothyroidism,and 5 (4.8%) were euthyroid.The mean duration of ocular symptoms was 13.2 (range 2-95) months) while the mean duration of dysthyroid symptoms was 39.4(range 6-180) months.Unilaterality was occurred in 12 patients.Eyelid retraction was present in 90 patients (87%),whereas the approximate frequency of exophthalmos was 77.6%(80 patients);restrictive extraocular myopathy.29% (30 patients);evidence of extraocular enlargement on CT-scan in 52 patients of 70 patients (74%) that was evaluated,and optic nerve dysfunction,5.8%(6 patients).22(21%)patients hadglaucoma associated with Graves' ophthalmopathy that 7 (6.7%)of them were normal-tension glaucoma.CONCLUSION:Eyelid retraction Was the most common clinical sign of Graves' ophthalmopathy in our patients.Larger prospective studies are suggested to evaluate both the prevalenoe and possible racial difference in its dinical presentation in Iranian population.%目的:研究分析伊朗 Graves 眼病患者的临床特点.方法:回顾分析 2003/2005 年确诊为 Graves 眼病的103例患者临床资料.结果:在103例 Graves 眼病患者中,48例(46.6%)为男性,55例(53.3%)为女性(男女比例为1.1).年龄18-73(平均45)岁,95例(92.2%)表现为甲状腺机能亢进,3例(2.9%)表现为原发性甲状腺机能减退,5例(4.8%)甲状腺机能正常.出现眼部症状的时间为2~95 (平均3.2)mo,而表现出甲状腺功能障碍的时间为6~180(平均39.4)mo.12例患者单眼发病,90例(87%)患者有眼睑退缩,80例(77.6%)患者

  18. CRM+ severe Fletcher factor deficiency associated with Graves' disease.

    Science.gov (United States)

    Kyrle, P A; Niessner, H; Deutsch, E; Lechner, K; Korninger, C; Mannhalter, C

    1984-01-01

    A 59-year-old male patient with Graves' disease and severe hereditary Fletcher factor deficiency is described. PKK clotting activity as well as the activity by a chromogenic substrate method (Chromozym PK) was less then 0.01 U/ml. In contrast to functional tests, the immunological assay (Laurell method) showed a PKK antigen concentration of 0.25 U/ml, indicating the presence of an abnormal nonfunctional PKK molecule (CRM+ variant). An inhibitor was excluded since the patient plasma did not inactivate partially purified PKK. Investigation of 11 family members revealed a reduction of the PKK clotting activity in 9 relatives of the patient. Since Graves' disease is considered an autoimmune disease, our case represents an example of an association of a severe hereditary deficiency of a contact factor and an autoimmune disease.

  19. Doenças da tireoide e miastenia grave

    Directory of Open Access Journals (Sweden)

    J. Lamartine de Assis

    1984-09-01

    Full Text Available Os autores estudam o comportamento da tireóide em um grupo de 304 pacientes com miastenia grave, constatando 15 casos de tireopatias, sendo 9 de hipertireoidismo, um de hipotireoidismo e 5 de bócio sem alterações da função tireoidiana. Nenhum paciente era proveniente de região de bócio endêmico e não havia bócio familiar. A tireotoxicose, que foi a disfunção mais frequente, foi estudada quanto a sua prevalência em pacientes miastênicos, quanto a sua influência sobre os sintomas da miastenia grave e quanto à época do seu aparecimento.

  20. 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.

  1. Hipertrigliceridemia familiar grave durante a gestação

    Directory of Open Access Journals (Sweden)

    Casulari Luiz Augusto

    2001-01-01

    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.

  2. Caracterización de la respuesta inflamatoria en la neumonía comunitaria grave. Efecto de los corticoides en la contención de dicha respuesta y en el curso evolutivo de la infección

    OpenAIRE

    Fernández Serrano, Silvia

    2012-01-01

    [spa] La neumonía adquirida en la comunidad (NAC) continúa siendo en la actualidad una enfermedad potencialmente grave, que con frecuencia presenta una evolución desfavorable, a pesar del tratamiento antibiótico adecuado. La hipótesis de la tesis plantea que es posible monitorizar la respuesta inflamatoria que tiene lugar durante la NAC y, que dicha respuesta, puede ser influenciada por los antibióticos utilizados en su tratamiento, así como modulada mediante una terapia adyuvante con co...

  3. Optimization of optical and mechanical properties of real architecture for 3-dimensional tissue equivalents: Towards treatment of limbal epithelial stem cell deficiency.

    Science.gov (United States)

    Massie, Isobel; Kureshi, Alvena K; Schrader, Stefan; Shortt, Alex J; Daniels, Julie T

    2015-09-01

    Limbal epithelial stem cell (LESC) deficiency can cause blindness. Transplantation of cultured human limbal epithelial cells (hLE) on human amniotic membrane (HAM) can restore vision but clinical graft manufacture can be unreliable. We have developed a reliable and robust tissue equivalent (TE) alternative to HAM, Real Architecture for 3D Tissue (RAFT). Here, we aimed to optimize the optical and mechanical properties of RAFT TE for treatment of LESC deficiency in clinical application. The RAFT TE protocol is tunable; varying collagen concentration and volume produces differing RAFT TEs. These were compared with HAM samples taken from locations proximal and distal to the placental disc. Outcomes assessed were transparency, thickness, light transmission, tensile strength, ease of handling, degradation rates and suitability as substrate for hLE culture. Proximal HAM samples were thicker and stronger with poorer optical properties than distal HAM samples. RAFT TEs produced using higher amounts of collagen were thicker and stronger with poorer optical properties than those produced using lower amounts of collagen. The 'optimal' RAFT TE was thin, transparent but still handleable and was produced using 0.6ml of 3mg/ml collagen. Degradation rates of the 'optimal' RAFT TE and HAM were similar. hLE achieved confluency on 'optimal' RAFT TEs at comparable rates to HAM and cells expressed high levels of putative stem cell marker p63α. These findings support the use of RAFT TE for hLE transplantation towards treatment of LESC deficiency.

  4. New target for immunotherapy of Graves ophthalmopathy%Graves 眼病免疫治疗的新靶点

    Institute of Scientific and Technical Information of China (English)

    王坚

    2010-01-01

    @@ Graves 眼病(Graves ophthalmopathy,GO) 或称甲状腺相关性眼病(thyroid associated ophthalmopathy,TAO)是长期以来困扰内分泌医师的常见病症之一,目前尚无理想的治疗方法,常用免疫调节、球后放射照射、眼眶减压术等疗法.GO 的发病机制尚未完全明了,目前认为细胞免疫和体液免疫共同参与了GO 的发生和发展.

  5. Insuficiencia mitral grave posvalvuloplastia mitral percutánea

    Directory of Open Access Journals (Sweden)

    Julio C. Echarte Martínez

    2010-01-01

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

  6. In vitro passage and line establishment of human limbal stem cells%人角膜缘干细胞体外传代及建系

    Institute of Scientific and Technical Information of China (English)

    李舒梅; 罗晓婷; 文道源; 曾祥云; 陈水亲; 黄勤; 胡利群

    2007-01-01

    膜缘干细胞经体外培养33代并逐代冻存后初步建立了人角膜缘干细胞系,人角膜缘干细胞更适合在含有羊膜细胞外基质为底物的培养基中生长.%BACKGROUND: The investigation of culturing, passaging and establishing human limbal stem cells can strengthen the recognition of the stem cells and provide the enough cellular reserve for the basic and clinical research of limbal stem cell transplantation.OBJECTIVE: To explore a method of pessaging and establishing cell line of human limbal stem cells cultured in vitro.DESIGN: Randomized controlled observation.SETTING: Gannan Medical College.MATERIALS: The experiment was performed at Scientific Center of Gannan Medical College and the National Key Laboratory of Ophthalmology Hospital Affiliated to Sun Yat-Sen University from June 2003 to April 2004. Fresh human limbus corneae were isolated from two healthy donors. Procedures were performed according to the informed consent of the donors. Main reagents contained RPMI-1640 (Sigma R8755, containing L-glutamine) and 200 g/L fetal calf serum (FCS) (Gibco 16140-071). DMEM medium, chondroitin sulfatase and human epidermal growth factor (hEGF) were purchased from Sigma Co. USA; HEPES and DMSO were bought from Gibco, USA; 100% glycerinum was purchased from Yunjia Huangpu Pharmaceutical Product Limited Company, PRC; glutaraldehyde was bought from E.Merk, Germany; Alcohol, chlorhydric acid, acetone and methyl aldehyde were purchased from Beijing Chemical Agent Company, PRC; 0.25% parenzyme was bought from Shanghai Xinhua Pharmaceutical Factory, PRC.Above-mentioned reagents were analytical pure grade.METHODS: After digestion, human limbal tissues in limbal basilar part with an abundant pigment were cultured in the culture flask containing RPMI-1640 and 200 g/L FCS and in culture dish containing amniotic extracellular matrix (AECM) as the cultural supporter. Primary and passage cells were observed under light microscope and scanning electron

  7. Esterificacion quimioselectiva de fitosteroles de madera mediante lipasas

    National Research Council Canada - National Science Library

    Illanes, Andres; Alvarez, Lorena; Alvaro, Gregorio

    2008-01-01

    .... Ambas sustancias son muy similares, lo que impide su separacion por metodos fisicos, siendo la esterificacion selectiva de esta mezcla con esteres de acidos grasos mediante lipasas quimioselectivas...

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

    Institute of Scientific and Technical Information of China (English)

    吕新生

    2000-01-01

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

  9. Living related conjunctival limbal allograft and amniotic membrane transplantation for limbal stem cell deficiency in chemically injured eyes%活体异体结膜缘和羊膜移植治疗化学性眼外伤造成的角膜缘干细胞缺失

    Institute of Scientific and Technical Information of China (English)

    Mehdi Hosseini Tehrani; Asoo Ali Mahmoudi; Hassan Hashemi; Syed Jafar Oskouee; Javad Amuzadeh; Mohammad Taher Rajabi; Masoomeh Taherzadeh; Hamideh Shenazandi

    2008-01-01

    目的:评价利用活体异体结膜缘和羊膜移植治疗化学性眼外伤造成的角膜缘干细胞缺失的临床效果.方法:从2005-07/2007-12,本研究包括了9名男性化学性眼外伤患者(10眼).所有患者接受了亲属活体异体结膜缘和羊膜移植,2例眼接受了睑缝术.用环孢菌素和泼尼松龙进行全身性免疫抑制.结果:在3例眼中观察到完全角膜上皮化(30%),其中1例在术后1.5mo出现免疫排斥,角膜溶解引起穿孔,加大全身性免疫抑制剂量来控制病情.3例眼中植片无法在角膜表面重新形成上皮,被定为原发性失败.其余4眼有部分上皮形成,但上皮细胞无法完全覆盖角膜表面.术前最佳矫正视力从手动到1m处数指,术后最佳矫正视力从光感到20/80.有5眼视力得到改进,不需其他治疗.手术失败的主要原因为干眼症和持续性炎症.结论:对于能控制泪量和眼部炎症的病例,亲属活体异体角膜缘和羊膜移植是治疗化学性眼外伤造成的角膜缘干细胞缺失最佳方法之一.%AIM: To evaluate the clinical success of living related conjunctival limbal and amniotic membrane transplantation for treatment of chemical injury induced limbal stem cell deficiency.METHODS: From July 2005 to December 2007, 10 eyes of 9 male patients with chemical injury induced limbal stem cell deficiency were included in the study. All subjects underwent living related conjunctival limbal and amniotic membrane transplantation. Blepharorrhaphy was performed in two cases. Systemic immunosuppression with cyclosporine and prednisolone was initiated.RESULTS: Complete corneal epithelialization was observed in 3 eyes (30%). In one of the patients immunologic rejection and corneal melting led to perforation 1.5 months after surgery. The increasing dose of systemic immunosuppression was used to control it. Three eyes were described as primary failure because graft could not re-epithelialize the corneal surface. The remained four

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

    OpenAIRE

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

    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...

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

    OpenAIRE

    González Cases, Juan Carlos

    2012-01-01

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

  12. Intoxicación grave por psicofármacos

    Directory of Open Access Journals (Sweden)

    Dr. B. Juan Pablo Acuña

    2011-05-01

    Los objetivos de este artículo son entregar nociones de las manifestaciones clínicas, del manejo inicial y de las complicaciones más frecuentes y graves del intoxicado por ingesta de psicofármacos. Serán agrupados por familia de acuerdo a su clase y uso terapéutico, describiendo los mecanismos de toxicidad. En algunos de ellos hay recomendaciones de consenso respecto del manejo prehospitalario y la derivación a centros de alta complejidad.

  13. Limbal Fibroblasts Maintain Normal Phenotype in 3D RAFT Tissue Equivalents Suggesting Potential for Safe Clinical Use in Treatment of Ocular Surface Failure.

    Science.gov (United States)

    Massie, Isobel; Dale, Sarah B; Daniels, Julie T

    2015-06-01

    Limbal epithelial stem cell deficiency can cause blindness, but transplantation of these cells on a carrier such as human amniotic membrane can restore vision. Unfortunately, clinical graft manufacture using amnion can be inconsistent. Therefore, we have developed an alternative substrate, Real Architecture for 3D Tissue (RAFT), which supports human limbal epithelial cells (hLE) expansion. Epithelial organization is improved when human limbal fibroblasts (hLF) are incorporated into RAFT tissue equivalent (TE). However, hLF have the potential to transdifferentiate into a pro-scarring cell type, which would be incompatible with therapeutic transplantation. The aim of this work was to assess the scarring phenotype of hLF in RAFT TEs in hLE+ and hLE- RAFT TEs and in nonairlifted and airlifted RAFT TEs. Diseased fibroblasts (dFib) isolated from the fibrotic conjunctivae of ocular mucous membrane pemphigoid (Oc-MMP) patients were used as a pro-scarring positive control against which hLF were compared using surrogate scarring parameters: matrix metalloproteinase (MMP) activity, de novo collagen synthesis, α-smooth muscle actin (α-SMA) expression, and transforming growth factor-β (TGF-β) secretion. Normal hLF and dFib maintained different phenotypes in RAFT TE. MMP-2 and -9 activity, de novo collagen synthesis, and α-SMA expression were all increased in dFib cf. normal hLF RAFT TEs, although TGF-β1 secretion did not differ between normal hLF and dFib RAFT TEs. Normal hLF do not progress toward a scarring-like phenotype during culture in RAFT TEs and, therefore, may be safe to include in therapeutic RAFT TE, where they can support hLE, although in vivo work is required to confirm this. dFib RAFT TEs (used in this study as a positive control) may be useful toward the development of an ex vivo disease model of Oc-MMP.

  14. The effect of culture medium and carrier on explant culture of human limbal epithelium: A comparison of ultrastructure, keratin profile and gene expression.

    Science.gov (United States)

    Pathak, Meeta; Olstad, O K; Drolsum, Liv; Moe, Morten C; Smorodinova, Natalia; Kalasova, Sarka; Jirsova, Katerina; Nicolaissen, Bjørn; Noer, Agate

    2016-12-01

    Patients with limbal stem cell deficiency (LSCD) often experience pain and photophobia due to recurrent epithelial defects and chronic inflammation of the cornea. Successfully restoring a healthy corneal surface in these patients by transplantation of ex vivo expanded human limbal epithelial cells (LECs) may alleviate these symptoms and significantly improve their quality of life. The clinical outcome of transplantation is known to be influenced by the quality of transplanted cells. Presently, several different protocols for cultivation and transplantation of LECs are in use. However, no consensus on an optimal protocol exists. The aim of this study was to examine the effect of culture medium and carrier on the morphology, staining of selected keratins and global gene expression in ex vivo cultured LECs. Limbal biopsies from cadaveric donors were cultured for three weeks on human amniotic membrane (HAM) or on tissue culture coated plastic (PL) in either a complex medium (COM), containing recombinant growth factors, hormones, cholera toxin and fetal bovine serum, or in medium supplemented only with human serum (HS). The expanded LECs were examined by light microscopy (LM), transmission electron microscopy (TEM), immunohistochemistry (IHC) for keratins K3, K7, K8, K12, K13, K14, K15 and K19, as well as microarray and qRT-PCR analysis. The cultured LECs exhibited similar morphology and keratin staining on LM, TEM and IHC examination, regardless of the culture condition. The epithelium was multilayered, with cuboidal basal cells and flattened superficial cells. Cells were attached to each other by desmosomes. Adhesion complexes were observed between basal cells and the underlying carrier in LECs cultured on HAM, but not in LECs cultured on PL. GeneChip Human Gene 2.0 ST microarray (Affymetrix) analysis revealed that 18,653 transcripts were ≥2 fold up or downregulated (p ≤ 0.05). Cells cultured in the same medium (COM or HS) showed more similarities in gene

  15. Evaluación de la Atención a las Personas con Enfermedad Mental Grave y Persistente: la Experiencia de Madrid

    Directory of Open Access Journals (Sweden)

    Manuel Muñoz López

    2009-01-01

    Full Text Available En este artículo se presenta una experiencia de evaluación de programas de atención a las personas con enfermedad mental grave y persistente llevada a cabo en la Comunidad de Madrid: la evaluación del Plan de atención social para personas con enfermedad mental grave y crónica 2003-2007, de la Consejería de Familia y Asuntos Sociales. En este caso se aborda la evaluación de una forma global, abarcando los distintos aspectos del Plan, aunque prestando una atención especial a la red de recursos que se incluyen en el mismo. Se describe el proceso de evaluación global explicando los objetivos, metodología y procedimientos seguidos, así como las fases del proceso, las tareas y actividades desarrolladas, los instrumentos aplicados y los procedimientos de evaluación establecidos. Se presentan también algunos de los resultados obtenidos mediante dicha evaluación durante el año 2006.

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

    Science.gov (United States)

    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

    2017-04-20

    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. Several clinical variants of GO exist, including euthyroid GO, recently listed as a rare disease in Europe (ORPHA466682). The objective was to estimate the prevalence of GO and its clinical variants in Europe, based on available literature, and to consider whether they may potentially qualify as rare. Recent published data on the incidence of GO and Graves' hyperthyroidism in Europe were used to estimate the prevalence of GO. The position statement was developed by a series of reviews of drafts and electronic discussions by members of the European Group on Graves' Orbitopathy. The prevalence of GO in Europe is about 10/10,000 persons. The prevalence of other clinical variants is also low: hypothyroid GO 0.02-1.10/10,000; GO associated with dermopathy 0.15/10,000; GO associated with acropachy 0.03/10,000; asymmetrical GO 1.00-5.00/10,000; unilateral GO 0.50-1.50/10,000. GO has a prevalence that is clearly above the threshold for rarity in Europe. However, each of its clinical variants have a low prevalence and could potentially qualify for being considered as a rare condition, providing that future research establishes that they have a distinct pathophysiology. EUGOGO considers this area of academic activity a priority.

  17. Craniotomia descompressiva bifrontal no tratamento do edema cerebral grave

    Directory of Open Access Journals (Sweden)

    Walter C. Pereira

    1977-06-01

    Full Text Available São apresentados os resultados obtidos com craniotomia descompressiva bifrontal ampla em 12 doentes com edema cerebral grave e irreversível com os métodos convencionais de tratamento, provocado em 10 por traumatismo crânio-encefálico. Todos os pacientes apresentavam quadro neurológico muito grave, com sinais de comprometimento do tronco cerebral superior. Angiografia caro-tídea bilateral foi praticada sistematicamente, tanto no pré como no pós-operatório, constituindo-se no fator decisivo para a indicação cirúrgica. Seis (50% dos doentes sobreviveram, apresentando 5 (41,6% recuperação neurológica e psíquica praticamente totais. Levando em conta estes resultados, consideramos esta técnica cirúrgica o melhor recurso de tratamento em tais casos, máxime se indicada precocemente. São necessários, contudo, cuidados pós-operatórios especiais com estes pacientes, que devem, sempre que possível, ser mantidos em unidade de terapia intensiva, em virtude da grande incidência de complicações, mormente respiratórias.

  18. 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.

  19. Outcomes following surgical decompression for dysthyroid orbitopathy (Graves' disease).

    Science.gov (United States)

    Leong, Samuel C; White, Paul S

    2010-02-01

    Graves' disease is a multiorgan autoimmune disease of complex pathophysiology that primarily affects the thyroid gland and orbit. The ophthalmic manifestations of Graves' disease may vary from mild proptosis which causes minimal cosmetic embarrassment to subluxation of the globe, exposure keratitis, corneal abrasion and even blindness. This article focuses on outcomes following orbital decompression. Surgical techniques have evolved with improved understanding of sinonasal anatomy and being technology-driven with the use of the fiberoptic endoscope and image guidance. The most common surgical outcome reported in the literature is reduction in proptosis, followed by visual acuity and intraocular pressure. Quality-of-life assessments are not routinely measured. There are a myriad of surgical techniques currently in practice which underscores the fact that no single technique is clearly superior to another. Endoscopic decompression results in a mean reduction of 3.50 mm and is associated with a low complication rate. Nevertheless, the literature suggests that the best techniques are likely to be multiwall approaches such as combined medial and lateral wall decompression. Management of dysthyroid ophthalmopathy is clearly multidisciplinary. Future studies should consider a minimum data set for reporting outcome measures which should include a quality of life tool.

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

    Energy Technology Data Exchange (ETDEWEB)

    Haibach, H.

    1976-06-01

    The radioimmunoassay for T/sub 3/ is now widely available and is a useful diagnostic tool for hyperthyroidism, especially in T/sub 3/-thyrotoxicosis. It is an essential tool in the management of hyperthyroidism that persists after treatment with normal T/sub 4/ serum levels or, in euthyroid cases, with low T/sub 4/ serum levels. In these conditions, it reflects the metabolic state more accurately than serum levels of T/sub 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/sub 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.

  1. Use of a Toric Intraocular Lens and a Limbal-Relaxing Incision for the Management of Astigmatism in Combined Glaucoma and Cataract Surgery

    Science.gov (United States)

    Gibbons, Allister

    2016-01-01

    Purpose We report the surgical management of a patient with glaucoma undergoing cataract surgery with high preexisting astigmatism. A combination of techniques was employed for her astigmatism management. Methods A 76-year-old female with 5.5 dpt of corneal astigmatism underwent surgery in her left eye consisting of one-site trabeculectomy, phacoemulsification, toric intraocular lens implantation and a single inferior limbal-relaxing incision. Results Intraocular pressure control was achieved with no medication at 11 mm Hg; before the filtering procedure, the pressure was 16 mm Hg on two topical drugs. Astigmatism was reduced to 0.75 dpt, and both corrected and uncorrected visual acuity improved. Conclusions Astigmatism management can have a good outcome in combined procedures. We encourage surgeons to address astigmatism in the preoperative planning of patients undergoing glaucoma surgery associated with phacoemulsification. PMID:27293408

  2. La imprescriptibilidad de la accion y la sancion disciplinaria por graves violaciones a los Derechos Humanos e infracciones graves al Derecho Internacional Humanitario

    National Research Council Canada - National Science Library

    Daza-Marquez, Tania-Milena

    2010-01-01

    El articulo presenta un analisis respecto a la problematica de la imprescriptibilidad de la accion y la sancion disciplinarias por graves violaciones e infracciones a los Derechos Humanos y el Derecho...

  3. An important role for adenine, cholera toxin, hydrocortisone and triiodothyronine in the proliferation, self-renewal and differentiation of limbal stem cells in vitro.

    Science.gov (United States)

    Yu, Min; Bojic, Sanja; Figueiredo, Gustavo S; Rooney, Paul; de Havilland, Julian; Dickinson, Anne; Figueiredo, Francisco C; Lako, Majlinda

    2016-11-01

    The cornea is a self-renewing tissue located at the front of the eye. Its transparency is essential for allowing light to focus onto the retina for visual perception. The continuous renewal of corneal epithelium is supported by limbal stem cells (LSCs) which are located in the border region between conjunctiva and cornea known as the limbus. Ex vivo expansion of LSCs has been successfully applied in the last two decades to treat patients with limbal stem cell deficiency (LSCD). Various methods have been used for their expansion, yet the most widely used culture media contains a number of ingredients derived from animal sources which may compromise the safety profile of human LSC transplantation. In this study we sought to understand the role of these components namely adenine, cholera toxin, hydrocortisone and triiodothyronine with the aim of re-defining a safe and GMP compatible minimal media for the ex vivo expansion of LSCs on human amniotic membrane. Our data suggest that all four components play a critical role in maintaining LSC proliferation and promoting LSC self-renewal. However removal of adenine and triiodothyronine had a more profound impact and led to LSC differentiation and loss of viability respectively, suggesting their essential role for ex vivo expansion of LSCs. Replacement of each of the components with GMP-grade reagents resulted in equal growth to non-GMP grade media, however an enhanced differentiation of LSCs was observed, suggesting that additional combinations of GMP grade reagents need to be tested to achieve similar or better level of LSC maintenance in the same manner as the traditional LSC media.

  4. 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.

  5. 75 FR 12377 - Native American Graves Protection and Repatriation Act Regulations-Disposition of Culturally...

    Science.gov (United States)

    2010-03-15

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

  6. 78 FR 27078 - Native American Graves Protection and Repatriation Act Regulations

    Science.gov (United States)

    2013-05-09

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

  7. 76 FR 69282 - Native American Graves Protection and Repatriation Review Committee: Meeting

    Science.gov (United States)

    2011-11-08

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

  8. 75 FR 9429 - Native American Graves Protection and Repatriation Review Committee: Meetings

    Science.gov (United States)

    2010-03-02

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

  9. 77 FR 7180 - Native American Graves Protection and Repatriation Review Committee: Meeting

    Science.gov (United States)

    2012-02-10

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

  10. 77 FR 53228 - Native American Graves Protection and Repatriation Review Committee: Meeting

    Science.gov (United States)

    2012-08-31

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

  11. 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 Graves' 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.

