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Sample records for tenosinovitis grave por

  1. Tenosinovitis por virus Chikungunya

    Directory of Open Access Journals (Sweden)

    Alfredo Seijo

    2014-12-01

    Full Text Available Se presenta a la consulta un hombre proveniente de la República Dominicana con una tenosinovitis del extensor del dedo medio derecho; en la convalecencia inmediata, segunda curva febril luego de 48 horas de permanecer asintomático de una enfermedad febril aguda, y marcada astenia, exantema pruriginoso, poliartralgias con impotencia funcional y rigidez articular generalizada. Los exámenes bioquímicos no aportaron datos de interés para el diagnóstico. La serología para virus dengue fue negativa. La detección de IgM y de anticuerpos neutralizantes para virus Chikungunya (CHIKV fueron positivos.

  2. Tenosinovitis por virus Chikungunya

    OpenAIRE

    Alfredo Seijo; Victoria Luppo; Alejandra Morales; Elisa Gancedo; Yamila Romer; Jorge Correa; Gladys Poustis; Sergio Giamperetti; Cintia Fabbri; Delia Enría

    2014-01-01

    Se presenta a la consulta un hombre proveniente de la República Dominicana con una tenosinovitis del extensor del dedo medio derecho; en la convalecencia inmediata, segunda curva febril luego de 48 horas de permanecer asintomático de una enfermedad febril aguda, y marcada astenia, exantema pruriginoso, poliartralgias con impotencia funcional y rigidez articular generalizada. Los exámenes bioquímicos no aportaron datos de interés para el diagnóstico. La serología para virus dengue fue negativa...

  3. Poliartritis y tenosinovitis grave por Streptococcus agalactiae en un paciente con hipoesplenia funcional Severe polyarthritis and tenosynovitis caused by Streptococcus agalactiae in a patient with functional hyposplenia

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    Domingo C. Balderramo

    2002-08-01

    Full Text Available La artritis por Streptococcus agalactiae es infrecuente. No conocemos publicaciones de casos sobre la afección tendinosa por este microorganismo. Se presenta una mujer de 46 años que consultó por fiebre, poliartralgias, mialgias, diarrea y vómitos. Como antecedentes presentaba carcinoma papilar de tiroides e hipoesplenia funcional. Al examen se encontraba hemodinámicamente inestable, febril, con artritis de mano izquierda, muñecas, codos, hombro derecho y tobillo izquierdo. Presentaba tenosinovitis en ambos pies y en la mano izquierda. Los hemocultivos y el cultivo de la bursa olecraniana derecha fueron positivos para S. agalactiae. La ecografía mostró signos de tenosinovitis del tibial anterior izquierdo. Completó 20 días de tratamiento endovenoso con cefazolina y 12 días de cefuroxima oral. El cuadro articular revirtió completamente en 60 días. El Streptococcus agalactiae puede causar, en forma infrecuente, un síndrome de poliartritis, tenosinovitis y fiebre similar al producido por la infección gonocócica.Cases of arthritis caused by Streptococcus agalactiae are infrequent and in our knowledge there are no case reports of tenosynovitis caused by S. agalactiae. A 46-year-old woman presented with fever, polyarthralgia, myalgia, diarrhea and vomiting. She had a history of papillary thyroid carcinoma and functional hyposplenia. She was febrile, with arthritis in hands, wrists, elbows, right shoulder and left ankle joints, and presented tenosynovitis in both feet and left hand. Blood and right olecranon bursa sample cultures were positive for S. agalactiae. An ultrasound scan made at the musculus tibialis anterior of left foot revealed signs of tenosynovitis. She was treated with intravenous cefazolin for 20 days and oral cefuroxime for 12 days. The joint involvement completely subsided in 60 days. Streptococcus agalactiae can cause, infrequently, a polyarthritis and tenosynovitis syndrome similar to disseminated gonococcal

  4. Poliartritis y tenosinovitis grave por Streptococcus agalactiae en un paciente con hipoesplenia funcional Severe polyarthritis and tenosynovitis caused by Streptococcus agalactiae in a patient with functional hyposplenia

    OpenAIRE

    Domingo C. Balderramo; Ana M. Bertoli; Miguel A. PaganiniI; Abel Zárate; Zlocowski, Juan C.; Alejandro Alvarellos; Francisco Caeiro; Caeiro, Juan P.

    2002-01-01

    La artritis por Streptococcus agalactiae es infrecuente. No conocemos publicaciones de casos sobre la afección tendinosa por este microorganismo. Se presenta una mujer de 46 años que consultó por fiebre, poliartralgias, mialgias, diarrea y vómitos. Como antecedentes presentaba carcinoma papilar de tiroides e hipoesplenia funcional. Al examen se encontraba hemodinámicamente inestable, febril, con artritis de mano izquierda, muñecas, codos, hombro derecho y tobillo izquierdo. Presentaba tenosin...