  12. Early medieval stone-lined graves in Southern Germany: analysis of an emerging noble class.

    Science.gov (United States)

    Rott, Andreas; Turner, Nils; Scholz, Ulrike; von Heyking, Kristin; Immler, Franziska; Peters, Joris; Haberstroh, Jochen; Harbeck, Michaela

    2017-04-01

    Stone-lined graves, which first appear in Bavarian territory during the 7(th) century AD, are assumed to be tombs of emerging nobility. While previous research on stone-lined grave goods supports their status as elite burials, an important factor defining nobility-kinship-has not been examined so far. Morphological analysis of the commingled skeletal remains of 21 individuals from three archaeological sites was carried out. Radiocarbon dating was conducted on these individuals to gain information on usage intervals of these graves. To test whether stone-lined graves can be considered family graves, analyses of mitochondrial HVR I, Y-chromosomal and autosomal STRs were carried out. Morphological examination revealed a surplus of males buried in stone-lined graves and radiocarbon dating points to usage of the tombs for several generations. According to aDNA analysis, kinship can be assumed both between and within stone-lined graves. Taken together, these results hint at burials of family members with high social status being inhumed at the same site, in some cases even the same grave, for several generations. They also suggest, for the first time, that an early medieval linear cemetery was structured according to biological kinship. © 2017 Wiley Periodicals, Inc.

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

    DEFF Research Database (Denmark)

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

    2008-01-01

    CONTEXT: Graves' disease is an autoimmune disease of the thyroid gland. Patients often have affective and cognitive complaints, whether these disappear after treatment remains disputed. OBJECTIVE: Our objective was to evaluate cerebral biochemistry in acute and treated Graves' disease. DESIGN: We...

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

    Science.gov (United States)

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

    2016-03-01

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

  15. Padrao epidemiologico das oclusopatias muito graves em adolescentes brasileiros

    Directory of Open Access Journals (Sweden)

    Karen Glazer Peres

    2013-12-01

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

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

    Science.gov (United States)

    Verger, Stéphane

    2011-01-01

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

  17. Doença Pariodontal: fator associado à asma grave?

    OpenAIRE

    Marques, Kaliane Rocha Soledade

    2012-01-01

    A periodontite constitui-se uma doença crônica de grande prevalência na população, com repercussões imunológicas em todo o organismo. Estima-se que a periodontite pode influenciar na hiper-resposta inflamatória em indivíduos com asma, por meio de alterações imuno-inflamatórias, além de servirem como fontes de microrganismos para o desenvolvimento de infecções pulmonares. Objetivo: Avaliar a possível associação entre a presença periodontite e a asma grave. Método: Estudo caso-co...

  18. The story of the only (? megalith grave on Gotland Island

    Directory of Open Access Journals (Sweden)

    Helene Martinsson-Wallin

    2010-12-01

    Full Text Available In this paper, we discuss the easternmost material expression of the Funnel Beaker Culture – a megalith grave on the west coast of Gotland Island in the Baltic Sea. The people who built and used the megalith brought the Neolithic lifestyle to Gotland. The biography of this monument includes two excavations, of which we participated in the latest in 1984. Our osteological analysis confirms that some thirty individuals of both sexes and various ages were buried there. The structure of the monument is that of a rectangular dolmen. This paper discusses the discovery of this specific site, and explores the existence of this type of monument in a Gotland context. Furthermore, is this really the only megalith on Gotland, or are more of these structures yet to be recognised? Finally, one may ask if the Neolithic way of life really was successful on Gotland.

  19. Changes of Regulatory T Cells in Graves' Disease

    Institute of Scientific and Technical Information of China (English)

    WANG Hongxiang; ZHAO Shi; TANG Xiaoqiong; LI Jingyuan

    2006-01-01

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

  20. Doenças da tireoide e miastenia grave

    OpenAIRE

    1984-01-01

    Os autores estudam o comportamento da tireóide em um grupo de 304 pacientes com miastenia grave, constatando 15 casos de tireopatias, sendo 9 de hipertireoidismo, um de hipotireoidismo e 5 de bócio sem alterações da função tireoidiana. Nenhum paciente era proveniente de região de bócio endêmico e não havia bócio familiar. A tireotoxicose, que foi a disfunção mais frequente, foi estudada quanto a sua prevalência em pacientes miastênicos, quanto a sua influência sobre os sintomas da miastenia g...

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

    Science.gov (United States)

    Yang, Morgan; Perros, Petros

    2012-06-01

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

  2. 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.

  3. Atypical Clinical Manifestations of Graves' Disease: An Analysis in Depth

    Directory of Open Access Journals (Sweden)

    Mohamed Osama Hegazi

    2012-01-01

    Full Text Available 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.

  4. 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.

  5. 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.

  6. Radioiodine treatment of recurrent hyperthyroidism in patients previously treated for Graves' disease by subtotal thyroidectomy

    DEFF Research Database (Denmark)

    Vestergaard, H; Laurberg, P

    1992-01-01

    Radioiodine therapy is often employed for treatment of patients with relapse of hyperthyroidism due to Graves' disease, after previous thyroid surgery. Little is known about the outcome of this treatment compared to patients with no previous surgery. A total of 20 patients who had received surgical...... treatment for Graves' hyperthyroidism 1-46 years previously and with relapse of the hyperthyroidism, and 25 patients with hyperthyroidism due to Graves' disease and no previous thyroid surgery were treated with radioiodine, following the same protocol. Early after treatment the previously operated patients...

  7. Mechanisms in endocrinology. Role of emotional stress in the pathophysiology of Graves' disease.

    Science.gov (United States)

    Falgarone, Géraldine; Heshmati, Hassan M; Cohen, Régis; Reach, Gérard

    2013-01-01

    The role of stress in the pathophysiology of Graves' disease is suggested by several clinical observations, by recent advances in immunology and by better understanding of autoimmune diseases which provides new insights into potential effects of stress hormones on T helper cell imbalance involved in the pathogenesis of autoimmune diseases. Stress management should therefore be an important part of the treatment of Graves' disease, as stress reduction may improve the effect of therapy. However, this field still requires interventional data to support stress management in the treatment of Graves' disease.

  8. 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

  9. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1994-09-01

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

  11. Transconjunctival orbital decompression in Graves' ophthalmopathy: lateral wall approach ab interno

    NARCIS (Netherlands)

    D.A. Paridaens; 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

  12. Outcome of orbital decompression for disfiguring proptosis in patients with Graves' orbitopathy using various surgical procedures

    NARCIS (Netherlands)

    Mourits, M. P.; Bijl, H.; Altea, M. A.; Baldeschi, L.; Boboridis, K.; Curro, N.; Dickinson, A. J.; Eckstein, A.; Freidel, M.; Guastella, C.; Kahaly, G. J.; Kalmann, R.; Krassas, G. E.; Lane, C. M.; Lareida, J.; Marcocci, C.; Marino, M.; Nardi, M.; Mohr, Ch; Neoh, C.; Pinchera, A.; Orgiazzi, J.; Pitz, S.; Saeed, P.; Salvi, M.; Sellari-Franceschini, S.; Stahl, M.; von Arx, G.; Wiersinga, W. M.

    2009-01-01

    Aim: To compare the outcome of various surgical approaches of orbital decompression in patients with Graves' orbitopathy (GO) receiving surgery for disfiguring proptosis. Method: Data forms and questionnaires from consecutive, euthyroid patients with inactive GO who had undergone orbital decompressi

  13. Disease Activity in Graves' Ophthalmopathy: Diagnosis with Orbital MR Imaging and Correlation with Clinical Score

    National Research Council Canada - National Science Library

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

    2013-01-01

    In Graves' ophthalmopathy (GO) it is important to distinguish acute inflammation at an early stage, responsive to immunosuppressive treatment, from inactive fibrotic end stage disease, unresponsive to the same treatment...

  14. Mechanisms in endocrinology. Role of emotional stress in the pathophysiology of Graves' disease

    National Research Council Canada - National Science Library

    Falgarone, Géraldine; Heshmati, Hassan M; Cohen, Régis; Reach, Gérard

    2013-01-01

    The role of stress in the pathophysiology of Graves' disease is suggested by several clinical observations, by recent advances in immunology and by better understanding of autoimmune diseases which...

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

    DEFF Research Database (Denmark)

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

    2007-01-01

    In the acute phase of Graves' thyrotoxicosis patients often have subjective cognitive complaints. Continuing controversy exists about the nature of these symptoms and whether they persist after treatment. This prospective study included 31 consecutively referred, newly diagnosed, and untreated pa...

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

    Science.gov (United States)

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

    2013-01-01

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

  17. Special features of Graves' disease in early childhood.

    Science.gov (United States)

    Segni, M; Leonardi, E; Mazzoncini, B; Pucarelli, I; Pasquino, A M

    1999-09-01

    Graves' disease (GD) is extremely rare in children younger than 4 years of age, but if not recognized and treated it can seriously interfere with growth and development. We report three unrelated children, all females, in whom GD occurred before the age of 3. These children presented with goiter, exophthalmos, tachycardia, and hyperactivity. Moreover, one showed a severe psychomotor delay, and had previously undergone surgery due to craniosynostosis; the other two manifested a language delay. All had high thyroid hormones and thyrotropin receptor antibody (TRAb) serum levels that clearly indicated autoimmune hyperthyroidism. In all of them, the disease presumably had developed during the first or second year of life. No maternal history of GD was present in two. The third child was born to a mother affected with GD during pregnancy, but it is likely that her GD began to develop after 6 months of life. These children are being treated with methimazole, and treatment is still necessary after 32 months. TRAb levels were persistently high at follow-up. Psychological evaluation including language development at follow-up was appropriate for age in two children; the third child improved, but severe mental retardation is still evident. GD assessment in early childhood also needs to focus on psychological evaluation. Pediatricians should be aware of the possibility of permanent brain damage and craniosynostosis due to hyperthyroidism in infancy.

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

    Science.gov (United States)

    Messina, G; Viceconti, N; Trinti, B

    1997-11-01

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

  19. Sheehan's syndrome co-existing with Graves' disease.

    Science.gov (United States)

    Arpaci, D; Cuhaci, N; Saglam, F; Ersoy, R; Cakir, B

    2014-01-01

    Sheehan's syndrome (SS), which is an important cause of hypopituitarism, is common in developing countries. The most common presentation is the absence of lactation and amenorrhea. Hypothyroidism rather than hyperthyroidism is the usual expected phenomenon in SS. Postpartum hyperthyroidism is also common and Graves' disease (GD) is an important cause of postpartum hyperthyroidism. Here we report a case of a 22-year-old female patient in our clinic presented symptoms of amenorrhea, lack of lactation, palpitations and sweating. Her physical examination revealed goiter, moist skin and proptosis. Her laboratory evaluation showed suppressed thyroid stimulating hormone, elevated levels of free thyroxine and free triiodothyronine. Thyroid antibodies were positive. Tec 99m thyroid scintigraphy results were gland hyperplasia and increased uptake consistent with GD. She gave birth 7 months ago; after delivery she had a history of prolonged bleeding, amenorrhea and inability to lactate. She had hypogonadotropic hypogonadism, hyperprolactinemia and growth hormone deficiency. Serum cortisol and adrenocorticotropic hormone levels were normal. Her magnetic resonance imaging was empty sella. Our diagnosis was GD co-existing with SS. GD with concomitant hypopituitarism is rare but has been described previously, but there are no reports of GD occurring with SS. In this case study, we report a patient with GD associated with SS.

  20. Desarrollo y evaluación de una aplicación para navegar por Internet mediante sistemas Brain Computer Interface orientada a personas con grave discapacidad

    OpenAIRE

    Martínez Cagigal, Víctor

    2015-01-01

    El electroencefalograma (EEG) fue desarrollado por Hans Berger en 1929 y las ondas cerebrales, hasta entonces desconocidas, fueron investigadas durante el siglo XX como ayuda para el diagnóstico de la epilepsia o diversos trastornos del sueño. Durante este periodo de tiempo se especuló sobre utilizar las señales EEG para desarrollar un sistema de comunicación entre el cerebro y el medio sin la intervención de los mecanismos normales de los nervios y los músculos periféricos. Ese sistema surgi...

  1. Prognostic factors of the outcomes of subtotal thyroid resection in graves disease

    Directory of Open Access Journals (Sweden)

    A J Tsurkan

    2011-03-01

    Full Text Available The long-term results of subtotal resection of thyroid gland on 82 patients with Graves' disease were studied. There was analysed the influence of three factors on outcome at Graves' disease: volume of a thyroid gland before operation, morphological structure of thyroid tissue and volume of thyroid remnant. Outcomes of subtotal resection of thyroid gland were studied on the basis of thyrotropic hormone level of blood in 3, 6, 12 months, 2 and 3 years after operation. Based on research it has been established that the volume of thyroid gland before operation does not influence to outcome of subtotal resection of thyroid gland with Graves' disease. Morphological changes of removed thyroid tissue in the form of colloidal nodules at patients with Graves' disease statistically significantly raise risk of development of postoperative complications after subtotal resection of thyroid gland. The surgeon defining the volume of thyroid rem-nant durng the operation could be mistaken as towards it's increase so towards it's reduction, with an average deviation about 35%. Various outcomes of subtotal resection of thyroid gland at the same volume of thyroid remnant let us conclude that this out-come depends more on intensity of autoimmune process rather than on the volume of thyroid remnant. According modern views to aetiology and patogenesis of Graves' disease, the optimum volume of operation at Graves' disease is thyroidectomy.

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

    Science.gov (United States)

    Wartofsky, L

    1997-04-01

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

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

    Directory of Open Access Journals (Sweden)

    Yeoree Yang

    2015-12-01

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

  4. Lineage tracing in the adult mouse corneal epithelium supports the limbal epithelial stem cell hypothesis with intermittent periods of stem cell quiescence

    Directory of Open Access Journals (Sweden)

    Natalie J. Dorà

    2015-11-01

    Full Text Available The limbal epithelial stem cell (LESC hypothesis proposes that LESCs in the corneal limbus maintain the corneal epithelium both during normal homeostasis and wound repair. The alternative corneal epithelial stem cell (CESC hypothesis proposes that LESCs are only involved in wound repair and CESCs in the corneal epithelium itself maintain the corneal epithelium during normal homeostasis. We used tamoxifen-inducible, CreER-loxP lineage tracing to distinguish between these hypotheses. Clones of labelled cells were induced in adult CAGG-CreER;R26R-LacZ reporter mice and their distributions analysed after different chase periods. Short-lived clones, derived from labelled transient amplifying cells, were shed during the chase period and long-lived clones, derived from stem cells, expanded. At 6 weeks, labelled clones appeared at the periphery, extended centripetally as radial stripes and a few reached the centre by 14 weeks. Stripe numbers depended on the age of tamoxifen treatment. Stripes varied in length, some were discontinuous, few reached the centre and almost half had one end at the limbus. Similar stripes extended across the cornea in CAGG-CreER;R26R-mT/mG reporter mice. The distributions of labelled clones are inconsistent with the CESC hypothesis and support the LESC hypothesis if LESCs cycle between phases of activity and quiescence, each lasting several weeks.

  5. Adenoviral Gene Therapy for Diabetic Keratopathy: Effects on Wound Healing and Stem Cell Marker Expression in Human Organ-cultured Corneas and Limbal Epithelial Cells.

    Science.gov (United States)

    Kramerov, Andrei A; Saghizadeh, Mehrnoosh; Ljubimov, Alexander V

    2016-04-07

    The goal of this protocol is to describe molecular alterations in human diabetic corneas and demonstrate how they can be alleviated by adenoviral gene therapy in organ-cultured corneas. The diabetic corneal disease is a complication of diabetes with frequent abnormalities of corneal nerves and epithelial wound healing. We have also documented significantly altered expression of several putative epithelial stem cell markers in human diabetic corneas. To alleviate these changes, adenoviral gene therapy was successfully implemented using the upregulation of c-met proto-oncogene expression and/or the downregulation of proteinases matrix metalloproteinase-10 (MMP-10) and cathepsin F. This therapy accelerated wound healing in diabetic corneas even when only the limbal stem cell compartment was transduced. The best results were obtained with combined treatment. For possible patient transplantation of normalized stem cells, an example is also presented of the optimization of gene transduction in stem cell-enriched cultures using polycationic enhancers. This approach may be useful not only for the selected genes but also for the other mediators of corneal epithelial wound healing and stem cell function.

  6. Autologous method for ex vivo expansion of human limbal epithelial progenitor cells based on plasma rich in growth factors technology.

    Science.gov (United States)

    Riestra, A C; Vazquez, N; Chacon, M; Berisa, S; Sanchez-Avila, R M; Orive, G; Anitua, E; Meana, A; Merayo-Lloves, J

    2017-04-01

    Develop an autologous culture method for ex vivo expansion of human limbal epithelial progenitor cells (LEPCs) using Plasma Rich in Growth Factors (PRGF) as a growth supplement and as a scaffold for the culture of LEPCs. LEPCs were cultivated in different media supplemented with 10% fetal bovine serum (FBS) or 10% PRGF. The outgrowths, total number of cells, colony forming efficiency (CFE), morphology and immunocytochemistry against p63- α and cytokeratins 3 and 12 (CK3-CK12) were analyzed. PRGF was also used to elaborate a fibrin membrane. The effects of the scaffold on the preservation of stemness and the phenotypic characterization of LEPCs were investigated through analysis of CK3-CK12, ABCG-2 and p63. LEPCs cultivated with PRGF showed a significantly higher growth area than FBS cultures. Moreover, the number of cells were also higher in PRGF than FBS, while displaying a better morphology overall. CFE was found to be also higher in PRGF groups compared to FBS, and the p63-α expression also differed between groups. LEPCs cultivated on PRGF membranes appeared as a confluent monolayer of cells and still retained p63 and ABCG-2 expression, being negative for CK3-CK12. PRGF can be used in corneal tissue engineering, supplementing the culture media, even in a basal media without any other additives, as well as providing a scaffold for the culture. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Radioiodine therapy in patients with Graves' disease; Radioiodoterapia em pacientes com doenca de Basedow-Graves

    Energy Technology Data Exchange (ETDEWEB)

    Correa, Margarida Maria Galvao; Blum, Bernardo; Pellegrini, Paulo Martins [Instituto Brasileiro de Medicina Nuclear, Rio de Janeiro, RJ (Brazil); Corbo, Rossana [Universidade Federal, Rio de Janeiro, RJ (Brazil). Faculdade de Medicina. Dept. de Radiologia; Rebello, Ana Maria de Oliveira [Hospital Universitario Clementino Fraga Filho, Rio de Janeiro, RJ (Brazil). Servico de Medicina Nuclear

    2000-04-01

    We studied retrospectively 104 patients with Graves' disease who underwent radioiodine therapy between 1983 and 1993. The administered dose varied from 2.0 to 9.0 mCi (74 to 333 MBq). In 1994 and 1998 the patients were asked to answer a questionnaire and were considered to have hypothyroidism when receiving T4 therapy. The importance of radioiodine therapy, its indications and the different methods of calculating the administered activity were studied. The results were compared with the literature. At the end of the evaluation, 62,4% of the patients presented hypothyroidism and 37,6% euthyroidism. There was no significant difference regarding the development of hypothyroidism when sex, number of doses, total activity (mCi), effective radiation ({mu}Ci per gram of tissue) and use of antithyroid drugs were considered. In conclusion, the period of time of post-radioiodine therapy is the most important factor in the analysis of the results, which may interfere with the development of hypothyroidism. (author)

  8. Desarrollo comunicación Alfa Arduino mediante Scada

    OpenAIRE

    Trallero Calvo, Jorge

    2015-01-01

    El siguiente proyecto pretende crear un sistema IoT (Internet of Things) girando en torno a Arduino, demostrando de este modo la facilidad de creación de proyectos y fiabilidad que nos aporta Arduino. Mediante una comunicación TCP/IP se procede a crear un sistema el cual es capaz de registrar valores a una cierta distancia mediante protocolos de procesos y comunicación (Telemedida) y de este modo monitorizar la temperatura en un punto determinado, sin estar limitado por la t...

  9. Desarrollo de un sistema de videoconferencia mediante WebRTC

    OpenAIRE

    Ibarrola Lerga, Josu

    2016-01-01

    El objetivo de este proyecto fin de carrera consiste en el desarrollo de un sistema de videoconferencia mediante WebRTC. Para realizar dicho desarrollo crearemos una página mediante el lenguaje de programación HTML5 y la tecnología que nos brinda WebRTC, todo ello dentro del marco de trabajo de Bootstrap, consiguiendo así una página web apta para cualquier dispositivo de visualización que se utilice. Debido a que se trata de una tecnología nueva que el autor desconoce, para pod...

  10. Current trends in the management of Graves' disease

    Energy Technology Data Exchange (ETDEWEB)

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

    1990-06-01

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

  11. Copy number variations exploration of multiple genes in Graves' disease.

    Science.gov (United States)

    Song, Rong-Hua; Shao, Xiao-Qing; Li, Ling; Wang, Wen; Zhang, Jin-An

    2017-01-01

    Few previous published papers reported copy number variations of genes could affect the predisposition of Graves' disease (GD). Herein, the aim of this study was to explore the association between copy number variations (CNV) profile and GD. The preliminary copy number microarray used to screen copy number variant genes was performed in 6 GD patients. Five CNV candidate genes (CFH, CFHR1, KIAA0125, UGT2B15, and UGT2B17) were then validated in an independent set of samples (50 GD patients and 50 matched healthy ones) by the Accucopy assay method. The CNV of the other 2 genes TRY6 and CCL3L1 was investigated in 144 GD patients and 144 healthy volunteers by the definitive genotyping technique using the Taqman quantitative polymerase-chain-reaction (Taqman qPCR). TRY6 gene-associated single nucleotide polymorphism (SNP), rs13230029, was genotyped by the PCR-ligase detection reaction (LDR) in 675 GD patients and 898 healthy controls. There were no correlation of the gene copy number (GCN) of CFH, CFHR1, KIAA0125, UGT2B15, and UGT2B17 with GD. In comparison with that of controls, the GCN distribution of TRY6 and CCL3L1 in GD patients did not show significantly differ (P > 0.05). Furthermore, TRY6-related polymorphism (rs13230029) showed no difference between GD patients and controls. No correlation was found between CNV or SNP genotype and clinical phenotypes. Generally, there were no link of the copy numbers of several genes, including CFH, CFHR1, KIAA0125, UGT2B15, UGT2B17, TRY6, and CCL3L1 to GD. Our results clearly indicated that the copy number variations of multiple genes, namely CFH, CFHR1, KIAA0125, UGT2B15, UGT2B17, TRY6, and CCL3L1, were not associated with the development of GD.

  12. Lithium as an Alternative Option in Graves Thyrotoxicosis

    Directory of Open Access Journals (Sweden)

    Ishita Prakash

    2015-01-01

    Full Text Available A 67-year-old woman was admitted with signs and symptoms of Graves thyrotoxicosis. Biochemistry results were as follows: TSH was undetectable; FT4 was >6.99 ng/dL (0.7–1.8; FT3 was 18 pg/mL (3–5; TSI was 658% (0–139. Thyroid uptake and scan showed diffusely increased tracer uptake in the thyroid gland. The patient was started on methimazole 40 mg BID, but her LFTs elevated precipitously with features of fulminant hepatitis. Methimazole was determined to be the cause and was stopped. After weighing pros and cons, lithium was initiated to treat her persistent thyrotoxicosis. Lithium 300 mg was given daily with a goal to maintain between 0.4 and 0.6. High dose Hydrocortisone and propranolol were also administered concomitantly. Free thyroid hormone levels decreased and the patient reached a biochemical and clinical euthyroid state in about 8 days. Though definitive RAI was planned, the patient has been maintained on lithium for more than a month to control her hyperthyroidism. Trial removal of lithium results in reemergence of thyrotoxicosis within 24 hours. Patient was maintained on low dose lithium treatment with lithium level just below therapeutic range which was sufficient to maintain euthyroid state for more than a month. There were no signs of lithium toxicity within this time period. Conclusion. Lithium has a unique physiologic profile and can be used to treat thyrotoxicosis when thionamides cannot be used while awaiting elective radioablation. Lithium levels need to be monitored; however, levels even at subtherapeutic range may be sufficient to treat thyrotoxicosis.

  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 (<18 years of age) with GD, diagnosed from 1982 to 2012. A curative option was offered to patients who did not respond to anti-thyroid drug (AT) at puberty. We analysed, the patient characteristics, TSH, T4, T3 and thyroid antibodies levels, AT response, remission post I(131), side effects, and hypothyroidism rates. A total of 50 patients were diagnosed with GD from 1982 to 2012. All patients received AT as initial treatment (mean duration: 35.3±25.9 months). Permanent remission was achieved in 46%. Thyroidectomy was performed in 5 patients, and 14 patients received I(131) (mean dose: 10.9±1.09 mCi). Remission with I(131) was obtained in 100%. The rate of permanent hypothyroidism was 90%. There was no progression of ophthalmopathy or side effects in any patients treated with I(131.) Radioiodine treatment of paediatric GD patients is safe, leads to complete remission at the expense of hypothyroidism, and does not exacerbate ophthalmopathy. It can be considered in patients older than 5 years, who do no not respond to AT or with significant side effects with this medication. Copyright © 2012 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  14. Estrategia más costo-efectiva para el diagnóstico de la infección bacteriana grave en lactantes con síndrome febril sin foco

    Directory of Open Access Journals (Sweden)

    Jefferson Antonio Buendía

    2016-09-01

    Full Text Available Introducción. A pesar de los avances en la vacunación, la infección bacteriana grave en menores de dos años con fiebre sin foco sigue siendo un motivo de preocupación para médicos y padres. Por ello, resulta relevante contar con información sobre el costo-efectividad de su diagnóstico para la adopción de las decisiones pertinentes. Objetivo. Evaluar el costo-efectividad de cuatro estrategias para la detección en Argentina de la infección bacteriana grave en lactantes con fiebre sin foco. Materiales y métodos. En una cohorte hipotética de 10.000 pacientes se evaluó mediante la técnica del árbol de decisiones la costo-efectividad de cuatro estrategias para la detección de la infección bacteriana grave: criterios de Rochester más prueba de proteína C reactiva, criterios de Rochester más prueba de procalcitonina, criterios de Rochester y conducta expectante. Resultados. La estrategia de aplicación de los criterios de Rochester más la prueba de proteína C reactiva resultó ser la más costo-efectiva, con una razón de costo-efectividad de USD$ 784 por caso correctamente diagnosticado frente a USD$ 839 para los criterios de Rochester más la prueba de procalcitonina, USD$ 1.116 para la conducta expectante y USD$ 1.193 para los criterios de Rochester. En el análisis de sensibilidad se determinó que, ante una probabilidad de infección bacteriana grave igual o menor de 14 %, la estrategia de elección era la conducta expectante. Conclusiones. La utilización combinada de los criterios de Rochester más la prueba de la proteína C reactiva constituyó la estrategia más costo-efectiva para la detección de la infección bacteriana grave en lactantes de uno a tres meses con fiebre sin foco. Sin embargo, en casos de bajo riesgo de dicha infección, la conducta expectante constituyó la estrategia de elección.