  5. Tenosinovitis por Mycobacterium chelonae: a propósito de un caso

    OpenAIRE

    Alfredo Berrocal Kasay; Juan Echevarria Zarate; Erick Ramirez Aranda; Elsa Castro Leon; Dina Gonzales Bendezu

    2004-01-01

    We report a patient with a diagnosis of synovial tenosynovitis who developed septic tenosinovitis with cold abscess on right hand, after a local punction. Mycobacterium chelonae a fast-growing mycobacteria, was isolated. We discuss aspects related to differential diagnosis, epidemiology, risk factors. diagnostic procedures and issues related to treatment of this nosocomial infection. (Rev Med Hered 2004;15:229-231).

  6. Tenosinovitis por Mycobacterium chelonae: a propósito de un caso

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    Alfredo Berrocal Kasay

    2004-10-01

    Full Text Available We report a patient with a diagnosis of synovial tenosynovitis who developed septic tenosinovitis with cold abscess on right hand, after a local punction. Mycobacterium chelonae a fast-growing mycobacteria, was isolated. We discuss aspects related to differential diagnosis, epidemiology, risk factors. diagnostic procedures and issues related to treatment of this nosocomial infection. (Rev Med Hered 2004;15:229-231.

  7. Aproximacion artroscopica de tenosinovitis traumatica de la vaina sinovial tarsiana: reporte de caso.(Perspectiva general de la enfermedad/trastorno)

    National Research Council Canada - National Science Library

    Giraldo Botero, Lucas; Vasquez Salinas, Laura

    2010-01-01

    ... que ocurren en los equinos, existen lesiones de tejidos blandos como lo es la Tenosinovitis, la cual implica la inflamacion de la membrana sinovial de la vaina tendinosa; la alteracion se manifiesta por la distension de la vaina tendinosa debido a la efusion sinovial. Tiene diferentes causas y manifestaciones clinicas. Los distintos tipos de tenosinovitis ...

  8. Infección grave por el virus del Chikungunya

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    Susana Ferreira-Sarmiento

    2015-01-01

    Full Text Available Publicaciones recientes han desafiado la visión convencional sobre la naturaleza benigna de la infección por el virus de Chikungunya (VCHIK. Las manifestaciones clínicas son muy variables y pueden ser graves en algunos casos. Los estudios sugieren que la forma grave de la infección por el VCHIK puede ser asociada con disfunción orgánica múltiple, hepatitis, meningitis, nefritis, encefalitis, dermatitis ampollosa, miocarditis, arritmias cardiacas, entre otras. La fisiopatología subyacente para algunas de las complicaciones de la enfermedad por el VCHIK sigue siendo poco clara. Sin embargo, de acuerdo con las características clínicas de los casos graves o atípicos descritos a la fecha, el desarrollo de complicaciones podría agruparse principalmente en tres categorías: la exacerbación de condiciones médicas subyacentes, el deterioro de un trastorno no reconocido previamente y la respuesta inmunológica inadecuada a la infección. Se ha encontrado asociación entre las manifestaciones graves de la infección, niveles elevados de citoquinas y algunas secuencias genómicas específicas del VCHIK. La inmunoterapia pasiva puede constituir una estrategia eficaz en el tratamiento de individuos expuestos al VCHIK con riesgo de infección grave. Actualmente no existe evidencia clínica que soporte el uso de antivirales en la prevención o tratamiento de la infección por el VCHIK.

  9. Muerte materna por malaria grave por Plasmodium vivax

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    Nancy Arróspide

    Full Text Available Se presenta el caso de una mujer de 19 años con 29 semanas de gestación, procedente de Llumpe (Ancash con antecedentes de viajes a las localidades de Chanchamayo (Junín y Rinconada (Ancash. Ingresó al Hospital de Chacas (Ancash por presentar mal estado general, deshidratación, dificultad respiratoria, ictericia, sensación de alza térmica y dolor abdominal, tuvo reporte de: hemoparásitos 60% en frotis sanguíneo. Fue transferida al Hospital Ramos Guardia (Huaraz donde presentó mayor dificultad respiratoria, coluria, hematuria, disminución del débito urinario y reporte de Plasmodium (+, luego fue transferida al Hospital Cayetano Heredia (Lima donde ingresó a la Unidad de Cuidados Intensivos (UCI, con evolución a falla multiorgánica, óbito fetal y muerte materna. Se confirmó infección por Plasmodium vivax. Destacamos la importancia de mejorar nuestras capacidades de diagnóstico y manejo para brindar un tratamiento adecuado y oportuno.

  10. Agranulocitosis inducida por metimazol en pacientes con enfermedad de Graves

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    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.

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

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    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.

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

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    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.

  13. Reacción de anafilaxia grave por dipirona sin antecedente de hipersensibilidad. Informe de caso

    National Research Council Canada - National Science Library

    Machado-Alba, Jorge Enrique; Urbano-Garzón, Sivia Fernanda; Gallo-Gómez, Yeinson Nabor; Zuluaica, Sergio; Henao, Yuly; Parrado-Fajardo, Ilsa Yadira

    2017-01-01

    ... libre y ampliamente utilizado ya que es costo-efectivo y puede administrarse por diferentes vías 1,2 . Pueden aparecer, aunque en poca frecuencia, reacciones alérgicas tan graves y letales como shock anafiláctico y síndrome de Stevens-Johnson, incluso con desenlaces fatales 1,3 . Descripción del caso Información de paciente e historial médico Pa...

  14. Tenosinovitis piógena flexora de la mano: experiencia en el Hospital Universitario Central de Asturias

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    Irene García-Martínez

    Full Text Available Introducción y Objetivos. La tenosinovitis piógena flexora de la mano es una infección severa de los tejidos blandos de la mano. Se asocia a secuelas funcionales graves que varían desde rigideces de las articulaciones interfalángicas y metacarpofalángicas hasta la necesidad de amputaciones digitales. La rapidez en la instauración de tratamiento antibiótico endovenoso de amplio espectro y el drenaje quirúrgico urgente son las claves para minimizar la aparición de secuelas. Nuestro objetivo es estudiar las características de los pacientes con dicha patología en nuestro medio. Material y método. Presentamos un estudio retrospectivo de 24 casos de infección de la vaina sinovial flexora diagnosticados y tratados por el Servicio de Cirugía Plástica del Hospital Universitario Central de Asturias (Oviedo, España durante un periodo de 8 años. Resultados. Los dedos más afectados fueron el índice y el medio y en todos los casos estuvo presente alguno de los 4 signos de Kanavel. Un 71% de nuestros pacientes precisó intervención quirúrgica urgente: 88% drenaje abierto, 76% abordaje volar tipo Bruner, 6% abordaje mediolateral longitudinal, y otro 6% desbridamiento amplio incluyendo piel. Los demás fueron tratados con antibioticoterapia endovenosa de amplio espectro, inmovilización y elevación de la extremidad afecta. En todos los casos se realizó lavado intraoperatorio con suero salino y/o antiséptico, y en el 65% irrigación postoperatoria continua. El germen más frecuénteme aislado fue Staphylococus aureus si bien en el 75% de los casos no se obtuvo crecimiento microbiológico. La media de estancia hospitalaria fue de 7.3 días. Todos siguieron rehabilitación precoz; el 42% lograron recuperación completa, el 29% sufrió limitación de extensión y el 16% déficit de flexio-extensión del dedo afecto. Conclusiones. Nuestros hallazgos ponen de manifiesto que la tenosinovitis piógena flexora es una patología poco frecuente en

  15. Síntomas de miastenia grave en un paciente con antecedente de timectomía por timoma invasor

    OpenAIRE

    Lilliana María Giraldo; Camilo Duque; Carlos Santiago Uribe; Olga Helena Hernández

    2015-01-01

    Introducción. La miastenia grave es una enfermedad autoinmunitaria mediada por anticuerpos. Entre 10 y 15 % de quienes la padecen tienen timoma y su presencia se asocia con una mayor gravedad de los síntomas, crisis miasténicas y fracaso del tratamiento de primera línea. La timectomía se recomienda en pacientes jóvenes con miastenia grave generalizada y en todos los pacientes con timoma. Caso clínico. Se presenta el caso de una mujer de 43 años que, en el 2005, presentó una primera crisis ...

  16. Pneumonia grave por "Chlamydia psittaci" Severe pneumonia due to Chlamydia psittaci

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    CRISTIANE MOSCHIONI

    2001-07-01

    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.Psittacosis, also known as ornithosis, is a disease caused by Chlamydia psittaci. The most common clinical presentation is insidious onset, mild symptoms resembling a nonspecific viral illness and preference for the lungs. It is rarely a systemic and fatal disease. It is described a rare case of pneumonia due to Chlamydia psittaci that progressively developed into respiratory failure, requiring mechanical ventilation. It is very important to consider psittacosis in cases of atypical pneumonia whose evolution is unsatisfactory, with no response to antimicrobial therapy and epidemiology is positive for exposure to birds. Prompt recognition is vital as the response to appropriate treatment is excellent. Delayed diagnosis may lead to a severe course and fatal outcome.