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

    Science.gov (United States)

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

    2016-09-01

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

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

    Directory of Open Access Journals (Sweden)

    Márcia Lait Morse

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2009-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Perla Vicari

    2004-03-01

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

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

    Directory of Open Access Journals (Sweden)

    Nataša VAMPELJ SUHADOLNIK

    2015-12-01

    Full Text Available The present article is a detailed study of the image of an ancient Chinese goddess, The Queen Mother of the West, called Xiwangmu 西王母 in Chinese. In the mythological tradition, Xiwangmu is a goddess who possesses the elixir of immortality and dwells in the western paradise, on the magic mountain Kunlun 崑崙. While her image can be found in mural paintings, and on lacquered objects and bronze mirrors, it appears primarily in the form of relief images on the stones and bricks of grave chambers and temples in the Han (206 BCE–220 CE grave complexes. The literary tradition reveals a multifunctional role of the mother, with her many attributes developing in accordance with the changing values of social and mythological concepts. The article concludes with a detailed discussion of her image and role within the wider cosmological context of Han grave art.

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

    DEFF Research Database (Denmark)

    Sandvik, Kjetil; Christensen, Dorthe Refslund

    place across media. We show how the death of an infant can lead to mediation, remediation and mediatization strategies which involves both the uses and arrangement of objects on memorial pages and on children’s graves as well as uses of new social technologies, that produce, negotiate and develop social......In this paper we analyze how bereaved parents make use of various media-strategies on online memorial sites and on children’s graves when performing processes of grief and commemoration for their stillborns and infants, and how these processes are not just linked to one particular media but take...... relations with the dead child and the (re)negotiating of parenthood. We understand media as a function of an object reflected in human practices and embedded and structured by the different materialities they are intertwined with. We argue that the use of media and materiality online and on the graves are...

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

    DEFF Research Database (Denmark)

    Enevold, Renée

    2013-01-01

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

  2. 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

     = 3965) between 1995 and 2012 were matched for age and gender with four control subjects. Median follow-up time was 7.9 years (range 0-17.5). Mortality risk in GO patients compared to the control population and compared to GD patients was calculated using Cox regression analyses, adjusting for pre......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...

  3. Reacciones adversas graves y mortales a los antimicrobianos. Sistema Cubano de Farmacovigilancia, 2003-2012

    Directory of Open Access Journals (Sweden)

    Ismary Alfonso Orta

    Full Text Available Introducción: las reacciones adversas a los antimicrobianos ocasionan más de 142 000 visitas a las salas de urgencias hospitalarias por año en los Estados Unidos. En Cuba han ocupado el primer lugar en el reporte, por ejemplo, en el año 2008 representaron el 31,4 % del total de las reacciones adversas graves y el 25 % de las reacciones adversas mortales. Objetivo: caracterizar las reacciones adversas graves y mortales a los antimicrobianos notificadas a la Unidad Nacional Coordinadora de Farmacovigilancia, durante el periodo 2003-2012. Métodos: se realizó un estudio de farmacovigilancia, observacional, descriptivo y transversal, utilizando la base de datos nacional de farmacovigilancia durante el periodo 2003-2012. Se trabajó con el total de reportes de reacciones adversas graves y mortales a los antimicrobianos. Las reacciones adversas se clasificaron según tipo de reacción, sistema de órgano afectado, imputabilidad y frecuencia. Se identificaron los principales antimicrobianos sospechosos y se estudiaron los pacientes que presentaron reacciones adversas según sexo y edad. Resultados: se detectaron 631 sospechas de reacciones adversas graves y mortales a los antimicrobianos, de ellas fueron 550 graves y 81 mortales. Predominaron el sexo femenino con 60,1 % y 405 adultos. Las reacciones adversas comprometieron los sistemas: general (30,4 %, respiratorio (25,2 % y cardiovascular (14,9 %. El shock anafiláctico fue la reacción más reportada y la penicilina el fármaco más relacionado con esta. El 73,5 % fueron probables y el 58,9 % ocasionales. Conclusiones: las reacciones adversas graves y mortales predominaron en el sexo femenino y en los adultos. La penicilina fue el fármaco más relacionado. Las reacciones adversas probables y ocasionales fueron la mayoría en el estudio.

  4. Mediastinal neoplasms in patients with Graves disease: a possible link between sustained hyperthyroidism and thymic neoplasia?

    Directory of Open Access Journals (Sweden)

    Boyd Jonathan D

    2012-07-01

    Full Text Available Abstract Background Anterior mediastinal masses are a rare but well documented finding in Graves disease. The vast majority of these lesions represents benign thymic hypertrophy and regress after treatment of the hyperthyroidism. A small percentage of these cases however represent neoplastic/malignant diseases which require further treatment. Cases 12 year old boy with one year history of refractory Graves disease was found to have an anterior mediastinal mass and underwent curative thyroidectomy for sustained hyperthyroidism. Cervical lymphadenopathy was detected during the procedure and biopsy was obtained. A 23 year old woman who presented with a one month history of hyperthyroid symptoms, was diagnosed with Graves disease and also was found to have an anterior mediastinal mass on imaging. Biopsy of the anterior mediastinal mass was obtained and subsequently the patient underwent robotic thymectomy. Histologic examination and immunophenotyping of the cervical lymph node in a 12 year old boy revealed neoplastic proliferation of T lymphoblasts diagnostic of T lymphoblastic leukemia/lymphoma. Examination of the anterior mediastinal mass biopsy in the 23 year old woman revealed type B1 thymoma which was confirmed after examination of the subsequent robotic thymectomy specimen. Conclusion This is the first reported case of T cell lymphoblastic lymphoma and the third reported case of thymoma associated with sustained hyperthyroidism due to Graves disease. These cases indicate that an anterior mediastinal mass in a patient with active Graves disease may be due to a neoplastic cause, which may require definitive treatment. Caution should be exercised when dismissing a mediastinal mass as benign thymic hyperplasia in patients with active Graves disease.

  5. Clinical Practice Guidelines for Severe Asthma Treatment. Guía de práctica clínica para el tratamiento del asma grave.

    Directory of Open Access Journals (Sweden)

    Belkys Rodríguez Llerena

    2009-03-01

    Full Text Available Clinical Practice Guidelines for Severe Asthma Treatment. This disease is characterized by an overreaction of the tracheobronchial tree with hyperactivity after certain stimulus consisting of a diffuse narrowing of the respiratory ways related with an excessive contraction of the bronchial smooth muscle, hyper-secretion of mucus and mucosa edema. It is spontaneously reversible or reversible after treatment. We include a review of its definition, classification and development, stressing those elements related with ventilation. It includes assessment guidelines focused on the most important aspects to be accomplished.Guía de práctica clínica para el tratamiento del asma grave, enfermedad caracterizada por una respuesta exagerada del árbol tráqueobronquial con hiperreactividad a determinados estímulos, consistente en un estrechamiento difuso de las vías aéreas en relación con una contracción excesiva del músculo liso bronquial, hipersecreción de moco y edema de la mucosa. Es reversible espontáneamente o mediante tratamiento médico. Se revisa su definición, clasificación y conducta; con énfasis en los elementos relacionados con la ventilación. Concluye con su guía de evaluación, enfocada en los aspectos más importantes a cumplir.

  6. Análisis funcional y tratamiento de un paciente con graves problemas de conducta diagnosticado de trastorno límite de la personalidad

    Directory of Open Access Journals (Sweden)

    Javier Virués Ortega

    2004-01-01

    Full Text Available Se presenta el caso de un paciente con diagnóstico de trastorno límite de personalidad institucionalizado en una comunidad terapéutica hospitalaria con una historia psiquiátrica prolongada y múltiples problemas de comportamiento asociados. Por motivos de eficiencia y ajuste del tratamiento al paciente se aplica un análisis funcional exhaustivo de las conductas-problema. Se usan tres fuentes de información: los registros de enfermería, rejilla de observación y entrevista conductual. Las dos primeras fuentes permitieron apoyar el análisis funcional con probabilidades condicionales. La intervención consideró el control de consumo de estimulantes, aumento de actividades de ocio, aumento de comportamientos de autocuidado y reducción de conductas- problema mediante economía de fichas y control de contingencias. Estas medidas fueron implementadas en un contrato conductual. Durante los dos meses de vigencia del tratamiento se observó una dramática reducción de todos los comportamientos problema, así como de otras conductas que no fueron objeto directo de intervención. Se discute el uso de esta metodología en trastornos de personalidad y otros trastornos graves como nuevas áreas de aplicación de la psicología conductual.

  7. Doença de Graves associada à artrite idiopática juvenil Graves' disease associated with juvenile idiopathic arthritis

    Directory of Open Access Journals (Sweden)

    Vanessa de Matos Santos Mendonça Marques

    2011-04-01

    Full Text Available Os autores relatam o caso de uma menina de 10 anos de idade com diagnóstico de doença de Graves (DG, em tratamento com propiltiouracil, que desenvolveu uveíte e artrite poliarticular e cuja mãe também tem DG e lúpus discoide. São discutidos os diagnósticos diferenciais de artrite inflamatória que surge em uma criança com doença tireoidiana autoimune medicada com drogas antitireóideas.The authors report the case of a 10-year-old girl with Graves' disease (GD, treated with propylthiouracil, who developed uveitis and polyarticular arthritis, and whose mother also had GD and discoid lupus. The differential diagnosis of inflammatory arthritis that appears in a child with autoimmune thyroid disease managed with antithyroid drugs is discussed.

  8. [Treatment of hyperthyroidism due to Graves' disease: what is the recommended antithyroid drug during pregnancy?].

    Science.gov (United States)

    Caron, P

    2013-05-01

    Clinical hyperthyroidism during the first trimester of pregnancy due to Graves' disease can be associated with maternal, obstetrical and fetal complications, indicating an active treatment to restore normal thyroid function. Antithyroid drugs are the first line treatment in pregnant women with hyperthyroidism. Due to the increased congenital malformations reported in neonates after first-trimester carbimazole/methimazole treatment and propylthiouracil associated hepatotoxicity, the recommended treatment for pregnant women with hyperthyroid Graves' disease is propylthiouracil during the first trimester of pregnancy and following the first trimester, consideration should be given switching to carbimazole/methimazole during the second part of gestation.

  9. Cuidados intensivos en peritonitis grave: análisis de 9 años

    OpenAIRE

    Avilés Cruz, Pura

    1990-01-01

    Se realizó un estudio perspectivo de los cuidados intensivos en los en los enfermos de peritonitis grave, ingresados en el Hospital V. I. Lenin desde enero de 1980 a septiembre de 1988. Se estudiaron 446 pacientes, con los siguientes objetivos: comportamiento de la peritonitis grave, los criterios de reintervención en aquellos pacientes en que persistía la sepsis intraabdominal y las experiencias con la técnica de abdomen abierto. La evolución fue satisfactoria en el 63, 63%, y no satisfac...

  10. Patogenia y tratamiento médico de la orbitopatía de graves

    OpenAIRE

    Soledad Hidalgo, V.

    2010-01-01

    La Orbitopatía de Graves se presenta clínicamente en aproximadamente 50% de los casos de Enfermedad de Graves. La mayoría de las veces es leve y sólo en menos del 5% pone en riesgo la visión, pese a lo cual deteriora significativamente la calidad de vida de los pacientes. Hasta el momento no se conoce totalmente la patogenia, siendo posiblemente el receptor de TSH el blanco de la autoinmunidad. En cuanto al tratamiento, las medidas preventivas como lograr el eutiroidismo y la suspensión de...

  11. Epidemiología del traumatismo torácico grave

    OpenAIRE

    Cordero Lorenzana, María Lourdes

    2016-01-01

    [Resumen] Objetivo: Características del traumatismo torácico grave en UCI. Mortalidad. Material y método: Análisis descriptivo retrospectivo, univariado y regresión de 100 variables en 1174 pacientes con traumatismo torácico grave (1993-2010). Resultados: Más varones (4:1) de 43,5±18,9 años. 96,5% de traumatismos torácicos cerrados y 89% asociado. Lesiones óseas frecuentes: fracturas costales (71,2%) y claviculares (17,9%). Otras: contusión pulmonar (44%), hemotórax (41,7...

  12. Postpartum thyrotoxicosis in a patient with Graves' disease. Association with low radioactive iodine uptake

    Energy Technology Data Exchange (ETDEWEB)

    Eckel, R.H.; Green, W.L.

    1980-04-11

    A patient with previously diagnosed Graves' hyperthyroidism had a transient episode of thyrotoxicosis three months postpartum. This was associated with a diffusely enlarged thyroid gland, a rise in antithyroid microsomal antibody titer, a 24-hour radioactive iodine uptake (RAIU) of 1%, and an aspiration biopsy specimen suggestive of chronic lymphocytic thyroiditis. An alternative cause for the depressed RAIU was not discovered. This case would suggest that patients with previously diagnosed Graves' disease can have thyrotoxicosis without an enhanced RAIU and that the postpartum thyrotoxin syndrome may involve an immunologic injury causing a release of performed thyroid hormone.

  13. Management of hyperthyroidism due to Graves' disease: frequently asked questions and answers (if any).

    Science.gov (United States)

    Bartalena, L; Chiovato, L; Vitti, P

    2016-10-01

    Graves' disease is the most common cause of hyperthyroidism in iodine-replete areas. Although progress has been made in our understanding of the pathogenesis of the disease, no treatment targeting pathogenic mechanisms of the disease is presently available. Therapies for Graves' hyperthyroidism are largely imperfect because they are bound to either a high rate of relapsing hyperthyroidism (antithyroid drugs) or lifelong hypothyroidism (radioiodine treatment or thyroidectomy). Aim of the present article is to offer a practical guidance to the reader by providing evidence-based answers to frequently asked questions in clinical practice.

  14. Efecto de la elastancia arterial efectiva sobre la función sistólica ventricular izquierda en la estenosis aórtica grave

    Directory of Open Access Journals (Sweden)

    Ricardo A. Migliore

    2006-01-01

    Full Text Available AntecedentesLa disfunción ventricular izquierda en la estenosis aórtica (EAo está relacionada con el exceso de poscarga. El aumento de la poscarga puede deberse a la reducción del área valvular aórtica (AVA, a cambios en la geometría ventricular y a las características de la vasculatura arterial. La elastancia arterial efectiva (Ea es un índice de carga vascular que incorpora la impedancia característica, la resistencia y la distensibilidad arterial.ObjetivoEvaluar el efecto de la Ea sobre la función sistólica del ventrículo izquierdo en la EAo grave.Material y métodosSe estudiaron prospectivamente 54 pacientes con EAo grave evaluados mediante los gradientes transvalvulares, el AVA, la resistencia valvular y el índice de pérdida de energía. La Ea se calculó mediante el cociente entre la presión de fin de sístole y el volumen sistólico. La presión de fin de sístole se obtuvo a partir del pulso carotídeo calibrado con la presión arterial medida con esfigmomanómetro. Como medida de la poscarga global, se calculó la impedancia valvuloaórtica (Zva, definida por: (presión sistólica + gradiente medio neto / índice de volumen sistólico. La Zva tiene en cuenta el efecto de la EAo y la Ea. Los pacientes se dividieron en tres grupos: G1, EAo con insuficiencia cardíaca (NYHA III-IV (n = 13, G2, EAo sintomática pero sin insuficiencia cardíaca (n = 13 y G3, EAo asintomática (n = 28. ResultadosLa fracción de eyección (Fey (% fue menor en el G1 (33 ± 15 en comparación con el G2 (42 ± 16 y el G3 (65 ± 14; p < 0,01. La Ea (mm Hg/ml fue mayor en el G1 (2,46 ± 0,8 con respecto al G2 y el G3 (1,83 ± 0,52 y 1,73 ± 0,47; p < 0,01, al igual que la Zva (mm Hg/ml/ m2: G1 (6,5 ± 2,2, G2 y G3 (4,8 ± 1,0 y 4,7 ± 1,5; p < 0,01. En el análisis univariado, la Zva se correlacionó con la Ea (r = 0,88; p < 0,0001 y la Fey (r = -0,41; p < 0,01. En el análisis multivariado, la Ea y la Zva fueron predictores independientes de la

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

    Directory of Open Access Journals (Sweden)

    Enrique Echeburúa

    2008-01-01

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

  16. The Roma: People without a Home or Grave

    Directory of Open Access Journals (Sweden)

    Vera Klopčič

    2010-12-01

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

  17. 78 FR 31570 - Prospective Grant of a Start-Up Exclusive Patent License Agreement: Treatment of Graves' Disease...

    Science.gov (United States)

    2013-05-24

    ... a Start-Up Exclusive Patent License Agreement: Treatment of Graves' Disease, Hyperthyroidism and...' Disease, hyperthyroidism and thyroid cancer. DATES: Only written comments or applications for a license... useful in treating hyperthyroidism and Graves' disease, an autoimmune disease that is commonly...

  18. Symmetric increased skeletal muscular uptake of F-18 fluoro-deoxyglucose: A clue for the diagnosis of Graves' disease.

    Science.gov (United States)

    Santhosh, Sampath; Mittal, Bhagwant Rai; Kashyap, Raghava; Bhattacharya, Anish; Singh, Baljinder

    2011-07-01

    F-18 fluoro-deoxyglucose (FDG) uptake in the thyroid and thymus is well reported in patients with Graves' disease. Incidental skeletal muscle uptake has also been reported in other non-musculoskeletal (benign and malignant) pathologies. We report a patient of Graves' disease showing symmetrical skeletal muscle uptake but no thyroidal or thymus uptake of FDG.

  19. 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

    ' 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......' disease versus 4% in nodular goitre (p = 0.038), anxiety was 18 versus 13% (p = 0.131). Symptoms of anxiety (p = 0.04) and depression (p = 0.01) increased with comorbidity. Anxiety symptoms increased with duration of Graves' disease (p = 0.04). Neither thyroid function nor autoantibody levels were...... associated with anxiety and depression symptoms.CONCLUSIONS: Anxiety and depression symptoms were more severe in Graves' disease than in nodular goitre. Symptoms were positively correlated to comorbidity and duration of Graves' disease but neither to thyroid function nor thyroid autoimmunity....

  20. Meta-analysis of limbal stem cell transplantation and amniotic membrane transplantation for pterygium%角膜缘干细胞移植与羊膜移植治疗翼状胬肉的Meta分析

    Institute of Scientific and Technical Information of China (English)

    于晓明; 吴欣怡

    2013-01-01

    Objective To evaluate the clinical effect of limbal stem cell transplantation and amniotic membrane transplantation in the treatment of pterygium by evidence based medicine. Methods Clinical data of effect in limbal stem cell transplantation and amniotic membrane transplantation were collected from computer literature searching, which was carried out in PubMed, EMBASE, Wanfang and VIP database etc, also performed searching based on www. baidu. com and www. google. com. Meta analysis that recommended by Cochrane Collaboration was done for the data obtained that 3 126 eyes that met with the eleven criteria of enrollment were included in this study. Publication bias was assessed by using a funnel plot. Results The results of meta-analysis showed that 35 RCTs evaluated the pterygium recurrent rate after grafting including 3 126 eyes, the incidence rate including 1 108 eyes, and the mean time of corneal epithelium wound healing including 900 eyes. In comparison with the amniotic membrane transplantation group, the recurrent rates of pterygium (P < 0.000 01) and the total complication rate (P = 0.01) were lower in the limbal stem cell transplantation group. Moreover , the mean time of corneal epithelium wound healing was shorter in the limbal stem cell transplantation group. Conclusion Corneal limbal stem cell autograft is an effective way to reduce the recurrent rate of pterygium and the incidence of symblepharon and to accelerate the healing of corneal wound comparing with amniotic membrane transplantation.%目的 以循证医学证据评价角膜缘干细胞移植和羊膜移植治疗翼状胬肉的临床疗效.方法 通过计算机检索Pubmed数据库、EMBASE、万方数据库、中国期刊全文数据库和维普数据库,并结合文献追溯的方法,收集关于角膜缘干细胞移植和羊膜移植治疗翼状胬肉临床疗效的随机前瞻性对照试验(RCT),并按Cochrane协作网推荐的方法对符合纳入标准的35个研究,共3 126只眼进

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

    DEFF Research Database (Denmark)

    Mannering, Ulla; Knudsen, Lise Ræder

    2007-01-01

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

  2. Outcome of inferior and superior rectus recession in Graves' orbitopathy patients

    NARCIS (Netherlands)

    Jellema, Hinke Marijke; Saeed, Peerooz; Groenveld, Linda; Kloos, Roel; Mourits, Maarten P

    2015-01-01

    PURPOSE: To evaluate the surgical effect of unilateral inferior rectus recession (IR-group) with or without a recession of contralateral superior rectus (IR-SR-group) on squint angle and motility restrictions in Graves' Orbitopathy (GO) patients. DESIGN: Retrospective case series. MATERIALS AND METH

  3. Graves' disease during immune reconstitution in HIV-infected patients treated with HAART.

    NARCIS (Netherlands)

    Vos, F.J.; Pieters, G.F.F.M.; Keuter, M.; Ven, A.J.A.M. van der

    2006-01-01

    Autoimmune phenomena after immune recovery due to HAART are not frequently described. Recently we found 3 patients with Graves' disease after starting HAART, outnumbering the expected incidence; 13 patients have been reported in the literature up to the present time.A probable relation between

  4. Characterization of Regulatory B Cells in Graves' Disease and Hashimoto's Thyroiditis

    DEFF Research Database (Denmark)

    Kristensen, Birte; Hegedüs, Laszlo; Lundy, Steven K

    2015-01-01

    A hallmark of regulatory B cells is IL-10 production, hence their designation as IL-10+ B cells. Little is known about the ability of self-antigens to induce IL-10+ B cells in Graves' disease (GD), Hashimoto's thyroiditis (HT), or other autoimmune disease. Here we pulsed purified B cells from 12 HT...

  5. Incidence of vitiligo in children with Graves' disease and Hashimoto's thyroiditis

    Directory of Open Access Journals (Sweden)

    Prindaville Brea

    2011-11-01

    Full Text Available Abstract Background Limited data are available on the association between vitiligo and autoimmune thyroid disease in pediatric patients. In addition, reported studies of pediatric patients have been based on a population known to have vitiligo and subsequently evaluated for the presence of thyroid function abnormalities. Methods A retrospective chart review was performed on 333 children who had been followed for thyroid disorders by endocrinologists at the Yale Pediatric Thyroid Center over the last 5 years for autoimmune thyroid disease. Demographical and clinical features of patients found to have thyroid disease and vitiligo were recorded. These studies were approved by the Yale Human Investigation Committee. Results Of the total 333 children and adolescents, 9 (2.7% were noted to have vitiligo. Four patients (44% had Graves' disease and 5 patients (66% had Hashimoto's thyroiditis. For patients with Graves' disease and vitiligo, the average age of onset of thyroid disease was young at 4 ± 0.7 years, and the diagnosis of vitiligo usually preceded that of thyroid disease. For children with Hashimoto's thyroiditis and vitiligo, thyroid disease was diagnosed at an average age of 13.25 ± 2.8 years. Conclusion In our population, 4.6% of children with Graves' disease and 2.0% of children with Hashimoto's thyroiditis had vitiligo. Interestingly, when vitiligo presents with Graves' disease, it occurs in younger rather than older children.

  6. 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

    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...

  7. T-cell prolymphocytic leukaemia (T-PLL): a rare disease with a grave prognosis.

    Science.gov (United States)

    Vivekanandarajah, Abhirami; Atallah, Jean Paul; Gupta, Shilpi

    2013-05-02

    T-cell prolymphocytic leukaemia (T-PLL) is an extremely uncommon haematological malignancy that has an aggressive course and a grave prognosis. We describe a patient who presented with lymphocytosis, scalp erythema, ascites and splenomegaly and was diagnosed with T-PLL. He was treated with alemtuzumab with a good response and was referred for allogeneic stem cell transplantation.

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

    Directory of Open Access Journals (Sweden)

    Jing Yu

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

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

    NARCIS (Netherlands)

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

    2004-01-01

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

  10. 78 FR 16295 - Native American Graves Protection and Repatriation Review Committee: Meeting

    Science.gov (United States)

    2013-03-14

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

  11. 77 FR 74874 - Native American Graves Protection and Repatriation Review Committee: Meeting

    Science.gov (United States)

    2012-12-18

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

  12. A refined study of FCRL genes from a genome-wide association study for Graves' disease

    National Research Council Canada - National Science Library

    Zhao, Shuang-Xia; Liu, Wei; Zhan, Ming; Song, Zhi-Yi; Yang, Shao-Ying; Xue, Li-Qiong; Pan, Chun-Ming; Gu, Zhao-Hui; Liu, Bing-Li; Wang, Hai-Ning; Liang, Liming; Liang, Jun; Zhang, Xiao-Mei; Yuan, Guo-Yue; Li, Chang-Gui; Chen, Ming-Dao; Chen, Jia-Lun; Gao, Guan-Qi; Song, Huai-Dong

    2013-01-01

    To pinpoint the exact location of the etiological variant/s present at 1q21.1 harboring FCRL1-5 and CD5L genes, we carried out a refined association study in the entire FCRL region in 1,536 patients with Graves' disease (GD...

  13. Too early to dismiss Yersinia enterocolitica infection in the aetiology of Graves' disease

    DEFF Research Database (Denmark)

    Brix, Thomas H; Hansen, Pia S; Hegedüs, Laszlo

    2008-01-01

    BACKGROUND: Yersinia enterocolitica (YE) infection has long been implicated in the pathogenesis of Graves' disease (GD). The association between YE and GD could, however, also be due to common genetic or environmental factors affecting the development of both YE infection and GD. This potential...