  17. Factores de riesgo laboral para tenosinovitis del miembro superior

    OpenAIRE

    Mayra Mevic Garrafa Núñez; María Cristina García Martín; Graciela Sánchez Lemus

    2015-01-01

    Objetivos: Identificar los factores de riesgo desencadenantes de tenosinovitis en los trabajadores verificando qué casos pueden ser considerados de origen laboral y reconocer las formas de presentación más frecuentes en relación al ámbito laboral. Metodología: Se realiza una revisión bibliográfica de la literatura científica publicada en Medline-PubMed, Cochrane Library, EMBASE, CISDOC-ILO/OSH UPDATE, Scopus, LILACS e IBECS en el período comprendido entre 2007 a 2014. Resultados: Se obtiene u...

  18. Factores de riesgo laboral para tenosinovitis del miembro superior

    Directory of Open Access Journals (Sweden)

    Mayra Mevic Garrafa Núñez

    2015-12-01

    Full Text Available Objetivos: Identificar los factores de riesgo desencadenantes de tenosinovitis en los trabajadores verificando qué casos pueden ser considerados de origen laboral y reconocer las formas de presentación más frecuentes en relación al ámbito laboral. Metodología: Se realiza una revisión bibliográfica de la literatura científica publicada en Medline-PubMed, Cochrane Library, EMBASE, CISDOC-ILO/OSH UPDATE, Scopus, LILACS e IBECS en el período comprendido entre 2007 a 2014. Resultados: Se obtiene un total de 14 artículos entre los cuales 10 eran transversales y 4 son casos y controles. Todos ellos muestran una elevada probabilidad de desarrollar tenosinovitis en el ámbito laboral. La relación con movimientos repetitivos fue el factor de riesgo más importante con OR > 2, seguido de posturas forzadas y el uso de herramientas vibratorias. Respecto a los factores psicosociales la depresión presenta una OR = 3,04 (IC95% 2,43-3,81 y la combinación de movimiento repetitivo y el estrés, OR = 4,94 (IC95% 3,532-6,91. Conclusión: Movimientos repetitivos, posturas forzadas y mantenidas, herramientas vibratorias, edad, ser mujer, raza blanca, estrés fueron los factores de riesgo encontrados sin poder demostrar en ninguno causalidad, siendo los trastornos musculoesqueléticos más prevalentes el síndrome del manguito de los rotadores, la enfermedad de De Quervain, dedo en gatillo y la epicondilitis lateral y medial.

  19. Enfermedad respiratoria grave en terapia intensiva durante la pandemia por el virus de influenza A (H1N1 2009

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    José Aquino-Esperanza

    2010-10-01

    Full Text Available Se describen pacientes hospitalizados en una unidad de terapia intensiva por enfermedad respiratoria aguda grave con características de influenza durante los primeros meses de la pandemia por influenza A(H1N1 2009 en la Argentina. Evaluamos datos clínicos, scores de gravedad, pruebas de laboratorio, microbiología y radiología torácica al ingreso, evolución y mortalidad hospitalaria, comparando pacientes con y sin confirmación de H1N1 por test de reacción de polimerasa en cadena, transcriptasa reversa (RT-PCR. Entre junio y julio de 2009 se internaron 31 pacientes adultos con una mediana de edad de 54 años (percentilo 25-75: 33-66. Presentaron test positivo para H1N1, 17 pacientes. Tenían al menos una condición concurrente 16 pacientes. La expresión radiográfica más frecuente fue infiltrados intersticio-alveolares bilaterales en 20 casos; 5 tenían consolidación lobar unilateral. La coinfección bacteriana (aislamiento de bacterias o IgM positiva para infecciones bacterianas, se demostró en 21 pacientes. Requirieron ventilación mecánica 23 pacientes y 18 desarrollaron síndrome de distrés respiratorio agudo (SDRA. La linfopenia y elevación de creatinina-fosfoquinasa fue frecuente (83% y 65%, respectivamente. Los 6 pacientes que murieron (19% eran mayores de 75 años o tenían cáncer o inmunodepresión. El tratamiento antiviral temprano (≤ 48 horas se asoció a menor necesidad de ventilación mecánica (54% vs. 89%; p: 0.043. No hubo diferencia significativa en las variables analizadas entre el grupo H1N1 positivo y el negativo, lo que sugiere tener igual enfoque terapéutico frente a una epidemia. La infección por H1N1 determinó falla respiratoria aguda y SDRA. La mortalidad ocurrió en pacientes añosos o con co-morbilidades graves.

  20. 120. Influencia del desajuste paciente-prótesis en la morbimortalidad intrahospitalaria del paciente joven intervenido de recambio valvular aórtico por estenosis grave

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    D. Hernández-Vaquero

    2012-04-01

    Conclusiones: El desajuste paciente-prótesis es un hallaz-go frecuente en el paciente joven intervenido de recambio valvular aórtico por estenosis grave. Además, su influencia a los 30 días de seguimiento parece relevante.

  1. Topiramate and severe metabolic acidosis: case report Acidose metabólica grave por topiramato: relato de caso

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    Jayme E. Burmeister

    2005-06-01

    Full Text Available Topiramate infrequently induces anion gap metabolic acidosis through carbonic anhydrase inhibition on the distal tubule of the nephron - a type 2 renal tubular acidosis. We report on a 40 years old woman previously healthy that developed significant asymptomatic metabolic acidosis during topiramate therapy at a dosage of 100mg/day for three months. Stopping medication was followed by normalization of the acid-base status within five weeks. This infrequent side effect appears unpredictable and should be given careful attention.Topiramato pode produzir raramente uma acidose metabólica através da inibição da anidrase carbônica no túbulo distal do néfron - acidose tubular renal do tipo 2. Relatamos o caso de mulher de 40 anos previamente saudável que desenvolveu quadro de acidose metabólica assintomática grave, sem outra etiologia identificável, durante uso de topiramato na dose de 100mg/dia por três meses. Este efeito colateral, embora infrequente, parece ser imprevisível e requer atenção cuidadosa.

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

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    Tania Milena Daza-Márquez

    2010-06-01

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

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

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    Carla Amaral de Almeida

    2005-05-01

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

  4. Graves disease

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/000358.htm Graves disease To use the sharing features on this page, please enable JavaScript. Graves disease is an autoimmune disorder that leads to an ...

  5. 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.

  6. 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.

  7. Valvuloplastia aórtica por balão como ponte para o tratamento definitivo na estenose aórtica grave

    Directory of Open Access Journals (Sweden)

    Pena Henrique Patrus Mundim

    1997-01-01

    Full Text Available Homem de 36 anos, com quadro de estenose aórtica crítica e choque cardiogênico refratário, foi submetido a valvuloplastia aórtica por balão como procedimento de salvamento, seguindo-se compensação clínica, o que possibilitou a realização de cirurgia de troca valvar aórtica no 48º dia após esse procedimento. O acompanhamento clínico e ecocardiográfico demonstrou melhora funcional significativa até o presente, oito meses após a cirurgia. A valvuloplastia aórtica por balão constitui opção terapêutica de salvamento em pacientes com estenose aórtica grave e elevado risco cirúrgico, servindo como ponte para a cirurgia de troca aórtica ou transplante cardíaco. A cirurgia de troca aórtica deve ser considerada, mesmo em pacientes com disfunção ventricular grave, reservando-se o transplante cardíaco aos pacientes em que se supõe depressão muito acentuada e irreversível da contratilidade miocárdica.

  8. Resultados do tratamento da Insuficiência Venosa Crônica grave com espuma de polidocanol guiada por ultrassom

    OpenAIRE

    Silva,Melissa Andreia de Moraes; Burihan,Marcelo Calil; Barros,Orlando da Costa; Nasser,Felipe; Ingrund,José Carlos; Neser,Adnan

    2012-01-01

    CONTEXTO: A insuficiência venosa crônica (IVC) em suas formas mais graves, com ulceração e lesões inflamatórias, associa-se a um tratamento cirúrgico convencional de difícil execução. A escleroterapia de veias tronculares com espuma de polidocanol é considerada uma alternativa terapêutica com resultados satisfatórios. OBJETIVO: Relatar os resultados da escleroterapia com espuma de polidocanol no tratamento de pacientes com IVC de membros inferiores com úlcera ativa. MÉTODOS: Em um período de ...

  9. Miastenia grave y miastenia grave ocular

    Directory of Open Access Journals (Sweden)

    Rosa María Naranjo Fernández

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

  10. Malária grave secundária a co-infecção por Plasmodium falciparum e Plasmodium ovale

    Directory of Open Access Journals (Sweden)

    Eduardo Ribeiro

    2013-03-01

    Full Text Available A malária é causada pela infeção por protozoários do género Plasmodium, sendo uma importante causa de doença, especialmente em países tropicais. O diagnóstico de malária é baseado na suspeita clínica e na deteção dos parasitas no sangue. O P. falciparum é a espécie que causa maior morbilidade e mortalidade. O efeito da co-infeção por múltiplas espécies sobre a evolução clínica não é certo. Se os doentes não forem tratados eficazmente na fase inicial, a doença pode evoluir para malária grave, cujas manifestações mais comuns no adulto são coma, acidose metabólica, insuficiência renal, icterícia grave, lesão pulmonar aguda e ARDS. A malária grave apresenta uma taxa de mortalidade alta, mesmo com tratamento adequado. Apresentamos o caso de um doente com malária grave, secundária a co-infecção pelo P. falciparum e P. ovale, com disfunção multiorgânica, que evoluiu favoravelmente após internamento na Unidade de Cuidados Intensivos. Malaria is caused by infection by protozoa of the genus Plasmodium, and is a major cause of disease, especially in tropical areas. The diagnosis of malaria is based on clinical suspicion and detection of the parasites in the blood. Plasmodium falciparum is the specie that causes most morbidity and mortality. The effect of multiple species co-infection on clinical outcomes of malaria is uncertain. If patients are not effectively treated in the early stages, the disease may progress to severe malaria, whose most common manifestations in adults are coma, metabolic acidosis, renal failure, severe jaundice, acute lung injury and ARDS. Severe malaria has a high mortality, even with appropriate treatment. We present a patient with severe malaria, secondary to co-infection by P. falciparum and P. ovale, with multiorgan dysfunction, which dramatically improved after admission on Intensive Care Unit.