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

    Directory of Open Access Journals (Sweden)

    Paulo E. Marchiori

    1984-12-01

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

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

    Science.gov (United States)

    de la Caba Collado, Mariangeles; Rojas, Isabel Bartau

    2010-01-01

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

  16. Eyelid retraction, lid lag, lagophthalmos, and von Graefe's sign quantifying the eyelid features of Graves' ophthalmopathy.

    Science.gov (United States)

    Gaddipati, Ramakrishna V; Meyer, Dale R

    2008-06-01

    To report the frequency and relationship of eyelid retraction, lid lag, lagophthalmos, and von Graefe's sign in a group of patients with Graves' ophthalmopathy and compare these findings to those in a group of normal individuals. Retrospective comparative cohort study. Fifty consecutive Graves' ophthalmopathy patients were compared to a control group of 50 normal individuals. Measurements were made of eyelid position in primary gaze and downgaze to assess eyelid retraction and lid lag, and the presence of lagophthalmos and von Graefe's sign was noted when present. Eyelid position in primary gaze and downgaze and presence of lagophthalmos and von Graefe's sign. In the Graves' group, eyelid retraction (38%), von Graefe's sign (36%) and lagophthalmos (16%) were observed at a significantly greater frequency (P<0.01) than in normals, whereas true eyelid lag was observed in only 8% (P = 0.67). The terms lid lag and von Graefe's sign have been used interchangeably in the past; however, they are distinct signs of downgaze-related upper eyelid static position and dynamic movement, respectively. Although von Graefe's sign was commonly exibited in Graves' patients, the relatively low frequency of lid lag suggests that factors other than restriction/fibrosis are likely responsible for the etiology of eyelid retraction in many cases.

  17. /sup 131/I-therapy of Graves' disease and non-immunogenic thyrotoxicosis

    Energy Technology Data Exchange (ETDEWEB)

    Hoeschel, M.; Heinze, H.G.

    1984-06-01

    From 1977 to 1982, 315 patients suffering from thyrotoxicosis with diffuse and/or nodular goitre or Graves' disease were treated with /sup 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 /sup 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 /sup 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.

  18. Reporte de cinco casos de malaria neonatal grave por Plasmodium vivax en Urabá, Colombia

    Directory of Open Access Journals (Sweden)

    Juan Gabriel Piñeros

    2008-12-01

    Conclusión. Se trata de un reporte de cinco casos de malaria neonatal grave por P. vivax, especie que habitualmente no se relaciona con complicaciones, sin que existiera en ningún caso la sospecha clínica y con tratamiento inadecuado.

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

    DEFF Research Database (Denmark)

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

    2007-01-01

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

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

    Science.gov (United States)

    de la Caba Collado, Mariangeles; Rojas, Isabel Bartau

    2010-01-01

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

  1. EJERCICIO Y LA DETECCION DEL MAL AGUDO DE MONTAÑA GRAVE

    Science.gov (United States)

    Garófoli, Adrián; Montoya, Paola; Elías, Carlos; Benzo, Roberto

    2012-01-01

    El Mal Agudo de Montaña (MAM) es un conjunto de síntomas inespecíficos padecidos por sujetos que ascienden rápidamente desde baja a alta altura sin adecuada aclimatación. Usualmente es autolimitado, pero las formas graves (edema pulmonar y cerebral) pueden causar la muerte. La hipoxemia exagerada en reposo está relacionada con el desarrollo de MAM pero su valor predictivo es limitado. Dado que el ejercicio en altura se acompaña de mayor hipoxemia y síntomas, postulamos el valor predictivo de un simple test de ejercicio para pronosticar MAM grave. Se estudió el valor predictivo de la saturación de oxígeno en reposo y ejercicio submáximo a 2 700m y 4 300m en 63 sujetos que ascendían al cerro Aconcagua (6 962m). Se consideró desaturación de oxígeno con ejercicio a una disminución >=5% respecto al reposo. Se utilizó la escala de Lake-Louise para establecer la presencia de MAM grave. 6 sujetos presentaron MAM grave (9.5%) y requirieron evacuación. La saturación de oxígeno en reposo a 2 700m no fue significativa para clasificar sujetos que luego desarrollaron MAM grave. Por el contrario, la asociación de desaturación durante el ejercicio a 2 700m más la saturación inapropiada en reposo a 4 300m fue significativa para clasificar a los sujetos que desarrollaron MAM grave con un valor predictivo positivo de 80% y un valor predictivo negativo del 97%. Nuestros resultados son relevantes para el montañismo y sugieren la adición de un simple test de ejercicio en la predicción del MAM grave. PMID:20228017

  2. Tratamento cirúrgico da laringomalácia grave: estudo retrospectivo de 11 casos

    Directory of Open Access Journals (Sweden)

    José Antonio Pinto

    2013-10-01

    Full Text Available A laringomalácia é a anomalia congênita da laringe mais frequente, sendo responsável por cerca de 60% a 75% dos casos de estridor congênito. Apesar de seu curso benigno e autolimitado, 10% dos casos necessitam de intervenção. Atualmente, as supraglotoplastias são consideradas o tratamento padrão da laringomalácia grave. OBJETIVO: Descrever a experiência adquirida pelos autores no tratamento cirúrgico dos pacientes com laringomalácia grave. Metodologia: Estudo retrospectivo. MÉTODO: Os prontuários de 11 casos consecutivos de laringomalácia grave, submetidos ao tratamento cirúrgico entre 2003 e 2012, foram analisados quanto à idade, gênero, sintomas, doenças associadas, técnica cirúrgica adotada, tempo de extubação, complicações cirúrgicas, tempo de internação e evolução clínica. RESULTADOS: Dos 11 casos de laringomalácia grave, seis pacientes (54,5% foram operados com o uso do laser de CO2 e em cinco pacientes (45,5% foram realizadas a técnica a frio. Apenas um paciente (9,1% necessitou reabordagem cirúrgica. Não foram observados casos de complicações cirúrgicas. Todos os pacientes apresentaram melhora clínica importante. CONCLUSÃO: A supraglotoplastia mostrou-se um procedimento eficaz e seguro no tratamento da laringomalácia grave.

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

    Directory of Open Access Journals (Sweden)

    Stefanović Ivan

    2009-01-01

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

  4. Incisões relaxantes limbares durante a cirurgia de catarata: resultados após seguimento de um ano Limbal relaxing incisions during cataract surgery: one-year follow-up

    Directory of Open Access Journals (Sweden)

    João Carlos Arraes

    2006-06-01

    ções pós-operatórias significativas.PURPOSE: To evaluate astigmatism variation between preoperative, 1st and 12th postoperative month of patients who underwent cataract surgery with limbal relaxing incisions (LRI aiming to reduce the preoperative astigmatism. METHODS: Sixteen patients who underwent cataract surgery by the phacoemulsification technique with a 5.5 mm escleral incision, at the Altino Ventura Foudation, between April and July of 2002. The limbal relaxing incisions were performed according to Gills' modified nomogram (1D - 1 LRI of 6 mm; 1-2D - 2 LRI of 6 mm; 2-3D - 2 LRI of 8 mm. They were done in the most curved meridians, determined by preoperative corneal topography. RESULTS: Significant reduction in preoperative astigmatism was observed in the 1st postoperative month in 2 limbal relaxing incisions of the 6 mm group (57% topographic astigmatism and 87% refractional and in 2 limbal relaxing incisions of the 8 mm group (50% topographic astigmatism and 65% refractional, maintaining the reduction with no significant alteration until the 12th postoperative month. The 1 limbal relaxing incision of the 6 mm group did not yield significant astigmatism reduction, but there was no significant alteration until de 12th postoperative month. There were also no complications such as postoperative discomfort, glare, aniseiconia, diplopia, incision infection and corneal thinning or ectasia. CONCLUSION: Two limbal relaxing incisions of 8 and 6 mm aiming to correct preoperative astigmatism of 2 to 3D and 1 to 2D, respectively, were safe and effective with a stable effect in the first postoperative follow-up year. The 1 limbal relaxing incision of 6 mm aiming to reduce 1 diopter of preoperative astigmatism was not effective, but it did not induce any significant postoperative complications.

  5. Cataract surgery with small incision under the limbal conjunctiva%结膜下角膜缘潜行小切口手法白内障手术

    Institute of Scientific and Technical Information of China (English)

    王文战; 陈晓君; 张效房

    2011-01-01

    目的 探讨结膜下角膜缘潜行小切口手法白内障摘出人工晶状体植入术的效果和并发症.方法 于9~12点位间角膜缘的角膜与结膜结合处后方0.5 mm,以45°角斜向切开结膜角膜组织,达1/2角膜厚度,切口宽5.5~6.0 mm.向前在透明角膜内制作隧道,长约2.0 mm.穿刺进入前房.常规连续环形撕囊或截囊,然后借助注水圈匙手法娩核,囊袋内植入人工晶状体.观察1210例1293眼.术前术后测视力及角膜曲率,并做裂隙灯显微镜检查及A/B超检查.随访4~6周.结果 视力:手术前:光感~0.15,手术后:0.05~1.0.角膜曲率:手术前:K1=(43.99±1.83)D,K2=(43.83±2.06)D,手术后2周:K1=(45.08±2.30)D,K2=(44.07±2.86)D(u检验:P>0.5).意外撞伤致切口裂开并虹膜脱出6例6眼,占0.46%.角膜水肿及前房渗出均较轻微,无前房积血、人工晶状体移位或感染等并发症.手术时间一般为5~8 min.结论 结膜下角膜缘潜行小切口手法白内障摘出人工晶状体植入术操作简单,易于掌握,且手术时间短伤口愈合快,并发症少.%Objective To explore the effects and complications of manual cataract extraction and IOL implantation with small incision under the limbal conjunctiva.Methods Cornea conjunctiva tissue Was incised with 45°beveled direction,0.5 mm after the junction of limbus and conjunctiva from 9'clock to 12'clock,with depth of 1/2 cornea and width of 5.5~6.0 mm.The tunnel incision Was produced up to clear cornea with length of 2.0 mm and then punctured into the anterior chamber.After continuous curvilinear capsulotomy or capsulorhexis and manual expulsion the nuclear,IOL Was implanted.1293 eyes of 1210 pa-tients were observed,visual acuity,corneal curvature,slit lamp microscope examination and A/B ultrasonic inspection were recorded before and after surgery.The patients were followed up for 4 to 6 weeks.Results The visual acuity:light pemepfion to 0.15 preoperatively and 0.05 to 1.0 postoperatively

  6. RECURSOS NO CONVENCIONALES SUSCEPTIBLES DE SER EXPLOTADOS MEDIANTE FRACKING

    OpenAIRE

    Jódar Abellán, Antonio

    2014-01-01

    En el presente trabajo se analizan en detalle los recursos de origen no convencional existentes en el contexto internacional, europeo, nacional y regional, que pueden ser explotados mediante fracking. Así mismo, se mencionará someramente la legislación aplicable a la fracturación hidráulica y los impactos, tanto beneficiosos como perjudiciales, que ésta puede acarrear. El estudio finaliza con una propuesta de posibles lugares en la Península Ibérica donde dicha técnica reporte mayores benefic...

  7. Phacoemulsification and foldable IOL implantation with limbal tunnel incision%角膜缘隧道切口白内障超声乳化折叠式人工晶体植入术

    Institute of Scientific and Technical Information of China (English)

    吴勇; 黄振平; 曹春林; 薛春燕

    2001-01-01

    目的:评价角膜缘隧道切口的白内障超声乳化折叠式人工晶体植入术的效果。方法:对66例(72眼)老年性、并发性、外伤性白内障采用3.2 mm角膜缘隧道切口,行白内障超声乳化并植入折叠式人工晶体,观察手术前后视力、角膜曲率、角膜地形图的变化。结果:术后1天、1周、1个月的视力达0.5以上者分别占69.4%、80.6%和86.1%,术后1周平均散光为(1.85±0.89)D,比术前增加0.30 D(P0.05,角膜地形图显示已恢复术前状态。结论:角膜缘隧道切口的白内障超声乳化折叠式人工晶体植入术能简化手术步骤,术后视力恢复快,炎症反应轻,具有早期恢复至术前眼屈光状态的优势。%Objectives: To evaluate the efficacy of phacoemulsification and foldable IOL implantation with limbal tunnel incision. Methods: A 3.2mm limbal tunnel incision was made on 72 eyes of 66 patients with senile, complicated and traumatic cataract. Phacoemulsification and foldable IOL implantation was performed. Visual acuity, corneal curvature and corneal topography were measured after the surgery.  Results: One day, one week and one month after the surgery, visual acuity exceeded 0.5 in 69.4%, 80.6%,86.1% of the patients respectively. One week after the surgery, the mean astigmatism was (1.85±0.89)D(P0.05,corneal topography had recovered.  Conclusions: Phacoemulsification and foldable IOL implantation with limbal tunnel incision have comparatively simple, with less postoperative inflammation and faster recovery of visual acuity.

  8. Infección odontogénica grave: Posibles factores predictores

    Directory of Open Access Journals (Sweden)

    Oscar García-Roco Pérez

    2003-04-01

    Full Text Available Se analizaron factores que pudieran predisponer a una infección odontogénica grave que requiera cuidados intensivos. Se realizó un estudio observacional descriptivo a 100 pacientes ingresados consecutivamente con infección odontogénica severa en el Hospital "Manuel Ascunce Domenech" de Camagüey desde 1999 al 2001. A partir de las historias clínicas se estudiaron diferentes variables que incluyeron parámetros médicos, sociales y procedimientos dentales previos. Se prestó particular atención al resultado de los cultivos bacterianos. La edad media de los 59 pacientes masculinos y 41 femeninos fue de 41 ± 15,8 años; 18 pacientes requirieron cuidados intensivos. El 41 % de los pacientes era de bajo nivel de escolaridad; 11 pacientes graves (61,1 % y 42 no graves (51,2 % eran fumadores. Dos pacientes (11,1 % de los graves y 8 (9,8 % de los no graves referían consumo excesivo de bebidas alcohólicas. La prevalencia de enfermedades crónicas fue mayor entre los no graves (31,7 %. La afección subyacente más común fue la osteítis periapical (70 % de los episodios infecciosos, seguido por la extracción dental en el 27,5 % de los graves y 10,9 % de los no graves. Ninguno de estos factores predijo la necesidad de cuidados intensivos. No existieron diferencias significativas en cuanto a síntomas, demora en solicitar atención médica, procedimientos dentales previos o terapéutica antimicrobiana. Predominaron los estreptococos aerobios (grupo S. milleri asociados con bacterias anaerobias variadas. No se encontraron variables sociales o clínicas predictoras de un curso grave en infecciones odontogénicas. Todos los pacientes deben ser cuidadosamente monitoreados para evitar complicaciones severas.Those factors that may predispose to a severe odontogenic infection requiring intensive care were analyzed. An observational descriptive study was conducted among 100 patients that were consecutively admitted with severe odontogenic infection at

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

    DEFF Research Database (Denmark)

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

    2007-01-01

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

  10. en sistemas modelo de gelatina mediante SPME-DED

    Directory of Open Access Journals (Sweden)

    J. Ruiz Carrascal

    2005-01-01

    Full Text Available Se llevó a cabo la determinación de 16 hidrocarburos aromáticos policíclicos y 9 nitrosaminas en sistemas modelo de gelatina (20% w/v mediante microextración en fase sólida acoplada a un dispositivo de extracción directa y posterior análisis mediante cromatografía-gaseosa-espectrometría de masas. La extracción se llevo a cabo a 25ºC. Se extrajeron la totalidad de las nitrosaminas y 9 de los 16 hidrocarburos aromáticos policíclicos. Se evaluaron la reproducibilidad, linealidad de respuesta y límite de detección de 3 tipos de fibras estacionarias para cada tipo de compuesto. Se seleccionaron las fibras de polidimetilsiloxano 100μm y carboxen/polidimetilsiloxano 85μm, para los hidrocarburos aromáticos policiclicos y nitrosaminas, respectivamente. La microextración en fase sólida acoplada a un dispositivo de extracción directa surge como una técnica interesante para la monitorización preliminar de la presencia de estos compuestos tóxicos en alimentos sólidos, sin necesidad de toma de muestras y sin deteriorar el producto

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

    Directory of Open Access Journals (Sweden)

    Tara-Jane Sutcliffe

    2008-02-01

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

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

    Institute of Scientific and Technical Information of China (English)

    龚莹; 蒋玲; 江维岩; 张晓黎; 武传龙

    2003-01-01

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

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

    Science.gov (United States)

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

    2014-04-01

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

  14. Hot and cold: coexistent Graves' disease and Hashimoto's thyroiditis in a patient with Schmidt's syndrome.

    Science.gov (United States)

    Dasari, Sowjanya; Naha, Kushal; Hande, Manjunath; Vivek, Ganapathiraman

    2014-05-21

    A 37-year-old housewife presented with generalised fatigue, palpitations and weight loss over the past 3 months. Physical examination revealed signs of hyperthyroidism. Thyroid function tests confirmed the presence of thyrotoxicosis. Pertechnetate radionuclide imaging of the thyroid showed diffusely increased radiotracer uptake consistent with Graves' disease and a cold nodule in the right lobe. Needle aspiration from the nodule yielded evidence of Hashimoto's thyroiditis. The patient also tested strongly positive for antithyroid peroxidase antibodies. Simultaneous laboratory evaluation revealed primary adrenal failure and probable pernicious anaemia, thus producing a diagnosis of Schmidt's syndrome. The patient was initiated on appropriate medical therapy for endocrinopathy. Graves' disease was treated with radioablation. 2014 BMJ Publishing Group Ltd.

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

    Science.gov (United States)

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

    2015-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

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

  17. Concurrent reactive arthritis, Graves' disease, and warm autoimmune hemolytic anemia: a case report.

    Science.gov (United States)

    Chiang, Elizabeth; Packer, Clifford D

    2009-08-13

    Warm antibody autoimmune hemolytic anemia is due to the presence of warm agglutinins that react with protein antigens on the surface of red blood cells causing premature destruction of circulating red blood cells. We report the first case of concurrent reactive arthritis, Graves' disease, and autoimmune hemolytic anemia. A 40-year-old man with reactive arthritis, Graves' disease, type 2 diabetes mellitus, mitral valve prolapse, and Gilbert's disease presented with a one month history of jaundice, fatigue, and black stools. After diagnosis of warm autoimmune hemolytic anemia, the patient was started on prednisone 1 mg/kg with rapid improvement in his anemia and jaundice. Our subject's mother and possibly his maternal grandmother also had autoimmune hemolytic anemia, which raises the possibility of hereditary autoimmune hemolytic anemia, a rarely reported condition.

  18. Unilateral gynecomastia and hypokalemic periodic paralysis as first manifestations of Graves' disease.

    Science.gov (United States)

    Wang, Yufan; Zhao, Li; Li, Fan; Chen, Hai-xi; Fang, Fang; Peng, Yong-de

    2013-06-01

    A 39-year-old Chinese man presented to the study hospital with right-sided gynecomastia. Underlying Graves' disease was not diagnosed until recurrent episodes of hypokalemic periodic paralysis were observed. The estradiol (E2) and progesterone levels and the E2-to-testosterone (T) (E2/T) ratio of the patient were elevated before treatment. Immediate intravenous potassium supplementation was started to reverse the paralysis. Additionally, antithyroid drugs were administered to restore a euthyroid state. After treatment, the patient gained strength. Gynecomastia regressed with a return to the euthyroid state; the E2 and progesterone levels normalized and the plasma E2/T ratio declined. In addition to the classic symptoms, some atypical symptoms of Graves' disease may also occur. One of the challenges lies in recognizing the underlying etiology. Early diagnosis and appropriate treatment can avoid unnecessary investigations and serious cardiopulmonary complications.

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

    DEFF Research Database (Denmark)

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

    2008-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    李从心

    2013-01-01

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

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

    DEFF Research Database (Denmark)

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

    2008-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

    Sridama, V.; DeGroot, L.J.

    1989-07-01

    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 (/sup 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.

  3. Seasonal changes in calcium homeostasis affect the incidence of postoperative tetany in patients with Graves' disease.

    Science.gov (United States)

    Yamashita, H; Noguchi, S; Murakami, T; Watanabe, S; Uchino, S; Ohshima, A; Kawamoto, H; Toda, M; Yamashita, H

    2000-04-01

    We have found that postoperative tetany occurs in patients with Graves' disease who have secondary hyperparathyroidism caused by a deficiency in calcium and vitamin D concomitant with transient hypoparathyroidism after surgery. There are seasonal variations in serum 25-hydroxyvitamin D (25[OH]D) concentrations. The purpose of this study was to investigate the effects of seasonal changes in calcium homeostasis on the incidence of postoperative tetany in patients with Graves' disease who undergo subtotal thyroidectomy. A prospective study was carried out to investigate sequential changes in serum levels of intact parathyroid hormone (iPTH), calcium and other electrolytes, 25(OH)D, and 1,25-dihydroxyvitamin D (1,25[OH]2D) in female patients with Graves' disease who underwent subtotal thyroidectomy during the summer (n = 89) and during the winter (n = 89). The serum levels of calcium, magnesium, and 25(OH)D were significantly higher, but iPTH levels and 1,25(OH)2D levels were lower in summer than in winter. The percentage of vitamin D deficiency (25(OH)D tetany developed in only 4 of 15 patients and in one patient whose iPTH level was below normal (incidence of tetany, 5.6%). In winter, however, tetany developed in 6 of 13 patients and in 4 patients whose iPTH level was below normal (incidence of tetany, 11.2%). Patients with Graves' disease are more susceptible to calcium and vitamin D deficiency during the winter than during the summer, resulting in the tendency toward a higher incidence of postoperative tetany in winter.

  4. Nutrición por sonda nasogástrica en la pancreatitis aguda grave

    National Research Council Canada - National Science Library

    García de Casasola, Gonzalo; Cacho Acosta, Guillermo; Gonzálvez-Gasch, Asunción; Barba Martín, Raquel; Herreros Valdepeñas, Benjamín; Barbado Cano, Ana

    2008-01-01

    ... alternativa a la nutrición parenteral es la nutrición enteral por sonda nasoyeyunal. Se han efectuado varios ensayos clínicos controlados y aleatorizados en los que se compara la nutrición parenteral total con la nutrición enteral por sonda nasoyeyunal en la pancreatitis aguda grave 2–4 . A pesar de las limitaciones de estos estudios, en la mayoría de ellos se...

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2009-04-15

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

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2007-09-30

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2007-09-30

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

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

    DEFF Research Database (Denmark)

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

    2011-01-01

    Treatment of Graves' disease during pregnancy with antithyroid drugs (ATDs) poses a risk of inducing hypothyroidism and, thus, development of a goiter to the fetus. PATIENT FINDINGS: We report two patients referred to our department after discovery of a fetal goiter by ultrasound examination in t...... hypothyroidism as the cause of goiter development. Reduction of maternal ATD dose and injection of levothyroxine intra-amniotically quickly reduced the goiter size, and both babies were born euthyroid and without goiters....

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

    Science.gov (United States)

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

    2015-04-01

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

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

    Science.gov (United States)

    Papapetrou, Peter D

    2015-01-01

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

  12. Graves' disease: measurement of the extraocular muscle thickness with the echobiometer.

    Science.gov (United States)

    Schenome, M; Polizzi, A; Buono, C; Ciurlo, C; Ciurlo, G

    1998-01-01

    The authors measured extraocular muscle thickness in normal subjects and in patients affected by Graves' disease, using a Sonomed A-2000 echobiometer (probe with 10-MHz frequency); Hertel's exophthalmometry was also performed. Statistically significant differences in muscle thickness between normals and patients were found. This technique seems to be sufficiently useful and reliable in extraocular thickness evaluation, showing data similar to those of the recent literature.

  13. Combination of Cerebral Demyelination and Graves Disease in a Case with Miller Fisher Syndrome

    OpenAIRE

    Sibel Güler; Levent Sinan Bir

    2010-01-01

    A 44-year-old male patient with a diagnosis of Miller Fisher syndrome, Graves disease and central nervous system demyelination is presented. Clinical and laboratory findings supported the diagnosis of Miller Fisher syndrome. On T2-weighted sections of cranial magnetic resonance imaging, many ovoid-shaped, hyperintense lesions in bilateral deep white matter were detected. Magnetic resonance imaging spectroscopy demonstrated low N-acetylaspartate to creatine (NAA/Cr) ratio consistent with demye...

  14. Does radioiodine cause the ophthalmopathy of Graves' disease; Editorial

    Energy Technology Data Exchange (ETDEWEB)

    McDougall, I.R. (Stanford Univ., CA (United States). Medical Center)

    1993-02-01

    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).

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

    Science.gov (United States)

    Jervis, John R.; Pringle, Jamie K.

    2014-09-01

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

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

    Directory of Open Access Journals (Sweden)

    Tomislav M. Pavlović

    2016-02-01

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

  17. Preserved brains from the Spanish Civil War mass grave (1936) at La Pedraja1, Burgos, Spain.

    Science.gov (United States)

    Serrulla, Fernando; Herrasti, Lourdes; Navarro, Carmen; Cascallana, Jose Luis; Bermejo, Ana Maria; Marquez-Grant, Nicholas; Etxeberria, Francisco

    2016-12-01

    During the excavation of the Spanish Civil War mass grave at La Pedraja (Burgos, Spain), 104 individuals were found interred within it, 45 of which displayed brains that were preserved but dehydrated and reduced in size. This exceptional finding has resulted in the formation of a multidisciplinary team, with the aim of obtaining as much information as possible and to primarily understand the taphonomic phenomena that has led to the preservation of these brains. The following types of analyses were undertaken on three of these brains: macroscopy, histology, radiology, chemical-toxicology, genetics, chemical analysis of the soil and 3D modelling for stereolithography. The historical context was considered, plus all archaeological and other forensic data provided by the investigation of the mass grave. The results of the analyses on these morphologically identifiable human brains confirmed the presence of nerve structures, fatty acids, and in one case ante-mortem evidence for an intracranial haemorrhage. The fatty acid profile corresponds to the process of saponification. Therefore, the interpretation is that the preservation of these brains at the mass grave of La Pedraja was due to the saponification process, which was influenced by the manner and cause of death, the chemical composition of the brain, the physicochemical properties of the soil and the meteorological conditions at the time.

  18. Avaliação e tratamento da hiperglicemia em pacientes graves

    Directory of Open Access Journals (Sweden)

    Marina Verçoza Viana

    2014-03-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

    Prummel, M.F.; Mourits, M.; Blank, L.; Berghout, A.; Koornneef, L.; Wiersinga, W.M. (Univ. of Amsterdam (Netherlands))

    1993-10-16

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

  20. Enfoque terapéutico de los traumatismos graves de los miembros

    Directory of Open Access Journals (Sweden)

    Roberto Joaquín del Gordo D´Amato

    2013-12-01

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

  1. Efficacy of (99m)Tc-EDDA/HYNIC-TOC SPECT/CT scintigraphy in Graves' ophthalmopathy.

    Science.gov (United States)

    Zhao, Rong; Wang, Jiang; Deng, Jinglan; Yang, Weidong; Wang, Jing

    2012-01-01

    The aim of this study was to investigate the predictive role of the orbital somatostatin receptor scintigraphy with (99m)Tc-EDDA/HYNIC-TOC ((99m)Tc-TOC) to detect clinical stage of Graves' ophthalmopathy and the response to corticosteroid therapy. The subjects of the experiment were 46 patients with Graves' ophthalmopathy (GO) and four volunteers without eye disease or GO as the normal group (NG). Single photon emission computed tomography (SPECT), computed tomography (CT) and the left and right lateral position planar imaging of the heads of the all subjects were obtained 4 h after the intravenous injection of 555 MBq of (99m)Tc-TOC. The (99m)Tc-TOC SPECT/CT was repeated 3 months later. 35 (35/46) patients were received corticosteroid therapy (prednisolone, 10 mg po tid ) for 3 months, however, the other 11 patients as control groups did not receive any treatment. The treatment effect was evaluated both by the orbital (99m)Tc-TOC uptake and NOSPECS. A significant decrease in the O/OC ratio was observed in 22 GO patients between pre- and post-treatment (1.64 ± 0.13 vs. 1.21 ± 0.09, P TOC scintigraphy is a feasible technique to estimate the Graves' ophthalmopathy activity and predict the response to subsequent corticosteroid therapy in GO patients. The technique could be a useful tool for physicians not familiar with CAS determination.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2008-07-01

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

  3. Transcaruncular Medial Wall Orbital Decompression: An Effective Approach for Patients with Unilateral Graves Ophthalmopathy

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    Robert H. Hill

    2012-01-01

    Full Text Available Purpose. To evaluate the reduction in proptosis, incidence of postoperative diplopia, and postoperative globe symmetry after transcaruncular medial wall decompression in patients with unilateral Graves ophthalmopathy. Methods. Retrospective review of 16 consecutive patients who underwent unilateral transcaruncular medial wall orbital decompression from 1995 to 2007. The diagnosis of Graves ophthalmopathy was based on history and clinical findings including proptosis, lagophthalmos, lid retraction, motility restriction, and systemic thyroid dysfunction. Results. The mean reduction in proptosis was 2.3 mm. The mean difference in exophthalmometry preoperatively between the two eyes in each patient was 3.1 mm whereas postoperatively the mean difference was 1.1 mm (P=0.0002. Eleven of 16 patients (69% had 1 mm or less of asymmetry postoperatively. There was no statistically significant difference in the incidence of diplopia pre- and postoperatively (P=1.0. Conclusions. Medial wall orbital decompression is a safe and practical surgical approach for patients with unilateral Graves orbitopathy. The procedure carries a low risk of morbidity and yields anatomic retrusion of the globe that is comparable to other more invasive methods and may yield more symmetric postoperative results.

  4. Is Graves' disease a primary immunodeficiency? New immunological perspectives on an endocrine disease.

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    Struja, Tristan; Kutz, Alexander; Fischli, Stefan; Meier, Christian; Mueller, Beat; Recher, Mike; Schuetz, Philipp

    2017-09-25

    Uncertainty about factors influencing the susceptibility and triggers for Graves' disease persists, along with a wide variation in the response to anti-thyroid drugs, currently at approximately 50% of non-responders. The aim of this narrative review is to summarize immunological concepts, with a combined endocrine and immunological perspective, to highlight potential new areas of research. Relevant studies were identified through a systematic literature search using the PubMed and EMBASE databases in March 2016. No cut-offs regarding dates were imposed. We used the terms "Graves' Disease" or "Basedow" or "thyrotoxicosis" together with the terms "etiology", "pathophysiology", "immunodeficiency", "causality", and "autoimmunity". The terms "orbitopathy", "ophthalmopathy", and "amiodarone" were excluded. Articles in English, French, German, Croatian, Spanish, and Italian were eligible for inclusion. While concepts such as the impact of iodine, smoking, human leucocyte antigen, infections, and ethnicity are established, new ideas have emerged. Pertaining evidence suggests the involvement of autoimmunity and immunodeficiency in the pathophysiology of Graves' disease. Recent studies point to specific immunological mechanisms triggering the onset of disease, which may also serve as targets for more specific therapies.

  5. Chronology of the Third – Fifth Centuries Male Graves from the Tarasovo Burial Ground

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    Goldina Rimma D.

    2016-09-01

    Full Text Available The article focuses on the chronological attribution of male graves from the late Mazunino stage of the Tarasovo burial ground and is a sequel to an earlier article about dating of the early Nyrgynda stage (1st – 2nd centuries of the same site. The three main methods employed in this research include those of formal typology, cultural stratigraphy and the nearest neighbor method. Eighty-six male graves of the third-fifth centuries were analyzed, with 12 identified as a result: first half of the 3rd c. AD (group 1, second half of the 3rd c. AD (2; 3rd c. (3; first half of the 4th c. (group 4; second half of the 3rd – 4th c. (5; third quarter of the 4th c. (6; fourth quarter of the 4th c. (group 7; second half of the 4th c. (8; second half of the 4th – 5th c. (9; 4th – 5th cc. (10; second half of the 3rd – 5th cc. (11 and 3rd – 5th cc. (12. This article minutes investigates the first six groups, while the rest will be covered in the next publication. Artifacts form the third – fifth century female graves of the Tarasovo burial ground will be studied separately.

  6. [A case of membranous nephropathy with ANCA-associated necrotizing glomerulonephritis during oral administration of PTU for Graves' disease].

    Science.gov (United States)

    Fujii, Takayuki; Kawamata, Toyotaka; Ueda, Shiro; Akikusa, Bunshiro; Hasegawa, Shigeru; Tsukahara, Tsunemichi; Iesato, Kenji; Ogawa, Makoto; Saisho, Hiromitsu

    2003-01-01

    We experienced a coincidental case of two types of glomerulopathy associated with Graves' disease. A 64-year-old man, who had been treated with propylthiouracil(PTU) for Graves' disease for 15 years, was admitted to our hospital for macroscopic hematuria and rapidly progressive deterioration of renal function. Although his thyroid function had been within the normal range during treatment, the level of thyrotropin receptor antibody(TRAb) gradually increased from a year before admission. Serological tests revealed that he was positive for myeloperoxidase-antineutrophil cytoplasmic antibody(MPO-ANCA). The renal biopsy specimen showed necrotizing and crescentic glomerulonephritis(GN) superimposed on membranous nephropathy(MN). This is a rare case of MN complicated with ANCA associated crescentic GN in a Graves' disease patient. Association of these two renal alterations was not clearly defined. MN involved with Graves' disease also has been rarely reported. Some reports demonstrated deposition of thyroglobulin and other thyroid related antigens in the glomeruli. In the present case, long-term impairment of Graves' disease and elevation of TRAb might have been responsible for the formation and deposition of thyroid-associated immune complex in the glomeruli. As for crescentic GN, PTU might have induced ANCA-associated GN independently of MN. This case is instructive for considering the relation between Graves' disease and renal injury.

  7. Valoración del programa social de atención a personas con trastorno mental grave: un estudio Delphi

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    A. Brugos

    Full Text Available Fundamento: En enero de 2005 el Gobierno de Navarra aprobó el "Programa de Atención a Personas con Trastorno Mental Grave" (PA-TMG. El objetivo del presente trabajo es conocer la opinión de expertos acerca del PA-TMG. Identificar los elementos de acuerdo en la valoración de aspectos positivos y aspectos mejorables. Realizar recomendaciones a partir de su opinión. Material y métodos: Se diseñó un estudio Delphi con 34 expertos en la atención sanitaria o social de enfermos mentales. Mediante cuestionarios repetidos se identificaron las ideas que alcanzaran un consenso ?90%, y se asignó un nivel de prioridad. Se presentan los porcentajes de acuerdo, estadísticos descriptivos de la prioridad, y se elaboran las recomendaciones de análisis de las áreas de consenso. Resultados: De los 34 expertos participantes, finalizaron el estudio 25 (71,4%: 1 socióloga, 5 trabajadoras sociales, 3 psiquiatras, 5 psicólogos, 1 representante de las familias, 3 terapeutas ocupacionales, 1 técnico en integración social y 6 médicos de familia. Valoran positivamente el Plan el 64% y 72% opinan que se ha elaborado sin suficiente participación profesional. Todos piensan que podría mejorarse si se amplia la participación de expertos. Conclusiones: Las principales ideas consensuadas han sido que: la atención socio-sanitaria debe garantizarse por los poderes públicos; se deben establecer buenos sistemas de información y de evaluación; el Plan debe tener presupuesto propio; debe garantizar el seguimiento profesional del paciente por los diferentes dispositivos; se deben descentralizar muchas tomas de decisiones; se debe universalizar el acceso a un catálogo de prestaciones sociales para estos enfermos.

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

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    Maria da Consolação Magalhães

    2012-06-01

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

  9. MEDIANTE LA APLICACIÓN DEL ENSAYO FÉNIX.

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    Linna Marcela Neme Ardila

    2013-01-01

    Full Text Available Las mezclas asfálticas son el material más utilizado en la fabricación de pavimentos y los ensayos que permiten caracterizarlas son costosos y demorados. Por esta razón, mediante esta investigación se planteó establecer la viabilidad del uso del ensayo Fénix en mezclas asfálticas colombianas con granulometrías del Instituto de Desarrollo Urbano (IDU y del Instituto Nacional de Vías (INVIAS con diferentes características. El estudio inició con la fabricación de probetas Fénix con diferentes materiales (Agregados, asfaltos, asfaltita, pavimento asfalto reciclado (RAP, cal, cemento y su ejecución a 15 °C, una velocidad de 1 mm/min y la medición de los parámetros del ensayo. De los resultados obtenidos de resistencia a tracción, índice de rigidez a tracción e índice de energía, área elástica y área de fluencia, se estableció que el ensayo Fénix es un procedimiento eficaz, eficiente, económico, rápido y sencillo para determinar las propiedades mecánicas y dinámicas de las mezclas asfálticas estudiadas, especialmente mediante el análisis de los parámetros de las curvas carga-desplazamiento, irrelevantemente de la mezcla asfáltica fabricada.

  10. 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.

    Science.gov (United States)

    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

    2015-11-01

    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 diagnosis of GO over a 4-month period in 2012 were included. Clinical and demographic characteristics, referral timelines and initial decisions about management were recorded. The data were compared with a similar EUGOGO survey performed in 2000. The demographic characteristics of 269 patients studied in 2012 were similar to those collected in the year 2000, including smoking rates (40.0% vs 40.2%). Mild (60.5% vs 41.2%, p<0.01) and inactive GO (63.2% vs 39.9%, p<0.01) were more prevalent in 2012. The times from diagnosis of thyroid disease to being seen in EUGOGO centres (6 vs 16 months) and from first symptoms of GO (9 vs 16 months) or from diagnosis of GO (6 vs 12 months) to first consultation in EUGOGO centres were shorter in 2012 (p<0.01). The initial management plans for GO were no different except surgical treatments for patients with mild inactive disease were more frequently offered in the 2012 cohort than in 2000 (27.3% vs 17%, p<0.05), and selenium supplements were offered only in the 2012 cohort (21.2% vs 0%, p<0.01). These findings suggest that the clinical manifestations of patients with GO may be changing over time in Europe. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  11. Persistent remission of Graves` disease or evolution from Graves' disease to Hashimoto's thyroiditis in childhood - a report of 6 cases and clinical implications.

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    Smyczńyska, Joanna; Cyniak-Magierska, Anna; Stasiak, Magdalena; Karbownik-Lewińska, Małgorzata; Lewiński, Andrzej

    2014-01-01

    The main clinical manifestations of autoimmune thyroid diseases are Graves' disease (GD) and Hashimoto's thyroiditis (HT). Graves' disease is the cause of most cases of hyperthyroidism in childhood. Indications for radical therapy (surgery or 131I treatment) in children are still a matter of discussion, as sustained (sometimes very long) remission of GD is possible, while the radical therapy almost always leads to hypothyroidism. Spontaneous evolution from GD with hyperthyroidism to HT with hypothyroidism may also be observed. The aim of the study was to analyze the clinical course of 6 cases of hyperthyroid girls with GD in whom a normalization of previously increased autoantibodies against thyrotropin (TSH) receptor (anti-TSHR) was observed together with a significant increase in autoantibodies against thyroid peroxidase (anti-TPO) and thyroglobulin (anti-Tg), with concomitant hypo- or euthyroidism but no recurrence of hyperthyroidism. Patients' age at diagnosis ranged from 5.0 to 16.5 years. Two (2) patients had Turner syndrome, another one (1), diabetic, was on insulin therapy. In all the girls, antithyroid drugs were administered and euthyroid state was achieved during the first 2.0-3.5 months of the treatment. Mild side effects were observed in only one case. The therapy was continued up to 1.5-4.0 years. Relapses during the therapy were observed in 2 cases. Up to now, no relapses have been observed for 0.5-7.5 years since the therapy withdrawal in 5 patients (1 patient was lost to follow-up), 2 patients are currently treated with levothyroxine due to hypothyroidism. It seems that the prolonged pharmacotherapy with antithyroid drugs, followed by observation after remission of hyperthyroidism, may be an appropriate therapeutic option at least in some children with GD as they can be cured without radical therapy and the potential risks of such treatment.

  12. Occurrence of Type 1 Diabetes in Graves' Disease Patients Who Are Positive for Antiglutamic Acid Decarboxylase Antibodies: An 8-Year Followup Study

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    Matsuo Taniyama

    2011-01-01

    Full Text Available Glutamic acid decarboxylase antibodies (GADAs are one of the markers of islet cell autoimmunity and are sometimes present before the onset of type 1 diabetes (T1D. GADA can be present in Graves' patients without diabetes; however, the outcome of GADA-positive Graves' patients is not fully understood, and the predictive value of GADA for the development of T1D in Graves' patients remains to be clarified. We investigated the prevalence of GADA in 158 patients with Graves' disease and detected GADA in 10 patients. They were followed up to discover whether or not T1D developed. In the course of eight years, 2 patients with high titers of GADA developed T1D, both had long-standing antithyroid drug-resistant Graves' disease. Thus, Graves' disease with high GADA titer seems to be at high risk for T1D.

  13. Common genetic variants associated with thyroid function may be risk alleles for Hashimoto's disease and Graves' disease.

    Science.gov (United States)

    Campbell, Purdey; Brix, Thomas H; Wilson, Scott G; Ward, Lynley C; Hui, Jennie; Beilby, John P; Hegedüs, Laszlo; Walsh, John P

    2015-02-14

    Recent studies have identified common genetic variants associated with TSH, free T4 and thyroid peroxidase antibodies, but it is unclear whether these differ between patients with Hashimoto's disease and Graves' disease. To examine whether 11 common genetic variants differ between Graves' disease and Hashimoto's disease. We genotyped 11 common variants in a discovery cohort of 203 Australian patients with autoimmune thyroid disease (AITD). Two variants with significant or suggestive associations were analysed in a replication cohort of 384 Danish patients. For rs753760 (PDE10A), the minor allele frequency in Graves' disease and Hashimoto's disease was 0·38 vs. 0·23, respectively, (P = 6·42 × 10(-4) ) in the discovery cohort, 0·29 vs. 0·24 (P = 0·147) in the replication cohort and 0·32 vs. 0·24 in combined analysis (P = 0·0021; all analyses adjusted for sex). In healthy controls from Busselton, the frequency was 0·29, significantly different from Hashimoto's disease but not Graves' disease. For rs4889009 (MAF gene region), the frequency of the minor G-allele in Graves' disease and Hashimoto's disease was 0·48 vs. 0·36 (P = 0·0156) in the discovery cohort, 0·48 vs. 0·34 (P = 1·83 × 10(-4) ) in the replication cohort and 0·48 vs. 0·35 in the combined analysis (P = 7·53 × 10(-6) ); in controls, the frequency was 0·38, significantly different from Graves' disease but not Hashimoto's disease. After further adjustment for smoking, associations with rs4889009 remained significant, whereas those with rs753760 were not. Common variants in PDE10A and MAF gene regions may influence whether patients with AITD develop Graves' disease or Hashimoto's disease. © 2015 John Wiley & Sons Ltd.

  14. Limbal stem cell transplantation combined with mitomycin treatment of recurrent pterygium%自体角膜缘干细胞移植联合丝裂霉素治疗复发性翼状胬肉疗效观察

    Institute of Scientific and Technical Information of China (English)

    梁艳丽

    2014-01-01

    目的:观察自体角膜缘干细胞移植联合丝裂霉素治疗复发性翼状胬肉手术疗效。方法对22只眼复发性翼状胬肉进行自体角膜缘干细胞移植联合丝裂霉素治疗。结果22例随访6~12月,平均16.5月。无1例复发,未发现睑球粘连者。结论自体角膜缘干细胞移植联合丝裂霉素治疗复发性翼状胬肉,方法简单,取材方便,无排斥反应,是治疗翼状胬肉的有效方法。%Objective to observe the limbal stem cell transplantation combined with mitomycin treatment of recurrent pterygium surgery. Methods 22 eyes with recurrent pterygium autologous limbal stem cell transplantation combined with mitomycin c treatment. Results 22 cases followed up for 6 to 12 months, an average of 16.5 months. no recurrence was not found symblepharon. Conclusion limbal stem cell transplantation combined with mitomycin treatment of recurrent pterygium, simple, easily obtained, no rejection is an effective method of treatment of pterygium.

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

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    Mohammad Pajhouhi

    1993-06-01

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

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

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    Chaitra

    2016-02-01

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

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

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

    2016-01-01

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

  18. Use of corticosteroids to prevent progression of Graves' ophthalmopathy after radioiodine therapy for hyperthyroidism

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    Bartalena, L.; Marcocci, C.; Bogazzi, F.; Panicucci, M.; Lepri, A.; Pinchera, A. (Univ. of Pisa (Italy))

    1989-11-16

    We studied the effects of radioiodine treatment of hyperthyroidism due to Graves' disease on Graves' ophthalmopathy and the possible protective role of corticosteroids. Between June 1985 and June 1988, 26 patients were randomly assigned to treatment with radioiodine alone (group 1) and 26 to treatment with this agent and concomitant administration of systemic prednisone for four months (group 2). The initial dose of prednisone was 0.4 to 0.5 mg per kilogram of body weight for one month; the drug was gradually withdrawn over the next three months. All patients were evaluated at 3-month intervals for 18 months after they underwent radioiodine therapy. Ocular changes were assessed with the ophthalmopathy index; patients with moderate-to-severe changes (scores greater than or equal to 4) were excluded from the study. Before treatment, 10 patients in group 1 and 5 in group 2 had no evidence of ophthalmopathy: in none of them did ocular symptoms appear after radioiodine therapy. Among the patients in group 1 with an initial ophthalmopathy index greater than or equal to 1, ocular disease worsened in 56 percent (mostly involving soft-tissue changes and extraocular-muscle function) and did not change in 44 percent. In contrast, ophthalmopathy improved in 52 percent and did not change in 48 percent of group 2. The mean ophthalmopathy index increased from 1.5 to 3.0 in group 1 (P less than 0.005) and decreased from 2.2 to 1.3 in group 2 (P less than 0.05). We conclude that systemic corticosteroid treatment prevents the exacerbations of Graves' ophthalmopathy that occur after radioiodine therapy in a substantial proportion of patients with hyperthyroidism who have some degree of ocular involvement before treatment.

  19. Discordant hypothyroxinemia and hypertriiodothyroninemia in treated patients with hyperthyroid Graves' disease

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    Chen, J.J.; Ladenson, P.W.

    1986-07-01

    Hypothyroxinemia and hypertriiodothyroninemia may occur in the course of antithyroid drug or /sup 131/I treatment for hyperthyroid Graves' disease. To determine the frequency of combined high serum T3 and low serum T4 concentrations during such treatment and to assess the clinical significance of its recognition, we reviewed 60 patients treated for hyperthyroid Graves' disease with antithyroid drugs (n = 43) or radioactive iodine (n = 17). Six of these patients (10%) were found to have high serum T3 and low serum T4 concentrations during therapy. Four were receiving antithyroid drugs, and 2 had received radioactive iodine. At the time this abnormality occurred, 4 patients were euthyroid, 1 was hypothyroid, and 1 was hyperthyroid. The serum TSH concentration was increased in 2, at the upper limit of normal in 1, and undetectable in 3 patients. After discontinuation or reduction in the dose of antithyroid drug, clinical and chemical euthyroidism was restored in 2 additional patients with previously elevated TSH levels. In 2 patients, both of whom previously had undetectable serum TSH levels, clinical hyperthyroidism persisted or recurred, and additional therapy was required. No patient developed permanent hypothyroidism during the period of follow-up (1-22 months). An additional 19 of the 60 patients (32%) had an elevated serum T3 level with a normal serum T4 concentration during the course of follow-up. Among the 19 patients, the magnitude of serum T3 elevation was not different between clinically euthyroid (n = 13) and hyperthyroid (n = 6) patients. We conclude that discordance of serum T4 and T3 concentrations is frequently encountered in patients with hyperthyroid Graves' disease during or after therapy. The low serum T4 level does not predict hypothyroidism, nor does a high serum T3 level predict hyperthyroidism.

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

    Directory of Open Access Journals (Sweden)

    Marc PORÉE

    2005-10-01

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

  1. Peritonitis secondary to ruptured splenic abscess:A grave complication of typhoid fever

    Institute of Scientific and Technical Information of China (English)

    Peter George; Ashfaq Ahmed; Roshan Maroli; Leo Francis Tauro

    2012-01-01

    Splenic abscesses are increasingly being identified, possibly due to widespread use of imaging modalities in clinical practice. The commonest clinical features are high grade fever and exclusively localised left upper quadrant abdominal pain. These symptoms are similar to most infectious diseases prevalent in the tropics, making imaging by ultrasonography or computer tomography a necessity in the diagnosis. There are reports from different geographic areas on splenic abscesses associated with typhoid fever. We reported ruptured splenic abscess presenting with peritonitis as a rare and grave complication of typhoid fever.

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

    DEFF Research Database (Denmark)

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

    2014-01-01

    handwriting, although this has not been studied yet. The aim of this study was to evaluate handwriting characteristics before and after therapy for hyperthyroid Graves' disease (GD). METHODS: Twenty-two patients (15 women, 7 men) with untreated GD (median age: 44 years; range: 20-70 years) were asked to write...... observation. Graphological examination showed statistically significant changes after patients become euthyroid, in the following parameters: size of letters (4.5±1.1 vs. 5.9±1.3 mm; p

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

    Science.gov (United States)

    Baugh, Frank G; Benjamin, Ludy T

    2006-01-01

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

  4. Tratamento cirúrgico da laringomalácia grave: estudo retrospectivo de 11 casos

    OpenAIRE

    2013-01-01

    A laringomalácia é a anomalia congênita da laringe mais frequente, sendo responsável por cerca de 60% a 75% dos casos de estridor congênito. Apesar de seu curso benigno e autolimitado, 10% dos casos necessitam de intervenção. Atualmente, as supraglotoplastias são consideradas o tratamento padrão da laringomalácia grave. OBJETIVO: Descrever a experiência adquirida pelos autores no tratamento cirúrgico dos pacientes com laringomalá...

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

    Directory of Open Access Journals (Sweden)

    C. GARCÍA MERINO

    2012-03-01

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

  6. Complicaciones hemorrágicas graves en las gestantes quirúrgicas

    OpenAIRE

    Yamila Zayas Nápoles; Dunior Peláez Rodríguez; Miladis Justo Hernández; Leticia Fernández Álvarez; Marjuris Arias Pérez

    2015-01-01

    Las hemorragias obstétricas ocurren aproximadamente en un tres a un cinco porciento de los embarazos y son responsables del 75 % de las complicaciones durante la gestación y del 25 % de la mortalidad materna. Se realizó un estudio descriptivo de corte transversal en 58 pacientes ingresadas en la Unidad de Cuidados Intensivos del Hospital General Docente “Dr. Ernesto Guevara de la Serna”, con el diagnóstico de hemorragia obstétrica grave; en el período de enero de 2010 a abril de 2013, con el ...

  7. Tratamiento quirúrgico del estrabismo en la enfermedad de graves

    OpenAIRE

    Iván Villaseca, C.

    2010-01-01

    El estrabismo en la Oftalmopatía (Orbitopatía) de Graves se origina en la fibrosis post inflamatoria de uno o varios músculos, en uno o ambos ojos. Esto provoca un desalineamiento de los ejes visuales con diplopia que puede llegar a ser invalidante. Los músculos más frecuentemente comprometidos son los Rectos Inferiores y Medios. Algunos pacientes compensan su diplopia con posiciones anómalas de la cabeza. La cirugía se plantea en la etapa inactiva de la inflamación orbitaria, con ángulos est...

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

    Directory of Open Access Journals (Sweden)

    Breese McCoy Sarah J

    2011-11-01

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

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

    Science.gov (United States)

    Canepa, Carlo; Venu, Maya

    2016-01-04

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

  10. Peritonitis secondary to ruptured splenic abscess: a grave complication of typhoid fever.

    Science.gov (United States)

    George, Peter; Ahmed, Ashfaq; Maroli, Roshan; Tauro, Leo Francis

    2012-12-01

    Splenic abscesses are increasingly being identified, possibly due to widespread use of imaging modalities in clinical practice. The commonest clinical features are high grade fever and exclusively localised left upper quadrant abdominal pain. These symptoms are similar to most infectious diseases prevalent in the tropics, making imaging by ultrasonography or computer tomography a necessity in the diagnosis. There are reports from different geographic areas on splenic abscesses associated with typhoid fever. We reported ruptured splenic abscess presenting with peritonitis as a rare and grave complication of typhoid fever.