  11. Evaluación de un programa de tratamiento en prisión de hombres condenados por violencia grave contra la pareja

    Directory of Open Access Journals (Sweden)

    Enrique Echeburúa

    2009-01-01

    Full Text Available En este estudio cuasi-experimental se ha puesto a prueba la efectividad de un programa de tratamiento psicológico para hombres encarcelados por haber cometido un delito grave de violencia de pareja. La muestra constó de 148 hombres que cumplían condena en 18 cárceles españolas. El tratamiento psicológico consistió en un programa cognitivo-conductual, con 20 sesiones de periodicidad semanal, que duró aproximadamente 8 meses. Según los resultados obtenidos, hubo una modificación significativa de los sesgos cognitivos tanto sobre la inferioridad de la mujer como sobre la violencia como forma válida de afrontar las dificultades cotidianas. Asimismo los sujetos tratados experimentaron una reducción de los síntomas psicopatológicos, de la impulsividad y de la ira, así como un aumento significativo en la autoestima. Por otra parte, la única diferencia entre los sujetos que abandonaron el tratamiento y los que lo completaron fue la ausencia de antecedentes penales. La alta impulsividad y los síntomas depresivos antes del tratamiento fueron predictores de unos resultados terapéuticos más pobres. Se comentan las implicaciones de este estudio para investigaciones futuras.

  12. Graves' Disease

    Science.gov (United States)

    ... to pump enough blood to the body (congestive heart failure). Thyroid storm. A rare, but life-threatening complication of Graves' disease is thyroid storm, also known as accelerated hyperthyroidism or thyrotoxic crisis. It's more likely when severe hyperthyroidism is untreated ...

  13. Graves consecuencias por desconocimiento de la presencia del primer molar permanente en la boca de un niño

    OpenAIRE

    Zubiarrain, C. V.; Vicente, D.; Iriquin, María Soledad

    2015-01-01

    La desinformación de familias y niños sobre la importancia del estado bucal en la dentición temporaria/permanente y la presencia del PMP como iniciador de la dentición mixta, hacen que la caries avance y no sea detectada de manera temprana para controlar el daño. Por ello es de vital importancia practicar la odontología restauradora y una odontología preventiva realizando campañas de concientización de la relevancia del primer molar definitivo y prevención bucal en los colegios, como agentes ...

  14. 40. Esperanza de vida de octogenarios operados de recambio valvular por estenosis aórtica grave. Comparación con la población general. Clase funcional y predictores independientes de mortalidad a largo plazo

    Directory of Open Access Journals (Sweden)

    D. Hernández-Vaquero Panizo

    2010-01-01

    Conclusiones: En nuestro centro, los pacientes con más de 80 años a los que se realizó recambio valvular por estenosis aórtica grave mediante cirugía convencional tuvieron una supervivencia media que iguala prácticamente a la que el INE otorga para la población general de la misma edad. Estos pacientes gozaron a largo plazo de un excelente grado funcional.

  15. Reversão de amaurose por neuropatia óptica em orbitopatia de Graves após descompressão orbitária: relato de caso Reversal of blindness due to Graves' optic neuropathy after orbital decompression: case report

    Directory of Open Access Journals (Sweden)

    Valmor Rios Leme

    2003-12-01

    Full Text Available OBJETIVO: Descrever o caso de uma paciente portadora de orbitopatia de Graves com baixa visual no olho esquerdo há 9 meses e amaurose no direito há 20 dias secundária à neuropatia óptica. MÉTODOS: Foi realizada descompressão orbitária bilateral ínfero-medial por via transconjuntival. RESULTADOS: Após a cirurgia a paciente evoluiu lentamente com melhora progressiva da acuidade visual, obtendo 20/20 em ambos os olhos ao cabo de 10 meses. CONCLUSÕES: A descompressão orbitária é eficaz em restabelecer a visão em casos de amaurose por neuropatia óptica da orbitopatia de Graves com até 20 dias de instalação.PURPOSE: To describe a patient with Graves' orbitopathy who presented with loss of vision of the left eye for 9 months and amaurosis of the right eye for 20 days. METHODS: Bilateral inferomedial transnconjunctival orbital decompression was performed. RESULTS: After orbital decompression, vision slowly improved and ten months after the surgery the vision was normal in both eyes. CONCLUSIONS: Orbital decompression can reestablish optic nerve function at least 20 days after amaurosis.