  11. Avaliação e tratamento da hiperglicemia em pacientes graves

    OpenAIRE

    Marina Verçoza Viana; Rafael Barberena Moraes; Amanda Rodrigues Fabbrin; Manoella Freitas Santos; Fernando Gerchman

    2014-01-01

    A hiperglicemia é um problema frequentemente encontrado em pacientes graves em ambiente de terapia intensiva. Sua presença se associa ao aumento da morbidade e da mortalidade, independentemente da causa da admissão (infarto agudo do miocárdio, condição após cirurgia cardiovascular, acidente vascular cerebral e sepse). Entretanto, permanecem muitas dúvidas com relação à fisiopatologia e, particularmente, em relação ao tratamento ...

  12. Pathogenesis of Graves disease%Graves病的发病机制

    Institute of Scientific and Technical Information of China (English)

    王曙; 郭华

    2010-01-01

    @@ Graves病(Graves disease,GD)是一种器官特异性自身免疫病,与桥本甲状腺炎(Hashimoto thyroiditis,HT)同属自身免疫性甲状腺疾病(autoimmune thyroid disease,AITD).其患病率约为1%-2%[1].患者主要临床表现为高代谢综合征,部分患者可以出现甲状腺相关眼病(thyroid associated ophthalmopathy,TAO)、胫前黏液性水肿和(或)肝脏损害.

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

    DEFF Research Database (Denmark)

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

    2009-01-01

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

  14. Manejo quirúrgico de la orbitopatía de graves

    OpenAIRE

    Rodrigo Poblete, S.

    2010-01-01

    La Enfermedad de Graves corresponde a un síndrome que comprende: bocio hipertiroídeo habitualmente, oftalmopatía asociada a la tiroides y dermatopatía. No se cuenta con estadísticas nacionales, sin embargo la mayoría de los estudios internacionales muestran una frecuencia mayor en la mujer. Desde el punto de vista del manejo quirúrgico de esta enfermedad, éste se basa en tres etapas fundamentales: descompresión orbitaria, cirugía de los músculos extraoculares y finalmente la cirugía de reposi...

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

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

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

  16. Traumatismo materno grave y cirugía múltiple con resultado perinatal exitoso

    OpenAIRE

    Hasbun H,Jorge; Benitez S,Susana; Cornejo R,Rodrigo; Asencio C,Ramón; Navarro A,José Luis; DANILLA E,STEFAN

    2011-01-01

    El traumatismo mayor de la embarazada es frecuente, tiene riesgo de muerte y agrega a sus complicaciones propias, las generadas por el embarazo como prematurez, desprendimiento placentario y daño perinatal. Presentamos el caso de una embarazada de 27 semanas, con traumatismo grave por atropello, fracturas óseas y desforramiento extenso de extremidad inferior derecha, que fue sometida a tratamiento quirúrgico con reducción y corrección de luxofracturas, aseo e injertos cutáneos. Se complica co...

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

    Directory of Open Access Journals (Sweden)

    Paulo E. Marchiori

    1988-09-01

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

  18. Factores pronósticos en el traumatismo craneoencefálico grave

    OpenAIRE

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

    2011-01-01

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

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

    DEFF Research Database (Denmark)

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

    2011-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Gabriel Gatti

    2011-07-01

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

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

    OpenAIRE

    2010-01-01

    Introducción: Realizamos un estudio clínico original sobre nutrición en pacientes graves, que incluye a un grupo heterogéneo típico de pacientes críticos, con/sin anemias, que nos han ingresado en la Unidad de Cuidados Intensivos, UCI. Es difícil individualizar y generalizar la relativa importancia de todos los factores que pueden contribuir a estas anemias en la admisión en la Unidad, incluyendo las deficiencias nutricionales, las alteraciones inflamatorias, la respuesta a las agresiones, la...

  2. Craniectomía descomprensiva precoz en el trauma craneoencefálico grave

    OpenAIRE

    Lacerda Gallardo, Angel Jesús

    2009-01-01

    Se realizó un estudio cuasiexperimental en pacientes con trauma craneoencefálico grave con 12 horas de evolución, cuyo objetivo fue evaluar el efecto de la craniectomía descompresiva precoz para controlar la hipertensión intracraneal asociada. Los pacientes fueron divididos en dos grupos de acuerdo al tratamiento recibido, en el Grupo I se incluyeron a los que se les realizó craniectomía descompresiva y en el Grupo II, los que recibieron el tratamiento convencional. Se estudiaron 68 casos, 45...

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

    Directory of Open Access Journals (Sweden)

    Márcia Lait Morse

    2011-06-01

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

  4. Enfermedad de Graves y cáncer de tiroides. Reporte de caso.

    OpenAIRE

    Manrique-Hurtado, Helard; Servicio de Endocrinología, Hospital Nacional Arzobispo Loayza. Lima.; Pinto-Valdivia, Miguel; Servicio de Endocrinología, Hospital Nacional Cayetano Heredia. Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia. Lima.; Acosta-Chacaltana, Max; Servicio de Endocrinología, Hospital Nacional Arzobispo Loayza. Lima.

    2011-01-01

    Se reporta el caso de una mujer de 62 años con antecedente de cáncer de recto curado, con Enfermedad de Graves de reciente diagnóstico. El examen físico mostró un bocio difuso y presencia de un nódulo en el polo inferior del lóbulo derecho. El perfil tiroideo mostró un TSH suprimido y hormonas tiroideas aumentadas. Los anticuerpos antitiroideos fueron negativos. La ecografía de tiroides confirmó la presencia de un nó...

  5. Valoración del Hiper e Hipotiroidismo Post operatorio en la enfermedad de graves Basedow

    OpenAIRE

    De La Fuente, Edgardo León

    2010-01-01

    Tesis Doctor en Medicina y Cirugía -- Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. La enfermedad de Graves es una enfermedad autoinmune que tiene múltiples factores que la mantienen y que aún no pueden ser determinados. En este trabajo se investigo, sin haber precedentes, el factor de proliferación celular en relación a la función tiroidea post operatoria como principal objetivo de esta tesis, además de otros factores como las tiroiditis autoinmune que potencialmente podr...

  6. A polymorphism within the vitamin D-binding protein gene is associated with Graves' disease but not with Hashimoto's thyroiditis.

    Science.gov (United States)

    Pani, Michael A; Regulla, Karoline; Segni, Maria; Hofmann, Stefan; Hüfner, Michael; Pasquino, Anna Maria; Usadel, Klaus-H; Badenhoop, Klaus

    2002-06-01

    Graves' disease and Hashimoto's thyroiditis are common autoimmune thyroid disorders. Experimentally, 1,25(OH)(2) D(3) prevents Hashimoto's thyroiditis. Vitamin D serum levels in Graves' disease were found to be significantly lower than in nonautoimmune hyperthyroidism. The polymorphic vitamin D-binding protein (DBP) greatly facilitates vitamin D actions, and DBP alleles differ regarding their affinity for 1,25(OH)(2) D(3). Therefore, we investigated polymorphisms of the DBP gene for an association with thyroid autoimmunity. Families with an offspring affected by Graves' disease (95 pedigrees) or by Hashimoto's thyroiditis (92 pedigrees) encompassing 561 individuals of Caucasian origin were genotyped for three DBP polymorphisms [(TAAA)(N) in intron 8; StyI; and HaeIII in exon 11]. Indirect haplotyping and (extended) transmission disequilibrium testing were performed. There was a significant transmission disequilibrium of the intron 8 polymorphism in patients with Graves' disease (P < 0.03) but not of the exon 11 polymorphism. In contrast, neither the intron 8 nor the exon 11 polymorphism was associated with Hashimoto's thyroiditis. Maternal and paternal transmission as well as allele frequencies in DQ2(+) and DQ2(-) patients did not differ in either disease. Therefore, allelic variants of the DBP gene confer susceptibility to Graves' disease but not to Hashimoto's thyroiditis in our population. These findings support a role of the vitamin D endocrine system in thyroid autoimmunity.

  7. Graves' Disease

    Science.gov (United States)

    ... This condition results from a buildup of certain carbohydrates in the skin — the cause of which also ... lead to heart rhythm disorders, changes in the structure and function of the heart muscles, and the ...

  8. Graves' Disease

    Science.gov (United States)

    ... Updated March 2017. Accessed August 17, 2017. [4] Ross DS, Burch HB, Cooper DS, et al. 2016 ... Sciences; Leonard Wartofsky, M.D., M.A.C.P., Washington Hospital Center and Georgetown University Hospital Contact ...

  9. Muestras y representatividad en vigilancia epidemiologica mediante sitios centinelas

    Directory of Open Access Journals (Sweden)

    Samaja Juan

    1996-01-01

    Full Text Available El artículo sostiene que las exigencias técnicas del muestreo para la vigilancia epidemiológica, exigen una revisión profunda de importantes conceptos de la Teoría de la Salud. En particular, es necesario hacer énfasis en las condiciones de vida, y, más específicamente, en los ambientes o contextos en que se desarrollan los procesos reproductivos de la vida social. Pero ambos campos temáticos exigen potenciar el acceso a datos más ricos que los que aportan las fuentes tradicionales. Este enfoque de la "vigilancia epidemiológica" exige una revisión de los tipos de muestras, y esto implica revisar las interpretaciones dominantes sobre los fundamentos lógicos de las inferencias a partir de muestras. Se torna necesario dejar atrás las muestras estadísticas (aún las estratificadas y promover procedimientos del tipo de los "sitios centinelas". Esta técnica, aplicada originariamente en sociedades con sistemas estadísticos deficitarios, puede desarrollarse para constituirse en un complemento substancial del monitoreo de condiciones de vida incluso en sociedades con buenos sistemas de información. El artículo propone transformar el concepto de "sitio centinela" incorporandole el requisito de la "representatividad cualitativa" mediante muestreos finalísticos sustentados en tipologías previas de las unidades espacio-poblacionales.

  10. Muestras y representatividad en vigilancia epidemiologica mediante sitios centinelas

    Directory of Open Access Journals (Sweden)

    Juan Samaja

    Full Text Available El artículo sostiene que las exigencias técnicas del muestreo para la vigilancia epidemiológica, exigen una revisión profunda de importantes conceptos de la Teoría de la Salud. En particular, es necesario hacer énfasis en las condiciones de vida, y, más específicamente, en los ambientes o contextos en que se desarrollan los procesos reproductivos de la vida social. Pero ambos campos temáticos exigen potenciar el acceso a datos más ricos que los que aportan las fuentes tradicionales. Este enfoque de la "vigilancia epidemiológica" exige una revisión de los tipos de muestras, y esto implica revisar las interpretaciones dominantes sobre los fundamentos lógicos de las inferencias a partir de muestras. Se torna necesario dejar atrás las muestras estadísticas (aún las estratificadas y promover procedimientos del tipo de los "sitios centinelas". Esta técnica, aplicada originariamente en sociedades con sistemas estadísticos deficitarios, puede desarrollarse para constituirse en un complemento substancial del monitoreo de condiciones de vida incluso en sociedades con buenos sistemas de información. El artículo propone transformar el concepto de "sitio centinela" incorporandole el requisito de la "representatividad cualitativa" mediante muestreos finalísticos sustentados en tipologías previas de las unidades espacio-poblacionales.

  11. CAPTURA DE CO2 MEDIANTE TRANSPORTADORES SÓLIDOS

    Directory of Open Access Journals (Sweden)

    Carmen Forero

    2011-01-01

    Full Text Available La evaluación de transportadores de oxígeno (TO, basados en CuO y NiO sobre Al2O3 y preparados por impregnación, se llevó a cabo en una planta piloto de dos lechos fluidizados interconectados de 500 Wte, donde se utilizaron tanto metano como gas de síntesis como gas combustible. Además, se estudió el efecto de diferentes impurezas presentes en el gas combustible como azufre o hidrocarburos ligeros en la eficacia de combustión del proceso y en el comportamiento de los TO. Los resultados obtenidos mostraron que ambos TO son adecuados para la captura de CO2 mediante transportadores sólidos de oxígeno en el proceso de combustión de metano, gas de síntesis o metano con impurezas como hidrocarburos ligeros o azufre en el gas.

  12. Análisis de varistores mediante STM y STS

    Directory of Open Access Journals (Sweden)

    Castro, M. S.

    2002-02-01

    Full Text Available ZnO-Varistors have been studied by scanning tunnelling microscopy and spectroscopy. Tunnelling current-voltage characteristics indicate that grains present a rectifying behaviour. Since the prebreakdown zone is controlled by Schottky barriers formed by intergranular states, current density vs. temperature curves were fitted considering the tunnelling current through these barriers. Then, the Schottky barrier heights determined using the model are compared with the barrier heights obtained from the scanning tunnelling spectroscopy analysis in the grain boundary.

    Varistores de ZnO fueron estudiados mediante el empleo de microscopía y espectroscopía de efecto túnel. Las curvas de corriente túnel vs. tensión indican que las muestras presentan una conducta rectificante. Dado que la conducción en la zona de pre-ruptura es controlada por la formación de barreras de Schottky en los bordes de grano debidas a la presencia de estados intergranulares, las curvas de densidad de corriente vs. temperatura fueron ajustadas considerando la corriente túnel que atraviesa dichas barreras. La altura de las barreras de Schottky determinada con el modelo es comparada con las alturas obtenidas a través del análisis de barrido por espectroscopía túnel (STS en la región del borde de grano.

  13. Limbal autograft transplantation in a dog with alkali-induced ulceration Transplante de limbo autógeno em cão com úlcera por álcali

    Directory of Open Access Journals (Sweden)

    Fábio Luiz da Cunha Brito

    2010-08-01

    Full Text Available A case of a 3-month-old female mongrel dog with a history of apathy and previous contact with an alkaline (sodium hydroxide is reported. The dog was reluctant to open the right eye. Ophthalmic examination revealed blepharospasm, photophobia, epiphora, discrete chemosis, conjunctival hyperemia, and diffuse corneal edema involving the limbus. The fluorescein test was positive and the result of the Schirmer tear test was 32mm min-1. On the basis of these findings the diagnosis was alkali-induced ulceration and limbal autograft transplantation was performed. Corneal vascularization was observed by the third postoperative day, with intensification in vessel number and caliber on subsequent days and small areas of corneal transparency. The present results show that limbal autograft transplantation is a feasible procedure for the therapeutic management of alkali-induced corneal ulcers.Descreve-se um caso de um animal da espécie canina, fêmea, sem raça definida, de três meses de idade, com histórico de apatia, contato prévio com produto alcalino (hidróxido de sódio e relutância em abrir o olho direito. Ao exame oftálmico, foram observados blefarospasmo, fotofobia, epífora, quemose discreta, hiperemia conjuntival, e edema corneal difuso com comprometimento do limbo. Foram realizados o teste da fluoresceína positivo e o Teste Lacrimal de Schirmer 32mm min-1. Com base nos achados, firmou-se o diagnóstico de úlcera por álcali e realizou-se transplante autógeno do limbo. No pós-operatório, observou-se vascularização corneal a partir do terceiro dia e sua intensificação, em número e calibre, nos dias subseqüentes. Também foram observadas mínimas áreas de transparência corneal. Os resultados obtidos permitem admitir que o transplante autógeno de limbo é procedimento factível para o manejo da terapia de úlceras de córnea por álcali.

  14. La nutrición enteral precoz en el enfermo grave Early enteral nutrition in the critically-ill patient

    OpenAIRE

    B. García Vila; Grau, T

    2005-01-01

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

  15. A 33-Year-Old Man with Gynaecomastia and Galactorrhea as the First Symptoms of Graves Hyperthyroidism.

    Science.gov (United States)

    Khoohaphatthanakul, Somdul; Sriwijitkamol, Apiradee

    2016-01-01

    Graves' hyperthyroidism has a various number of well-recognized manifestations. Galactorrhea is a rare manifestation in this disease. We describe a 33-year-old man who presented with the symptoms of hyperthyroidism, gynaecomastia, and galactorrhea for 2 months. Physical examination revealed goitre, gynaecomastia, and galactorrhea, bilaterally. Laboratory investigations demonstrated high free thyroxine with suppressed thyroid-stimulating hormone level together with elevated anti-TSH receptor; therefore, the diagnosis of Graves' disease was confirmed. Other investigations to elucidate the etiology of galactorrhea were normal, so the galactorrhea was hypothesized to be caused by Graves' disease. The gynaecomastia and galactorrhea resolved with the successful treatment of hyperthyroidism. Although the galactorrhea is extremely rare in thyrotoxicosis male patients, to the best of our knowledge, this is the third case which reported gynaecomastia and galactorrhea in male patient who presented with thyrotoxicosis.

  16. Antiphospholipid Antibody Syndrome Associated with Graves' Disease Presenting As Inferior Vena Cava Thrombosis with Bilateral Lower Limb DVT.

    Science.gov (United States)

    Jain, Ankur

    2014-01-01

    We report a case of a 60-year-old lady who presented with bilateral lower limb swelling and a thyroid swelling with clinical features consistent with thyrotoxicosis. Investigations revealed the presence of a thrombus in bilateral external, internal iliac veins, and inferior vena cava extending up to its infrahepatic part. Hormone profile and radioiodine uptake scan confirmed the diagnosis of Graves' disease. Further workup revealed the presence of antiphospholipid antibodies (confirmed after a repeat test at 12 weeks). The patient was treated with antithyroid drugs and anticoagulants. The patient improved with normalization of thyroid function and partial recanalization of the infrahepatic part of inferior vena cava. Hyperthyroidism has been implicated as a potential hypercoagulable state; however, the association of Graves' disease with antiphospholipid antibody syndrome is limited to isolated case reports. This case highlights a new mechanism underlying hypercoagulability associated with Graves' disease.

  17. Prediction of remission in Graves' disease after thionamide therapy by technetium-99m early uptake

    Energy Technology Data Exchange (ETDEWEB)

    Misaki, Takashi; Dokoh, Shigeharu; Koh, Toshikiyo; Shimbo, Shin-ichiro (Kyoto City Hospital, Kyoto (Japan)); Hidaka, Akinari; Iida, Yasuhiro; Kasagi, Kanji; Konishi, Junji

    1991-02-01

    In the clinical management of Graves' thyrotoxicosis, one of the most important subject is when to stop antithyroid drugs after achieving an euthyroid state. T{sub 3} suppression test and other methods have been used to forecast the outcome after drug cessation, but the results were not always satisfactory. We have attempted to predict remission of Graves' disease by single measurement of early technetium uptake without administration of triiodothyronine. Drugs were discontinued in the seventy-five patients with Graves' disease on maintenance doses of either methimazole or propylthiouracil who showed normalized uptake (4.0% or less). Of 64 patients evaluable after twelve months, 55 (86%) remained euthyroid, 8 relapsed, and 1 became hypothyoid. With its accuracy in prediction of short-term remission comparable or superior to T{sub 3} suppression test, this rapid and simple method seemed suitable for routine use in clinical practice. (author).

  18. Transient Hypothyroidism after Radioiodine for Graves' Disease: Challenges in Interpreting Thyroid Function Tests.

    Science.gov (United States)

    Sheehan, Michael T; Doi, Suhail A R

    2016-03-01

    Graves' disease is the most common cause of hyperthyroidism and is often managed with radioactive iodine (RAI) therapy. With current dosing schemes, the vast majority of patients develop permanent post-RAI hypothyroidism and are placed on life-long levothyroxine therapy. This hypothyroidism typically occurs within the first 3 to 6 months after RAI therapy is administered. Indeed, patients are typically told to expect life-long thyroid hormone replacement therapy to be required within this timeframe and many providers expect this post-RAI hypothyroidism to be complete and permanent. There is, however, a small subset of patients in whom a transient post-RAI hypothyroidism develops which, initially, presents exactly as the typical permanent hypothyroidism. In some cases the transient hypothyroidism leads to a period of euthyroidism of variable duration eventually progressing to permanent hypothyroidism. In others, persistent hyperthyroidism requires a second dose of RAI. Failure to appreciate and recognize the possibility of transient post-RAI hypothyroidism can delay optimal and appropriate treatment of the patient. We herein describe five cases of transient post-RAI hypothyroidism which highlight this unusual sequence of events. Increased awareness of this possible outcome after RAI for Graves' disease will help in the timely management of patients.

  19. Protracted Hypofractionated Radiotherapy for Graves' Ophthalmopathy: A Pilot Study of Clinical and Radiologic Response

    Energy Technology Data Exchange (ETDEWEB)

    Casimiro de Deus Cardoso, Cejana; Giordani, Adelmo Jose [Department of Clinical and Experimental Oncology, Division of Radiotherapy, Federal University of Sao Paulo, Sao Paulo, SP (Brazil); Borri Wolosker, Angela Maria [Department of Radiology, Federal University of Sao Paulo, Sao Paulo, SP (Brazil); Souhami, Luis [Department of Radiotherapy, McGill University Heath Centre, Montreal, Quebec (Canada); Gois Manso, Paulo [Department of Ophthalmology, Federal University of Sao Paulo, Sao Paulo, SP (Brazil); Souza Dias, Rodrigo; Comodo Segreto, Helena Regina [Department of Clinical and Experimental Oncology, Division of Radiotherapy, Federal University of Sao Paulo, Sao Paulo, SP (Brazil); Araujo Segreto, Roberto, E-mail: segreto.dmed@epm.br [Department of Clinical and Experimental Oncology, Division of Radiotherapy, Federal University of Sao Paulo, Sao Paulo, SP (Brazil)

    2012-03-01

    Purpose: To evaluate the clinical and radiologic response of patients with Graves' ophthalmopathy given low-dose orbital radiotherapy (RT) with a protracted fractionation. Methods and Materials: Eighteen patients (36 orbits) received orbital RT with a total dose of 10 Gy, fractionated in 1 Gy once a week over 10 weeks. Of these, 9 patients received steroid therapy as well. Patients were evaluated clinically and radiologically at 6 months after treatment. Clinical response assessment was carried out using three criteria: by physical examination, by a modified clinical activity score, and by a verbal questionnaire considering the 10 most common signs and symptoms of the disease. Radiologic response was assessed by magnetic resonance imaging. Results: Improvement in ocular pain, palpebral edema, visual acuity, and ocular motility was observed in all patients. Significant decrease in symptoms such as tearing (p < 0.001) diplopia (p = 0.008), conjunctival hyperemia (p = 0.002), and ocular grittiness (p = 0.031) also occurred. Magnetic resonance imaging showed decrease in ocular muscle thickness and in the intensity of the T2 sequence signal in the majority of patients. Treatments were well tolerated, and to date no complications from treatment have been observed. There was no statistical difference in clinical and radiologic response between patients receiving RT alone and those receiving RT plus steroid therapy. Conclusion: RT delivered in at a low dose and in a protracted scheme should be considered as a useful therapeutic option for patients with Graves' ophthalmopathy.

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

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    Óscar Alberto Beltrán-Salazar

    2010-01-01

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

  1. Automatic health record review to help prioritize gravely ill Social Security disability applicants.

    Science.gov (United States)

    Abbott, Kenneth; Ho, Yen-Yi; Erickson, Jennifer

    2017-07-01

    Every year, thousands of patients die waiting for disability benefits from the Social Security Administration. Some qualify for expedited service under the Compassionate Allowance (CAL) initiative, but CAL software focuses exclusively on information from a single form field. This paper describes the development of a supplemental process for identifying some overlooked but gravely ill applicants, through automatic annotation of health records accompanying new claims. We explore improved prioritization instead of fully autonomous claims approval. We developed a sample of claims containing medical records at the moment of arrival in a single office. A series of tools annotated both patient records and public Web page descriptions of CAL medical conditions. We trained random forests to identify CAL patients and validated each model with 10-fold cross validation. Our main model, a general CAL classifier, had an area under the receiver operating characteristic curve of 0.915. Combining this classifier with existing software improved sensitivity from 0.960 to 0.994, detecting every deceased patient, but reducing positive predictive value to 0.216. True positive CAL identification is a priority, given CAL patient mortality. Mere prioritization of the false positives would not create a meaningful burden in terms of manual review. Death certificate data suggest the presence of truly ill patients among putative false positives. To a limited extent, it is possible to identify gravely ill Social Security disability applicants by analyzing annotations of unstructured electronic health records, and the level of identification is sufficient to be useful in prioritizing case reviews.

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

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    Lineu Cesar Werneck

    1982-03-01

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

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

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    Belsing Tina Z

    2010-09-01

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

  4. Intraoperative parathyroid hormone assay in patients with Graves' disease for prediction of postoperative tetany.

    Science.gov (United States)

    Moriyama, Taiki; Yamashita, Hiroyuki; Noguchi, Shiro; Takamatsu, Yuji; Ogawa, Takahiro; Watanabe, Shin; Uchino, Shinya; Ohshima, Akira; Kuroki, Syoji; Tanaka, Masao

    2005-10-01

    We measured intraoperative parathyroid hormone (IOPTH) levels before and after thyroidectomy in a large group of patients to test whether changes in IOPTH can predict postoperative tetany. Subjects were 111 consecutive patients (94 females and 17 males) with Graves' disease undergoing subtotal thyroidectomy. Blood samples for IOPTH assay were obtained after anesthesia (basal) and following skin closure (postoperative). Data were compared between patients who developed tetany (n = 9) and those who did not (n = 102). There was no significant difference in sex, age, period of antithyroid drug administration, or the weight of the thyroid between the two groups. The preoperative serum calcium level was significantly lower (p tetany group than in the non-tetany group. The IOPTH level was significantly lower (p tetany group than in the non-tetany group. A decrease in IOPTH of more than 70% was shown to be 78% sensitive, 94% specific, and 93% accurate, and it has 78% positive predictive value and 94% negative predictive value for the development of tetany. Our study shows that a postoperative decrease of IOPTH level is the most predictive of postoperative tetany of the clinical risk factors investigated. We recommend IOPTH measurement as an adjunct to postoperative management of patients with Graves' disease to assist in preventing hypocalcemia and determining the earliest time for safe discharge.

  5. Predictive risk factors for postoperative tetany in female patients with Graves' disease.

    Science.gov (United States)

    Yamashita, H; Noguchi, S; Murakami, T; Uchino, S; Watanabe, S; Ohshima, A; Toda, M; Yamashita, H; Kawamoto, H

    2001-04-01

    Postoperative tetany occurs in patients with secondary hyperparathyroidism caused by a deficiency in calcium and vitamin D concomitant with transient hypoparathyroidism induced by surgery. In the present study, we further clarified the risk factors by referring to serum 25-hydroxyvitamin D [25(OH)D] and alkaline phosphatase. The serum levels of intact parathyroid hormone, calcium and other electrolytes, and 25-hydroxyvitamin D [25(OH)D] were measured preoperatively in 178 female patients with Graves' disease who underwent subtotal thyroidectomy. Of the 178 female patients, 15 (8.4%) developed tetany. Univariate analysis of 16 possible risk factors showed that 2 were statistically significant: serum 25(OH)D and alkaline phosphatase levels. The incidence of tetany according to the serum levels of 25(OH)D and alkaline phosphatase was 19.1% (9/47) in patients with 25(OH)D 155, 11.8% (4/34) in those with 25(OH)D 25 nmol/L and alkaline phosphatase > 155, and 0% (0/50) in those with 25(OH)D > 25 nmol/L and alkaline phosphatase tetany. Serum 25(OH)D and alkaline phosphatase should be monitored in patients with Graves' disease.

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

    Directory of Open Access Journals (Sweden)

    Rocha Maria Sheila Guimarães

    2001-01-01

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

  7. Adverse Events Associated with Methimazole Therapy of Graves' Disease in Children

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    Kerry Stephenson

    2010-01-01

    Full Text Available Objective. Graves' disease is the most common cause of hyperthyroidism in the pediatric population. Antithyroid medications used in children and adults include propylthiouracil (PTU and methimazole (MMI. At our center we have routinely used MMI for Graves' disease therapy. Our goals are to provide insights into adverse events that can be associated with MMI use. Methods. We reviewed the adverse events associated with MMI use in our last one hundred consecutive pediatric patients treated with this medication. Results. The range in the patient age was 3.5 to 18 years. The patients were treated with an average daily dose of MMI of 0.3±0.2 mg/kg/day. Adverse events attributed to the use of the medication were seen in 19 patients at 17±7 weeks of therapy. The most common side effects included pruritus and hives, which were seen in 8 patients. Three patients developed diffuse arthralgia and joint pain. Two patients developed neutropenia. Three patients developed Stevens-Johnson syndrome, requiring hospitalization in 1 child. Cholestatic jaundice was observed in 1 patient. No specific risk-factors for the development of adverse events were identified. Conclusions. MMI use in children is associated with a low but real risk of minor and major side effects.

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

    Institute of Scientific and Technical Information of China (English)

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

    2012-01-01

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

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

    Science.gov (United States)

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

    2016-05-31

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

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

    Directory of Open Access Journals (Sweden)

    Haroldo Falcão Ramos da Cunha

    2013-03-01

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

  11. Grave number 121 of the argaric site of Castellón Alto (Galera, Granada

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    Molina, Fernando

    2003-06-01

    Full Text Available A new grave with partly mummified bodies was discovered during fieldwork to prepare the argaric site of Castellón Alto for public visits. Timber slabs and a dry stone wall seal the artificial cave preserving the interior. The human bones belong to one adult and one infant, both with preserved hair and skin fragments. The grave goods comprise several pottery vessels, one dagger, one ax with wooden handle, metal ornaments and fragments of flax and possibly wool.

    Recientes excavaciones en el yacimiento argárico de Castellón Alto con motivo de los trabajos de acondicionamiento para su visita publica han permitido descubrir una sepultura con restos humanos momificados en su interior. La sepultura de tipo covacha se encontraba sellada por tablones de madera y un muro de mampostería. En el interior aparecieron un individuo adulto y un infantil que conservan restos de pelo y piel. El ajuar se compone de varias vasijas cerámicas, un puñal, una azuela con mango de madera y adornos en metal, así como restos de lino y posiblemente lana.

  12. Therapeutic use of mini-scleral lenses in a patient with Graves' ophthalmopathy.

    Science.gov (United States)

    Harthan, Jennifer S

    2014-01-01

    Patients with Graves' ophthalmopathy can be very challenging to manage secondary to the complex nature of their disease presentation. Patients may present with a variety of ocular findings including: lid retraction, periorbital and lid swelling, chemosis, conjunctival hyperemia, proptosis, optic neuropathy, restrictive myopathy, exposure keratopathy and/or keratoconjunctivitis sicca. Mini-scleral and scleral lens designs have been important in the management of irregular and regular corneas, and in the therapy of ocular surface diseases. We present here the case of a 48-year-old Caucasian male who had been diagnosed with Graves' ophthalmopathy 13 years earlier. With significant ocular surface staining and over ten diopters of astigmatism, the patient had never been able to wear contact lenses comfortably. After being fit with the Mini-Scleral Design™ lenses, his vision improved to 20/25 OU, his ocular surface improved, and overall quality of vision increased. Copyright © 2012 Spanish General Council of Optometry. Published by Elsevier Espana. All rights reserved.

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

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    José Lamartine de Assis

    1976-09-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2014-01-01

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

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

    Science.gov (United States)

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

    2016-04-01

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

  16. Timectomia na miastenia grave: avaliação dos resultados em 73 pacientes

    Directory of Open Access Journals (Sweden)

    J. Lamartine de Assis

    1978-03-01

    Full Text Available Foi feita avaliação dos resultados da timectomia transtorácica em 73 pacientes com miastenia grave generalizada, sendo 64 não timomatosos e 9 com timomas. Os resultados foram analisados à curto, médio e, em muitos casos, a longo prazo. Foi feito, também um estudo comparativo dos resultados em relação à idade, sexo, tempo de doença e à presença ou não do timoma. A experiência adquirida neste grupo de pacientes sugere que a timectomia transtorácica é método terapêutico útil na miastenia grave generalizada não timomatosa; seu efeito benéfico aparece no pós-operatório mediato e se mantém a longo prazo na maioria dos pacientes. Os resultados da timectomia em pacientes com timoma foram menos favoráveis. A análise estatística não mostrou diferenças significantes na evolução pós-operatória entre os pacientes não timomatos selecionados e não selecionados.

  17. Miastenia grave tratamento clínico x cirúrgico

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    Lineu Cesar Werneck

    1991-12-01

    Full Text Available A indicação da timectomia na miastenia grave ainda é controversa e, na atualidade, é difícil encontrar séries comparando tratamento conservador, devido à indicação gene. ralizada da timectomia. Na presente série foram estudados 65 casos divididos em três grupos : (1 15 pacientes timectomizados e 50 com tratamento conservador; (2 15 pacientes timectomizados pareados com 15 pacientes semelhantes clinicamente, mas tratados conservadoramente; (3 49 pacientes tratados com corticosteróides, com 16 sem corticosteróides. Estes três grupos foram comparados quanto a idade, idade de início dos sintomas, tempo de doença, formas clinicas, escala funcional e intensidade dos sintomas, seguidos durante vários anos, estudando-se o número de remissões, melhora, estabilidade ou piora dos sintomas e número de óbitos. Somente tiveram melhora dos sintomas (p<0,05 os timectomizados do grupo 1; os demais parâmetros de todos os grupos não se mostraram estatisticamente significativos. Esses resultados sugerem que o tipo de tratamento pouco interferiu na evolução da miastenia grave neste grupo de pacientes.

  18. Associação rara: polimiosite, miastenia grave e timoma

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    V. Van Boekel

    1990-12-01

    Full Text Available Fundamentados no fato de que, tanto na literatura nacional quanto na estrangeira, inexiste referência da associação de polimiosite, miastenia grave e timoma em adulto jovem do sexo masculino, os autores se propõem a descrever um caso da citada síndrome. O paciente aqui apresentado teve sua doença iniciada aos 22 anos de idade, atingindo sua expressão clínica máxima 4 anos miais tarde. No estudo em apreço, são enfatizadas as dificuldades no diagnóstico diferencial entre polimiosite e miastenia grave, doenças que, a principio, têm suas manifestações clinicas características, de modo geral bem individualizadas. Na presente observação chamamos a atenção para a possível existência de aspectos clínicos sugestivos de miastenia em enfermos com polimiosite e, por outro lado, alterações histopatológicas típicas de polimiosite em músculos de miastênicos, inviabilizando muitas vezes o diagnóstico clínico de certeza.

  19. Safety of different types of methylprednisolone puls-therapy in the treatment of Graves' orbitopathy

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    O I Vinogradskaya

    2012-09-01

    Full Text Available According to the EUGOGO’s (European Group On Graves' Orbitopathy last consensus, the treatment of choice for Graves’ Orbitopathy (GO is pulses of glucocorticoid (GC. There is a lack of evidence for superiority of any intravenous (iv GC schedules. As a rule this therapy is pretty safe. However, acute cardiovascular diseases and acute severe liver damage has been reported in sporadic cases during ivGC, resulting in fatal acute liver failure in a few patients. Design: we performed a prospective study in 36 Graves' patients with GO who were treated with 1000 mg of ivGC daily for 5 days (group I, n = 20 or weekly for 5 weeks (group II, n = 16. Results: ALAT and ASAT increases were much more prominent in group I than in group II especially during the treatment and in the first 4 weeks after the treatment. Increase of blood pressure, glycemia and negative ECG alterations in group I resulted to their management. And we revealed much more patients complains in group I. Conclusion: Both schedules seem to be pretty safe, but therapy once a week (for 5 weeks is safer and allows to treat patients in outpatient clinics, reduce expenditures on inpatient care, accelerate of initial treatment and include more patients into treatment.

  20. Association between age at diagnosis of Graves' disease and variants in genes involved in immune response.

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    Beata Jurecka-Lubieniecka

    Full Text Available BACKGROUND: Graves' disease (GD is a complex disease in which genetic predisposition is modified by environmental factors. The aim of the study was to examine the association between genetic variants in genes encoding proteins involved in immune response and the age at diagnosis of GD. METHODS: 735 GD patients and 1216 healthy controls from Poland were included into the study. Eight genetic variants in the HLA-DRB1, TNF, CTLA4, CD40, NFKb, PTPN22, IL4 and IL10 genes were genotyped. Patients were stratified by the age at diagnosis of GD and the association with genotype was analysed. RESULTS: Polymorphism in the HLA-DRB1, TNF and CTLA4 genes were associated with GD. The carriers of the HLA DRB1*03 allele were more frequent in patients with age at GD diagnosis ≤30 years than in patients with older age at GD diagnosis. CONCLUSIONS: HLADRB1*03 allele is associated with young age at diagnosis of Graves' disease in Polish population.

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

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    Allan C. Pieroni Gonçalves

    2012-11-01

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

  2. Modelado de sistemas complejos mediante simulación basada en agentes y mediante dinámica de sistemas

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    LUIS R. IZQUIERDO

    2008-01-01

    Full Text Available Este trabajo compara dos técnicas de modelado de sistemas complejos: la simulación basada en agentes y la dinámica de sistemas. Esta comparación se lleva a cabo dentro del marco general del proceso de modelado científico. Los autores concluyen que la principal diferencia entre las dos metodologías se encuentra en el proceso de abstracción que cada una de ellas realiza para construir el modelo formal a partir del sistema complejo observado. Esta diferencia inicial se extiende a las restantes etapas del proceso de modelado científico. Finalmente, se indican los principales factores y las propiedades generales de un sistema complejo que hacen que una u otra técnica sea más relevante, aunque los autores destacan que, en la mayoría de los casos, modelizar un mismo sistema mediante las dos técnicas es la solución idónea.

  3. Elastic modulus of orbicularis oculi muscle in normal humans, humans with Graves' eye disease, and cynomolgus monkeys.

    Science.gov (United States)

    Oestreicher, J H; Frueh, B R

    1995-06-01

    We built an experimental apparatus to investigate the passive elastic characteristics of orbicularis oculi muscle and examined specimens from normal humans, humans with stable Graves' eye disease, and cynomolgus monkeys. Stress-strain curves were determined and found to be exponential. The elastic modulus (Young's modulus), analogous to the stiffness of the material, was calculated as a function of strain. Elastic modulus as a function of instantaneous stress was linear. Monkey elastic modulus values were determined, but did not allow meaningful interspecies comparison because of the small sample size. No significant difference was found between normal humans and humans with Graves' eye disease with respect to elastic modulus values.

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

    Institute of Scientific and Technical Information of China (English)

    魏枫; 杜婧; 苏秀兰; 乌兰; 王津京; 霍晓静

    2008-01-01

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

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

    DEFF Research Database (Denmark)

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

    2012-01-01

    with GD. These abnormal patterns of IGF-1R display are also found in rheumatoid arthritis and carry functional consequences. In addition, activating IgGs capable of displacing IGF-1 from IGF-1R have also been detected in patients with these diseases. IGF-1R forms a complex with TSHR which is necessary......The etiology of Graves' orbitopathy (GO) remains enigmatic and thus controversy surrounds its pathogenesis. The role of the thyroid stimulating hormone receptor (TSHR) and activating antibodies directed against it in the hyperthyroidism of Graves' disease (GD) is firmly established. Less well...

  6. O terapeuta na clínica do sofrimento psíquico grave : particularidades e vivências

    OpenAIRE

    Brito,Luciana Stoimenoff

    2012-01-01

    Este trabalho teve como objetivo principal investigar e descrever as vivências experimentadas pelo terapeuta que trabalha na clínica do sofrimento psíquico grave, bem como apontar de que maneira a vivência desses profissionais dialoga com a teoria clínica das psicoses, especialmente a teoria winnicottiana. Foram realizadas entrevistas individuais semi-estruturadas com oito terapeutas que atuam na clínica do sofrimento psíquico grave. Para a análise das narrativas utilizamos a a...

  7. Climático: evaluación mediante modelos

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    P. Ruiz-Benito

    2013-01-01

    Full Text Available Los bosques son ecosistemas fundamentales en la generación de servicios ecosistémicos y, por tanto, para el bienestar humano. El cambio global (incluyendo cambio climático y cambios en el uso del suelo puede, sin embargo, alterar la dinámica y el funcionamiento de los ecosistemas, afectando al futuro suministro de servicios ecosistémicos. La vulnerabilidad frente al cambio global depende de la exposición (magnitud del cambio, la sensibilidad (susceptibilidad al cambio, y la capacidad de adaptación (habilidad para ajustarse al cambio de las especies. En el presente trabajo presentamos diversas aproximaciones de modelización que permiten analizar los diferentes componentes de la vulnerabilidad, e incluimos ejemplos desarrollados para bosques de la península Ibérica. A pesar de estos avances, la evidencia empírica y teórica para integrar los impactos potenciales (i.e. incluyendo la exposición y la sensibilidad y la capacidad de adaptación de las especies, es escasa. Por ello, para una adecuada evaluación sería necesario me-jorar el conocimiento existente sobre la sensibilidad y capacidad de adaptación de las especies y su respuesta frente a cambios ambientales extremos (por ejemplo, mediante redes de seguimiento a largo plazo, integrando adecuadamente la información obtenida en modelos que incluyan procesos basados en diferentes niveles de organización biológica, desde procesos fisiológicos a modelos agregados de distribución de especies.

  8. Chirurgia della valvulopatia mitralica mediante Port Access. Esperienza di due centri.

    OpenAIRE

    Iorio, Francesco

    2014-01-01

    La chirurgia mininvasiva della mitrale mediante Port Access, risulta una delle maggiori innovazioni in cardiochirurgia in grado di migliorare gli outcome a breve medio e lungo termine se paragonata alla chirurgia convenzionale. In questo studio sono sono prese in esame le esperienze di due centri di eccellenza che hanno condotto tali interventi mediante approcci tecnici intraoperatori diversi per il clampaggio aortico: l'Endoclamp ed il clampaggio aortico transtoracico. Vengono altresì discus...

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

    DEFF Research Database (Denmark)

    Laurberg, Peter; Nygaard, Birte; Andersen, Stig

    2014-01-01

    Background. Graves' disease may have a number of clinical manifestations with varying degrees of activity that may not always run in parallel. Objectives. To study associations between serum levels of TSH-receptor autoantibodies and the three main manifestations of Graves' disease (hyperthyroidis...

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

    DEFF Research Database (Denmark)

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

    2007-01-01

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

  11. Grave 22 of the Belgrade necropolis in Karaburma: Retrospective and perspective

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    Blečić-Kavur Martina

    2010-01-01

    Full Text Available Almost four decades after its discovery was initially announced, the Celtic necropolis in Karaburma, a suburb of Belgrade, is still one of the most important archaeological sites for the interpretation of the historical, economic, and cultural processes taking place in the central Balkans from the 4th to the end of the 1st centuries B.C. Most of all, it represents a wide-ranging source for explaining the chronology of the oldest Celtic presence in this area, also illustrating cultural exchanges in the network in which they were included. In this necropolis, belonging to the regional military elite, there are several graves in which, in addition to standard offerings relating to the regional material culture, items originating from a wider cultural area were found. Amongst these, grave number 22, the subject of our research, is especially important. In this grave were found objects mainly made of bronze and iron, with a smaller fragment of pottery. The iron items represent the attire of the deceased and his offensive weapons, while bronze items are characteristically imported vessels and a smaller bronze ring (figs. 1, 2. The imported vessels are represented by the well-known situla and cup. According to the basic typological scheme, we can classify the situla within the large group of ovoid situlae with the leaf-shaped or the so-called heart-shaped ornament under the attachment (figs. 1, 9; 2; 3, 7. According to the typological scheme here suggested, the situla found in Karaburma belongs to the first group, namely to its variant b (Ib, which is characterized by situlae with a leaf-shaped ornament on the attachment, separately cast and then pinned down or soldered to the body of the vessel (fig. 3, 7. Also belonging to this group are situlae from Skillountia, Goce Delčev (fig. 3, 8, Vărbica (fig. 3, 9 and from Chirnogi (fig. 3, 10. Situlae from Budva (fig. 3, 11 and Belgrade (fig. 3, 12 should also be included here, probably the one from Bitola

  12. The distinctive grave goods from Palhais (Beja, Portugal. New insights into the metallurgical evolution under Orientalizing influence in the southwestern end of Iberia

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    Valério, Pedro

    2013-12-01

    Full Text Available Grave goods from the Early Iron Age necropolis of Palhais offers a unique opportunity to study the metallurgy introduced in Southern Portugal by Orientalizing influence. Metals include two sets of instruments for body grooming, an “Alcores fibula” and a belt-lock, whose typology and/or decoration shows an Orientalizing inspiration. The composition and manufacture of artefacts is determined by conventional EDXRF, Micro-EDXRF, SEM-EDS, optical microscopy and Vickers microhardness testing. Elemental compositions indicate low tin bronzes (4.4 ± 2.4% evidencing significant use of scrap as inexpensive raw-material or intentional alloying with low tin amounts for economical or technological reasons. Post-casting work involved hammering and annealing operations showing that these grave goods were produced as functional artefacts. A comparison with Late Bronze Age and Early Iron Age artefacts from Southern Portugal shows that the low tin contents are common among the Phoenician bronzes. Moreover, an assessment of the coeval metals from the Southwestern Iberian Peninsula identifies other features of the Orientalizing metallurgy, such as an increase in unalloyed coppers and leaded bronzes, which can be related to the diversification of the bronze production methods during this period.El ajuar funerario de la necrópolis de Palhais (Primera Edad del Hierro ofrece una oportunidad única para estudiar la introducción de la metalurgia orientalizante en el sur de Portugal. Los metales incluyen objetos destinados al aseo del cuerpo, una fíbula de tipo Alcores y un broche de cinturón, cuya tipología y/o decoración es de inspiración orientalizante. La composición y la cadena operativa de los artefactos se determinaron por EDXRF, Micro-EDXRF, SEM-EDS, microscopía óptica y microdureza Vickers. Las composiciones indican que se trata de bronces con bajo contenido de estaño (4,4 ± 2,4%, debido al uso de chatarra o al uso intencionado de peque

  13. The clandestine multiple graves in Malaysia: The first mass identification operation of human skeletal remains.

    Science.gov (United States)

    Mohd Noor, Mohd Suhani; Khoo, Lay See; Zamaliana Alias, Wan Zafirah; Hasmi, Ahmad Hafizam; Ibrahim, Mohamad Azaini; Mahmood, Mohd Shah

    2017-09-01

    The first ever mass identification operation of skeletal remains conducted for the clandestine graves in Malaysia consisted of 165 individuals unearthed from 28 human trafficking transit camps located in Wang Kelian, along the Thai-Malaysia border. A DVI response was triggered in which expert teams comprising of pathologists, anthropologists, odontologists, radiologists and DNA experts were gathered at the identified operation centre. The Department of Forensic Medicine, Hospital Sultanah Bahiyah, Alor Star, Kedah, located approximately 75km away from Wang Kelian, was temporarily converted into a victim identification centre (VIC) as it is the nearest available forensic facility to the mass grave site. The mortuary operation was conducted over a period of 3 months from June to September 2015, and was divided into two phases; phase 1 involving the postmortem examination of the remains of 116 suspected individuals and for phase 2 the remains of 49 suspected individuals. The fact that the graves were of unknown individuals afforded the mass identification operation a sufficient duration of 2 weeks as preparatory phase enabling procedurals and daily victim identification workflow to be established, and the setting up of a temporary body storage for the designated mortuary. The temporary body storage has proven to be a significant factor in enabling the successful conclusion of the VIC operation to the final phase of temporary controlled burials. Recognition from two international observers, Mr. Andréas Patiño Umaña, from the International Committee of Red Cross (ICRC) and Prof. Noel Woodford from Victoria Institute of Forensic Medicine (VIFM) had proven the mortuary operation was in compliance to the international quality and standards. The overall victim identification and mortuary operation identified a number of significant challenges, in particular the management of commingled human remains as well as the compilation of postmortem data in the absence of

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

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    Maurício Gustavo Ieri Yamanari

    2007-02-01

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

  15. Postoperative tetany in Graves disease: important role of vitamin D metabolites.

    Science.gov (United States)

    Yamashita, H; Murakami, T; Noguchi, S; Shiiba, M; Watanabe, S; Uchino, S; Kawamoto, H; Toda, M; Murakami, N

    1999-02-01

    To test the authors' hypothesis of the causal mechanism(s) of postoperative tetany in patients with Graves disease. Previous studies by the authors suggested that postoperative tetany in patients with Graves disease occurs during the period of bone restoration and resulted from continuation of a calcium flux into bone concomitant with transient hypoparathyroidism induced by surgery. A prospective study was carried out to investigate sequential changes in serum levels of intact parathyroid hormone (iPTH), calcium and other electrolytes, 25-hydroxyvitamin D (25OHD), 1,25-dihydroxyvitamin D (1,25(OH)2D), and bone metabolic markers in 109 consecutive patients with Graves disease who underwent subtotal thyroidectomy. Preoperative serum iPTH levels negatively correlated with ionized calcium levels and positively correlated with 1,25(OH)2D or 1,25(OH)2D/25OHD. After the operation, there was a significant decline in levels of ionized calcium, magnesium, and iPTH. Serum iPTH was not detected in 15 patients after surgery. Four of these 15 patients, and 1 patient whose iPTH level was below normal, developed tetany. Preoperative serum ionized calcium levels were significantly lower, and iPTH levels were higher, in the 5 patients with tetany than in the 11 patients who did not develop tetany despite undetectable iPTH levels. The tetany group had significantly lower serum 25OHD levels and higher 1,25(OH)2D levels, and had increased 1,25(OH)2D/25OHD as an index of the renal 25OHD-1-hydroxylase activity than those in the nontetany group. These results suggest that patients with a high serum level of iPTH as a result of low serum calcium levels (secondary hyperparathyroidism) are susceptible to tetany under conditions of hypoparathyroid function after surgery. Postoperative tetany occurs in patients with secondary hyperparathyroidism caused by a relative deficiency in calcium and vitamin D because of their increased demand for bone restoration after preoperative medical therapy

  16. Deformação miocárdica pelo speckle tracking na cardiomiopatia dilatada grave

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    Maria Cristina Donadio Abduch

    2012-09-01

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

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

    Science.gov (United States)

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

    2014-01-01

    La cellulite cervico-faciale grave est une infection polymicrobienne extensive et redoutable du tissu cellulo-adipeux de la face et du cou. L'objectif de cette étude est d'analyser certains facteurs favorisants et d’évaluer les critères de gravité en fonction des formes anatomo-cliniques. Il s'agit d'une étude rétrospective réalisée, entre janvier 2007 et décembre 2012, au service de chirurgie maxillo faciale de l'hôpital militaire Avicenne de Marrakech. Sur 147 cas de cellulites cervico-faciales pris en charge au niveau du service, 13 dossiers de cellulites graves ont été retenus. Neuf hommes (69%) et quatre femmes (31%) ont fait l'objet de cette étude, avec un âge moyen de 35 ans. Tous les patients ont été adressés pour prise en charge secondaire après avoir pris des anti-inflammatoires (AI). Sept cas (54%) étaient immunocompétents. La cause dentaire était soulevée chez neufs cas (69%). Cinq cas (38%) ont présenté une forme pseudo phlegmoneuse avec des signes compressifs des voies aéro-digestives. L'extension médiastinale a été observée chez quatre patients (31%). La forme nécrosante extensive a été retrouvée dans trois cas (23%). L’étude bactériologique, réalisée chez tous les patients, avait mis en évidence une flore microbienne mixte et polymorphe. Les cellulites cervico-faciales graves posent un réel problème de prise en charge thérapeutique. L'analyse des facteurs favorisants et l’évaluation des critères de gravité dans cette série ont permis de limiter une évolution défavorable. PMID:26113891

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1999-12-01

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

  19. Sepsis y nutrición artificial en pacientes graves desnutridos

    Directory of Open Access Journals (Sweden)

    Pedro Alexei Bacardí-Zapata

    2016-05-01

    Full Text Available Objetivo: Relacionar la repercusión de las sepsis con la desnutrición y el soporte nutricional en pacientes gra-ves, conforme a variables epidemiológicas de interés. Método: Se realizó una investigación aplicada y descriptiva en el período comprendido desde marzo del año 2014 hasta enero del año 2015, en el Servicio de Cuidados Intermedios del Hospital Provincial Clínicoquirúrgico Docente “Saturnino Lora Torres” de la ciudad de Santiago de Cuba. La muestra la constituyeron 32 pacientes sépticos y desnutridos a quienes se les realizó una valoración nutricional a los siete días de estadía y se les aplicó Nutrición Artificial para evaluar la interrelación entre la sepsis, desnutrición y soporte nutricional. Resultados: Predominó el grupo de edades de 65 años y más en la investigación con 15 pacientes para un 46,9%; prevaleciendo la nutrición parenteral total con 14 casos para un 43,7%. En el estudio los pacientes con sepsis graves representaron el 46,9% y dentro de este grupo la mayoría de los enfermos se encontraron desnutridos de forma severa con siete individuos. Fueron las infecciones precedentes del sistema digestivo las más frecuente con un total de 11 enfermos para un 34,4%. Conclusiones: Existe una interrelación muy potente de forma negativa para el enfermo grave entre nutrición parenteral, gra-vedad de la sepsis y severidad de la desnutrición, de tal manera que mientras más intensa sea, más perpetúa de forma negativa a la otra desencadenando finalmente una mala evolución de estos individuos que incluso los pueden llevar a la muerte. Palabras clave: cuidados intensivos; estado nutricional; pacientes internos.