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

    Directory of Open Access Journals (Sweden)

    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. MEDIDAS DE EXPOSICIÓN A LA MOVILIDAD EN LAS LESIONES GRAVES POR TRÁFICO EN LA COMUNIDAD DE MADRID

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    Luis Velázquez Buendía

    2015-01-01

    Full Text Available Fundamentos: La búsqueda de indicadores apropiados para estimar el riesgo de lesiones por tráfico es actualmente un área de interés relevante. El objetivo de este estudio fue realizar una descripción de la morbilidad hospitalaria y la mortalidad por lesiones por tráfico en la Comunidad de Madrid, según edad y sexo, utilizando y comparando entre sí tasas por población, por personas-km y por personas-horas. Métodos: Estudio descriptivo transversal en la Comunidad de Madrid referido al período 2003-2005. Se estimaron y compararon por edad y sexo tasas de morbilidad y mortalidad por población, por personas-km recorridos y por personas-horas de desplazamiento. Se utilizaron como fuentes de información el Conjunto Mínimo Básico de Datos Hospitalarios de 2003-2005, la Encuesta Domiciliaria de Movilidad de 2004 en la Comunidad de Madrid y el registro de mortalidad del Instituto de Estadística de la Comunidad de Madrid. Resultados: Se identificaron 7.413 altas hospitalarias y 1.046 defunciones. Las tasas poblacionales de morbilidad hospitalaria y mortalidad fueron de 62,24 y 9,20/100.000 habitantes respectivamente en hombres, y de 23,80 y 2,97/100.000 en mujeres, siendo las más elevadas en varones de 16-24 años (119,27 altas y 12,00 fallecidos por 100.000 habitantes. Las tasas por exposición más altas correspondieron a mujeres de 65 y más años: 649,78 altas y 96,72 fallecidas por 109 km, y 13,11 altas y 1,95 fallecidas por 106 horas de desplazamiento. Conclusiones: La morbi-mortalidad fue mayor en hombres en todos los indicadores. Los indicadores basados en la exposición a la movilidad, frente a las tasas poblacionales, reducen la morbi-mortalidad de lesiones por tráfico en hombres y en edades jóvenes y aumentan la misma en edades avanzadas.

  18. Infecções urinárias causadas por Trichosporon spp. em pacientes graves internados em unidade de terapia intensiva

    Directory of Open Access Journals (Sweden)

    Maria das Graças Silva Mattede

    2015-09-01

    Full Text Available RESUMOObjetivo:Avaliar a incidência de infecções do trato urinário por Trichosporon spp. em uma unidade de terapia intensiva.Métodos:Estudo descritivo observacional realizado em uma unidade de terapia intensiva no período de 2007 a 2009. Foram analisados todos os pacientes consecutivos que internaram na unidade de terapia intensiva e tiveram o diagnóstico confirmado.Resultados:Vinte pacientes apresentaram infecções do trato urinário por Trichosporon spp. A prevalência foi maior no sexo masculino (65% e na faixa etária superior a 70 anos (55%. A mortalidade foi de 20%. A média de permanência na unidade de terapia intensiva foi de 19,8 dias. Seu aparecimento esteve relacionado ao uso pregresso de antibióticos e foi mais frequente no período que compreendeu o outono e o inverno.Conclusão:A infecção por Trichosporon spp. predominou no sexo masculino, de idade acima de 70 anos, com uso de sonda vesical de demora por mais de 20 dias e com uso de antibióticos de amplo espectro acima de 14 dias. Os pacientes que apresentaram a infecção urinária por Trichosporon spp. ficaram internados nos setores de terapia intensiva, com maior frequência, no período de outono e inverno.

  19. Genetics Home Reference: Graves disease

    Science.gov (United States)

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

  20. Estudio experimental anatómico y clínico de la tenosinovitis de los tendones flexores de la mano en la polea proximal

    OpenAIRE

    Brotat Rodríguez, María

    2016-01-01

    La tenosinovitis estenosante de los flexores de los dedos es uno de los motivos más frecuentes de consulta en los especialistas de cirugía de la mano. Aunque la técnica convencional es efectiva, las complicaciones observadas han hecho que, en los últimos años, la técnica percutánea haya cobrado importancia. Sin embargo, la estrecha relación que mantienen el primer, segundo y quinto dedo con las estructuras neurovasculares adyacentes ha promovido la búsqueda de referencias anatómicas y ecográf...