  20. A bioassay for thyroid stimulating immunoglobulins of patients with Graves' disease using porcine thyroid monolayer cells.

    Science.gov (United States)

    Fukue, Y; Uchimura, H; Kuzuya, N; Okano, S; Kanaji, Y; Takaku, F

    1986-06-01

    A bioassay for thyroid stimulating immunoglobulins (TSI) of patients with Graves' disease was developed by porcine thyroid monolayer cells. Thyroid cells were prepared by dispersion using collagenase and trypsin. Aliquots of the cell suspension (2 X 10(6) cells/1.5 ml/dish) in Ham's F-12 medium (pH 7.2) containing 10% calf serum and 1.5 mM Hepes were seeded and cultured in air at 36 C. On day 6 of culture, cells were incubated with test samples (IgG or bTSH) in 1 ml of serum-free, 0.5 mM IMX-included fresh medium for an additional time, and cAMP in the cells was measured by radioimmunoassay. Intracellular cAMP was increased within 5 minutes after the addition of bTSH and the maximal increase was observed after 30 min. Responses of cAMP were in a dose-related manner up to 10 mU/ml of bTSH. With the addition of IgG from untreated Graves' patients, dose-related increases in cAMP were also observed up to 10 mg/ml IgG and the maximal response was seen at 2 hours incubation. Thyroid stimulating activity in IgG's from normal subjects and patients with Graves' disease was tested with a dose of 10 mg/ml and 2 hours incubation and the activity was expressed as a percent of the control (incubated in the same experiment without IgG). One hundred forty one of 145 untreated patients showed higher activity (228 +/- 51.8%, mean +/- SD; 127-393%, range) than normal subjects (103 +/- 13.3%, mean +/- SD, n = 24; 80-129%, range). Sequential changes in TSI activity in 27 patients after initiating thionamide drugs were studied for 24 months. Initially all 27 patients showed positive TSI and 6 months later 15 remained positive. At 6 months after that, 10 of 23, 4 of 16, and 2 of 6 followed patients showed positive TSI. These results indicate that this bioassay is clinically useful for detecting TSI.

  1. Desarrollo de la lectura mediante estratégias integradoras

    Directory of Open Access Journals (Sweden)

    Solé, Maira

    2005-06-01

    Full Text Available La lectura y la escritura son procesos que cada día ameritan nuevos cambios y transformaciones. La propuesta de un Proyecto Pedagógico Integrador, (Fraca 2003 desarrollado con éxito en algunas instituciones venezolanas, se perfila como una alternativa significativa para el desarrollo de estos elementos. La idea o núcleo central es la integración de las diferentes asignaturas curriculares y lograr una globalización partiendo de sus objetivos y contenidos programáticos. El eje pedagógico integrador le permite al docente, evidenciar con mayor prontitud los resultados mediante actividades prácticas de lectura y escritura. Así mismo combina elementos claves del aprendizaje ausbeliano: información previa, información nueva y construcción de la información definitiva o integrada. La puesta en ejecución de las estrategias integradoras, en esta ocasión por maestros en formación (UNEG, a diferentes niños de escuelas del Estado Bolívar (Venezuela, certificando cómo la lectura y la escritura pueden tener un espacio ideal y significativo en la instrucción actual. Solo se necesita la intención, creatividad, dinamismo e ingenio. The reading and the writing plows processes that every day they require new changes and transformations. The proposal of an Integrative Pedagogic Project, (Fraca 2003 developed with success in some Venezuelan institutions; it is profiled like a significant alternative for the development of these elements. The idea or central nucleus is the integration of the different curricular subjects and to achieve a globalization leaving of its objectives and programmatic contents. The integrative pedagogic axis allows to the educational one, to evidence with more readiness the results by means of practical activities of reading and it notarizes. Likewise it combines key elements of the learning ausbeliano: previous information, new information and construction of the definitive or integrated information. The operation of

  2. de teorías mediante un estudio de caso

    Directory of Open Access Journals (Sweden)

    Verónica Alonso Jiménez

    2008-01-01

    Full Text Available La democracia representativa como forma de gobierno, implica que el poder se ejerce por personas, que elegidas por el pueblo, actúan en su nombre y representación. El modo de participación en la elección y la manera como éstas se convierten en cargos públicos, requiere del dise- ño de instituciones que sistematicen dicha participación. La república de tipo presidencial, es una modalidad del gobierno electivo y popular, cuyo titular es el jefe del ejecutivo, electo por el pueblo o sus representantes, en donde el ejercicio del poder es limitado y mantiene un régimen de responsabilidades políticas. El diseño institucional que le corresponde a esta forma de gobierno es la parcelación del poder pú- blico en tres: poder ejecutivo, poder legislativo y poder judicial. Las ventajas políticas de este esquema es que la división de poderes, neutraliza el riesgo de caer en el autoritarismo, al impedir que el poder se concentre. La división de poderes es un dispositivo de restricción de facultades de los órganos estatales, por lo que no existe superioridad jerárquica entre los poderes, al contrario, cada órgano tiene bien delimitadas sus funciones y atribuciones, las que están reguladas por un marco jurídico común llamado Constitución. Y la división de poderes contribuye a mantener el equilibrio entre estos, mediante el llamado sistema de “pesos y contrapesos”. El presente trabajo se centra en el estudio de la Cámara de Diputados, considerada como una de las parcelas en las que está divida la autoridad del Estado, cuyo objetivo es la validación de los modelos teóricos en la tipificación del Congreso y la comprensión de las variables internas y externas que influyen en el comportamiento legislativo.

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

    DEFF Research Database (Denmark)

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

    1984-01-01

    In 50 consecutive patients with Graves' disease treated with PTU, 7 (group 1) developed increasing goitre in spite of unmeasurable TSH. Thyroid variables were compared with those from 10 controls with an ordinary response to PTU (group 2). Serum T4 decreased in group 1 from 246 +/- 47 nmol/l (mean...

  4. Loss of integrity of thyroid morphology and function in children born to mothers with inadequately treated Graves' disease.

    NARCIS (Netherlands)

    Kempers, M.J.E.; Trotsenburg, A.S. van; Rijn, R.R. van; Smets, A.M.; Smit, B.J.; Vijlder, J.J. de; Vulsma, T.

    2007-01-01

    CONTEXT: Central congenital hypothyroidism (CH-C) in neonates born to mothers with inadequately treated Graves' disease usually needs T(4) supplementation. The thyroid and its regulatory system have not yet been extensively studied after T(4) withdrawal, until we observed disintegrated thyroid

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

    NARCIS (Netherlands)

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

    1989-01-01

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

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

    NARCIS (Netherlands)

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

    2015-01-01

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

  7. Hulth$\\grave{e}$n potential models for $\\alpha−\\alpha$ and $\\alpha−He^3$ elastic scattering

    Indian Academy of Sciences (India)

    J BHOI; U LAHA

    2017-03-01

    Simple Hulth$\\grave{e}$n-type potential models are proposed to treat the $\\alpha−\\alpha$ and $\\alpha−He^3$ elastic scattering. The merit of our approach is examined by computing elastic scattering phases through the judicious use of the phase function method. Reasonable agreements in scattering phase shifts are obtained with the standard data.

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

    Science.gov (United States)

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

    2011-12-01

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

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

    NARCIS (Netherlands)

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

    2015-01-01

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

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

    NARCIS (Netherlands)

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

    1989-01-01

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

  11. A Refined Study of FCRL Genes from a Genome-Wide Association Study for Graves Disease: e57758

    National Research Council Canada - National Science Library

    Shuang-Xia Zhao; Wei Liu; Ming Zhan; Zhi-Yi Song; Shao-Ying Yang; Li-Qiong Xue; Chun-Ming Pan; Zhao-Hui Gu; Bing-Li Liu; Hai-Ning Wang; Liming Liang; Jun Liang; Xiao-Mei Zhang; Guo-Yue Yuan; Chang-Gui Li; Ming-Dao Chen; Jia-Lun Chen; Guan-Qi Gao; Huai-Dong Song; of Autoimmune Thyroid Disease

    2013-01-01

      To pinpoint the exact location of the etiological variant/s present at 1q21.1 harboring FCRL1-5 and CD5L genes, we carried out a refined association study in the entire FCRL region in 1,536 patients with Graves' disease (GD...

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

    Directory of Open Access Journals (Sweden)

    Paola Toth

    2014-04-01

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

  13. Síntomas de miastenia grave en un paciente con antecedente de timectomía por timoma invasor

    Directory of Open Access Journals (Sweden)

    Lilliana María Giraldo

    2015-12-01

    Conclusiones. Los pacientes con miastenia grave y aquellos con timoma asociado, deben someterse a la timectomía como parte del tratamiento. Sin embargo, la exacerbación de los síntomas o su reaparición después del procedimiento no necesariamente implica una nueva alteración en el timo.

  14. Tratamento não operatório do trauma de baço grave

    Directory of Open Access Journals (Sweden)

    Bernardino C. Branco

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

  15. Loss of integrity of thyroid morphology and function in children born to mothers with inadequately treated Graves' disease.

    NARCIS (Netherlands)

    Kempers, M.J.E.; Trotsenburg, A.S. van; Rijn, R.R. van; Smets, A.M.; Smit, B.J.; Vijlder, J.J. de; Vulsma, T.

    2007-01-01

    CONTEXT: Central congenital hypothyroidism (CH-C) in neonates born to mothers with inadequately treated Graves' disease usually needs T(4) supplementation. The thyroid and its regulatory system have not yet been extensively studied after T(4) withdrawal, until we observed disintegrated thyroid gland

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

    OpenAIRE

    Paola Toth; Roberto Bernd

    2014-01-01

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

  17. Onset of Graves' disease during pregnancy in a woman with established hypothyroidism.

    Science.gov (United States)

    Alberiche, María; Sánchez-Hernández, Rosa María; López Mérida, Xabier; Wägner, Ana María

    2017-01-01

    Pregnancy strongly influences the thyroid gland and its function. Thyroid guidelines recommend a 30 to 50% increase of the preconceptional levothyroxine dose in women with hypothyroidism, when pregnancy is diagnosed. A 33 year-old, 8-week pregnant woman with hypothyroidism, presents with a 2-week history of palpitations, sweating, nervousness and fatigue. Physical examination shows tachycardia (108 bpm), distal tremors and diffuse goiter. After biochemical confirmation of hyperthyroidism, her levothyroxine dose is reduced and finally interrupted. Propylthiouracil is started and maintained until after the delivery of a healthy baby at week 40. Two weeks postpartum, hyperthyroidism worsens and propylthiouracil is replaced by methimazole. Eighteen months after delivery 7.5 mCi 131Iodine was given. Two months later, hypothyroidism developed and levothyroxine was initiated. Although conversion of Hashimoto's hypothyroidism into Graves' disease is exceptional in pregnancy, pregnant women with autoimmune hypothyroidism should ideally have their TSH concentrations measured before empirically increasing their levothyroxine dose.

  18. Recurrent Thyrotoxicosis due to Both Graves' Disease and Hashimoto's Thyroiditis in the Same Three Patients.

    Science.gov (United States)

    Schaffer, Ashley; Puthenpura, Vidya; Marshall, Ian

    2016-01-01

    Hashimoto's thyroiditis (HT) and Graves' disease (GD) are the 2 most common autoimmune disease processes affecting the thyroid gland. The relationship between the two is complex and not clearly understood. It has been theorized that HT and GD are 2 separate disease processes due to unique genetic differences demonstrated by genome studies. On the other hand, based on occurrence of both HT and GD in monozygotic twins and within the same family, they have been regarded to represent 2 ends of the same spectrum. This case report describes 3 patients who presented with thyrotoxicosis due to both GD and HT. The initial presentation was thyrotoxicosis due to GD treated with antithyroid medication followed by temporary resolution. They all subsequently experienced recurrence of thyrotoxicosis in the form of Hashitoxicosis due to HT, and then eventually all developed thyrotoxicosis due to GD, requiring radioablation therapy.

  19. Digital Memory: The Visual Recording of Mass Grave Exhumations in Contemporary Spain

    Directory of Open Access Journals (Sweden)

    Francisco Ferrándiz

    2008-09-01

    Full Text Available Exhumations of the victims of Franco's repressive policies are cultural practices of tremendous heuristic value and allow for the analysis of the public emergence, circulation and consumption of traumatic memory in local contexts. The use of visual media to capture social action in the surroundings of the exhumations serves as both a recording and as a triggering device for this emerging social memory. In the first part of this article we shall reflect on the different forms of visual and audiovisual interventions by different social actors that shape around mass grave exhumations. In the second part we will focus on the visual methods used by social scientists, particularly the recording of video-testimony of survivors and witnesses. URN: urn:nbn:de:0114-fqs0803351

  20. PTU-associated vasculitis in a girl with Turner Syndrome and Graves' disease.

    Science.gov (United States)

    Hardy, Olga T; Smolinski, Kara N; Yan, Albert C; Grimberg, Adda

    2006-01-01

    Palpable purpura is a concerning clinical finding in pediatric patients and can have many causes, including infectious and autoimmune processes. A rare cause, drug-induced vasculitis, may result from the production of antineutrophil cytoplasmic antibodies (ANCAs) in response to a medication. We report a girl with Turner syndrome and Graves' disease who presented with palpable purpuric lesions. The diagnosis of propylthiouracil (PTU)-associated vasculitis was made by observation of consistent clinical features, the detection of elevated ANA and ANCA in the blood, and the observed clinical resolution of symptoms following withdrawal of PTU. Subsequent treatment of persistent hyperthyroidism with radioablation did not result in an exacerbation of the vasculitis, a complication described in prior case reports.

  1. Prótesis total y unicompartimental en el manejo de artrosis grave de rodilla

    Directory of Open Access Journals (Sweden)

    DR. U. Jaime duboy

    2014-09-01

    Full Text Available La artrosis grave de rodilla es una patología prevalente y puede ser en algunos casos invalidante. Se revisan los fundamentos e historia sobre cómo la prótesis de rodilla ha llegado a ser el tratamiento de elección para eliminar el dolor y recuperar función, mejorando la calidad de vida de los pacientes. Se muestran las alternativas actuales que incluyen las prótesis Unicompartamentales, de creciente uso en los últimos años y se señalan también las mejoras en los cuidados perioperatorios y rehabilitación que han permitido una mejora significativa de los resultados.

  2. Grave's病患者外周血T细胞亚群变化意义

    Institute of Scientific and Technical Information of China (English)

    施毕; 成兴波; 金皆怡

    2001-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2011-09-15

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2003-12-01

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

  5. Respuesta al tratamiento de la Enfermedad de Graves-Basedow en pacientes pediátricos

    Directory of Open Access Journals (Sweden)

    Martha Calagua Quispe

    2014-04-01

    Full Text Available Objetivos: Describir la respuesta clínica y bioquímica al tratamiento del hipertiroidismo por enfermedad de Graves en pacientes pediátricos. Diseño: Estudio retrospectivo. Institución: Instituto Nacional de Salud del Niño, Lima, Perú. Participantes: Niños con enfermedad de Graves. Métodos: Se incluyó 32 pacientes con diagnóstico de hipertiroidismo por Enfermedad de Graves, entre 1996 a 2007. Se consideró remisión, cuando se encontraban asintomáticos y bioquímicamente eutiroideos, luego de 6 meses de suspendido el tratamiento; y recaída, si luego de este periodo de tiempo, se encontró valores hormonales alterados. Principales medidas de resultados: Remisión o recaída luego del tratamiento. Resultados: Al diagnóstico, la edad promedio fue 10,5 años (3,2 a 17,9 años; 26 pacientes (81,2% fueron de sexo femenino, 13 (40,6% púberes y 19 (59,3% pre-púberes. Los síntomas y signos más frecuentes fueron bocio, sudoración, nerviosismo, pérdida de peso, taquicardia y exoftalmos. Se usó metimazol como primera opción terapéutica a una dosis inicial promedio de 0,78 mg/kg/ día (0,4 a 2 mg/kg/día. La TSH (57,1% y el T4L (50% alcanzaron valores normales entre los 6 y 8 meses. Se observó remisión en 11 pacientes (34,3%, 3 (9,3% sufrieron recaída, 12 (37,5% pasaron a tratamiento con radioyodo (I131 y 6 (18,7% continuaron recibiendo metimazol. La remisión de la enfermedad se alcanzó a los 2,81± 0,91 años de tratamiento (rango de 1.5 a 4,8; 4,1% remitió luego del primer año, y 35,3%, 37,5% y 25% luego del segundo, tercer y cuarto año de tratamiento, respectivamente. La edad promedio de los que recibieron I131 fue 14,6 años (7,1 a 19,6 años, a una dosis alrededor de 7mCi. El 75% de ellos remitió a los 0,64± 0,60 años (rango de 0,16 a 1,5 años. Conclusiones: El hipertiroidismo por enfermedad de Graves es de relativa frecuencia en pediatría. Se obtuvo remisión en 34,3% de pacientes tratados con metimazol en un tiempo

  6. Amnésia retrógrada funcional grave: relato de caso

    OpenAIRE

    Neves,Maila de Castro L.; Beato,Rogério Gomes; Girodo,Carla Monteiro; Lauar,Hélio; Nicolato,Rodrigo; Salgado,João Vinícius; Teixeira, Antônio Lúcio

    2008-01-01

    CONTEXTO: Uma síndrome amnésica clássica caracteriza-se por evidente prejuízo da memória anterógrada, variável e temporária amnésia retrógrada, sendo as formas não-declarativas da memória poupadas. Entretanto, publicações recentes relataram casos de prejuízo desproporcional da memória retrógrada em relação à anterógrada. OBJETIVOS: Relatar o caso de um paciente de 26 anos de idade com um quadro grave de amnésia retrógrada, aparentemente sem fatores desencadeantes. MÉTODOS: Entrevista psiquiát...

  7. Hazardous materials management using a Cradle-to-Grave Tracking and Information System (CGTIS)

    Energy Technology Data Exchange (ETDEWEB)

    Kjeldgaard, E.; Fish, J.; Campbell, D.; Freshour, N.; Hammond, B.; Bray, O. [Sandia National Labs., Albuquerque, NM (United States); Hollingsworth, M. [Ogden Environmental & Energy Services Co., Inc., Albuquerque, NM (United States)

    1995-03-01

    Hazardous materials management includes interactions among materials, personnel, facilities, hazards, and processes of various groups within a DOE site`s environmental, safety & health (ES&H) and line organizations. Although each group is charged with addressing a particular aspect of these properties and interactions, the information it requires must be gathered into a coherent set of common data for accurate and consistent hazardous material management and regulatory reporting. It is these common data requirements which the Cradle-to-Grave Tracking and Information System (CGTIS) is designed to satisfy. CGTIS collects information at the point at which a process begins or a material enters a facility, and maintains that information, for hazards management and regulatory reporting, throughout the entire life-cycle by providing direct on-line links to a site`s multitude of data bases to bring information together into one common data model.

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

    Science.gov (United States)

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

    2008-01-01

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

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

    Directory of Open Access Journals (Sweden)

    FRANCISCO MARCOS B. CUNHA

    1999-06-01

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

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

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

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

  11. 3D GPR in forensics: Finding a clandestine grave in a mountainous environment.

    Science.gov (United States)

    Novo, Alexandre; Lorenzo, Henrique; Rial, Fernando I; Solla, Mercedes

    2011-01-30

    In the present work we show a forensic case study carried out in a mountainous environment. Main objective was to locate a clandestine grave which is around 10-20 years old and contains human remains of one individual and a metallic tool, probably a pick. Survey design started with an experimental burial of a pick at the expected depth (1m) as well as the calculation of synthetic radargrams in order to know if the 250MHz antenna was suitable for its detection and to have a record of the reflection of the pick. Conclusions extracted from the experiments together with rough terrain conditions suggested the use of the 250MHz antenna which allowed a good compromise between target detection and dense grid acquisition of an extensive survey area.

  12. Expression and clinical significance of connective tissue growth factor (CTGF) in Graves' ophthalmopathy.

    Science.gov (United States)

    Huang, Yi-Ming; Chang, Pei-Chen; Wu, Shi-Bei; Kau, Hui-Chuan; Tsai, Chieh-Chih; Liu, Catherine Jui-Ling; Wei, Yau-Huei

    2017-05-01

    To examine the expression of connective tissue growth factor (CTGF) in human cultured orbital fibroblasts from patients with Graves' ophthalmopathy (GO) and investigate whether a correlation exists between the presence of CTGF protein and clinical parameters of the disease. The protein expression levels of CTGF were analysed by western blots in cultured orbital fibroblasts from 10 patients with GO and 7 age-matched normal controls. Associations between the protein expression of CTGF and the clinical factors of GO, including clinical demographics, thyroid function, clinical activity score (CAS) and ophthalmopathy index (OI), was evaluated. The mean protein expression levels of CTGF in the GO orbital fibroblasts were significantly higher than those of normal controls (ppathophysiology of GO. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

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

    Directory of Open Access Journals (Sweden)

    V V Lazanovich

    2008-09-01

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

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

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    Rivkees ScottA

    2010-08-01

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

  15. 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

  16. [Distribution of IgG subclasses of TgAb and TPOAb in sera from patients with Graves' disease, Graves' disease plus Hashimoto's thyroiditis and Hashimoto's thyrotoxicosis].

    Science.gov (United States)

    Yuan, Shanshan; Yu, Nan; Gao, Ying; Huang, Wei; He, Yifan; Dong, Bin; Lu, Guizhi; Li, Maorong; Cai, Xiaopin; Peng, Dingqiong; Wang, Yunhong; Li, Ting; Huang, Youyuan; Gao, Yanming; Guo, Xiaohui; Shi, Bingyin

    2014-01-14

    To evaluate the distribution of IgG subclasses of TgAb and TPOAb in sera from patients with Graves' disease (GD), Graves' disease plus Hashimoto's thyroiditis (GH) and Hashimoto's thyrotoxicosis. Patients with GD (n = 33), GH (n = 31) or Hashimoto's thyrotoxicosis (n = 18) diagnosed by fine needle aspiration cytology at Department of Endocrinology of Peking University First Hospital, Beijing Haidian Hospital, China-Japan Friendship Hospital and Civil Aviation General Hospital during the period from January 2010 to May 2013 were enrolled. All of them had TgAb and TPOAb. The total serum IgG and IgG subclasses of TgAb and TPOAb were detected by antigen-specific enzyme-linked immunosorbent assay (ELISA). The prevalence and relative amount of IgG subclasses were calculated and compared among three groups. The levels of TRAb in GD group (21.80(7.53, 40) U/L) were significantly higher than those in GH (7.30(3.10, 25.40) U/L) (P = 0.000) and Hashimoto's thyrotoxicosis groups (4.90(1.69, 16.43) U/L) (P = 0.003). And no significant differences were found in the levels of TgAb and TPOAb. The prevalence of TgAb IgG3 subclass in Hashimoto's thyrotoxicosis group (66.7%) was higher than GD group (35.5%) and GH group (36.4%) and the difference was close to significance (P = 0.066). There were significant differences of relative amount of TgAb IgG2 and TgAb IgG4 among three groups (P = 0.039 and 0.013), and GD patients had higher relative amounts of TgAb IgG2 (0.59(0.34, 0.94)) and TgAb IgG4 (0.57(0.28, 0.97)) than GH patients (TgAb IgG2, 0.31(0.23, 0.34); TgAb IgG4, 0.26(0.09, 0.48)) or patients with Hashimoto's thyrotoxicosis (TgAb IgG2, 0.32(0.24, 0.83); TgAb IgG4, 0.33(0.10, 0.65)) (for TgAb IgG2, P = 0.009 and 0.167; for TgAb IgG4, P = 0.005 and 0.041 respectively). No significant difference was found in the prevalence of each TPOAb IgG subclass. The difference of relative amount of TPOAb IgG2 among three groups was close to significance (P = 0.069). And the relative amount

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

    Directory of Open Access Journals (Sweden)

    Carla Amaral de Almeida

    2005-05-01

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

  18. Supervoltage orbital radiotherapy for progressive Graves' ophthalmopathy; Results of a twenty-year experience

    Energy Technology Data Exchange (ETDEWEB)

    Kriss, J.P.; McDougall, I.R. (Division of Nuclear Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Stanford University School of Medicine, Stanford Medical Center, Palo Alto, California (USA)); Petersen, I.A.; Donaldson, S.S. (Department of Radiation Oncology, Stanford University School of Medicine, Stanford Medical Center, Palo Alto, California (USA))

    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 {le} 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).

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

    Directory of Open Access Journals (Sweden)

    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.

  20. O mosaico patogênico da pancreatite aguda grave The pathogenic mosaic of severe acute pancreatitis

    Directory of Open Access Journals (Sweden)

    Márcio Cavalcante Carneiro

    2004-12-01

    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.Acute pancreatitis has been the objective of discussion, principally regarding its physiopathology and treatment. It is recognized that pancreatic necrosis, infections and multiple organ dysfunction are associated with high mortality. This disease remains a challenge for physicians and surgeons. However, a better understanding of evolved mechanisms may be the key for an appropriated treatment, principally for severe forms of disease in which mortality remains elevated. This study reviews the physiopathology and natural history of severe acute pancreatitis, and its association to SIRS and sepsis.