  1. Tenosinovitis flexora piógena de la mano: hallazgos ecográficos Pyogenic flexor tenosynovitis of the hand: sonographic findings

    OpenAIRE

    Rodríguez, A; F. J. Pérez-Fontán; Fernández, P.; Álvarez, A.; Midón, J.; Martelo, F.

    2007-01-01

    Los autores describen los hallazgos ecográficos en tres pacientes con tenosinovitis flexora piógena (TFP) de la mano. Los hallazgos patológicos encontrados en el Eco-Doppler Color fueron un halo hipoecogénico peritendinoso y una hipervascularización de la vaina sinovial. La Ecografía es un procedimiento no invasivo que permite diagnosticar de manera eficiente y precoz la TFP y permite además realizar un estadiaje preoperatorio siendo una guía útil para planificar la cirugía en función de la c...

  2. Aplicación clínica de la técnica percutánea en la tenosinovitis estenosante de los flexores de la mano

    OpenAIRE

    Brotat, M.; Simón Pérez, C.; García Medrano, B.; García Flórez, L.; Martín Ferrero, Miguel Ángel; M.F. Muñoz Moreno

    2014-01-01

    Producción Científica La tenosinovitis estenosante de los flexores de la mano es una patología que conduce al bloqueo de la polea de flexión proximal del dedo. Aunque el tratamiento inicial es conservador, si éste no es efectivo, está indicado el tratamiento quirúrgico mediante liberación abierta o percutánea. Material y método: Estudio descriptivo retrospectivo de 116 pacientes intervenidos de dedo en resorte en el HCUV (enero 2005- diciembre 2007), seguimiento medio 36 meses. Análisis...

  3. Reação cutânea grave induzida por carbamazepina no tratamento da neuralgia pós-herpética: relato de caso Reacción cutánea grave inducida por la carbamazepina en el tratamiento de la neuralgia postherpética: relato de caso Severe carbamazepine-induced cutaneous reaction in the treatment of post-herpetic neuralgia: case report

    Directory of Open Access Journals (Sweden)

    João Batista Santos Garcia

    2010-08-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O herpes zoster tem como principal complicação a neuralgia pós-herpética (NPH. Utiliza-se para o tratamento a carbamazepina (CXB, um anticonvulsivante bem tolerado, porém frequentemente associado a reações Cutâneas graves, como, por exemplo, a síndrome de Stevens-Johnson (SSJ e a necrólise epidérmica tóxica (NET. O objetivo deste trabalho é relatar um caso de SSJ/NET secundário ao uso de CBZ em paciente com NPH. RELATO DO CASO: Paciente do sexo feminino, com dor contínua em região torácica e dorso, intensa, em queimação, fisgada, choque, alteração de força de membro superior ipsilateral e sudorese. Apresentava lesões crostosas e eritematosas em região dorsal do tórax, com alodinia e disestesias em dermátomo acometido. Iniciou-se CBZ 300 mg.dia-1, amitriptilina (AMT 12,5 mg à noite e infiltração com anestésico local na região afetada. Após 15 dias, referia mal-estar, febre, dores musculares e artralgias com rash cutâneo leve e inespecífico. Retirou-se a carbamazepina imediatamente. Uma semana depois, foi internada com urticária e exantema generalizados, erupções Cutâneas eritematosas, bolhosas e máculas purpúricas por todo o corpo. A impressão era de SSJ/NET induzida por carbamazepina. Houve progressiva piora do quadro, com aumento do número e do tamanho das lesões Cutâneas, além de rash eritematoso macular generalizado, áreas de necrose e erosões, com destacamento simétrico da epiderme em face, pescoço, tórax, dorso e membros acometendo mais de 50% da área de superfície, além de envolvimento da mucosa bucal, conjuntival e genital com erosões vesiculares. Apresentou piora funcional progressiva, evoluindo com choque séptico e falência múltipla de órgãos, indo a óbito. CONCLUSÕES: A SSJ/NET é uma reação Cutânea grave com potencial para morbidade e mortalidade elevadas e que demanda intervenção rápida e tratamento adequado. Fica também o alerta para o uso

  4. Højfolkets Grave

    DEFF Research Database (Denmark)

    2007-01-01

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

  5. Pertussis with severe pulmonary hypertension in a newborn with good outcome - case report Infecção por Bordetella pertussis com hipertensão pulmonar grave num recém -nascido com boa evolução clínica - Caso clínico

    Directory of Open Access Journals (Sweden)

    Sérgia Soares

    2008-10-01

    Full Text Available In spite of the availability and widespread use of vaccines, pertussis is far from controlled. Newborns and infants too young to be fully vaccinated, born from mothers with low antibody titers to Bordetella pertussis, are highly susceptible to infection and at risk of severe disease and death. Pertussis associated with pulmonary hypertension in the newborn is often fatal. The authors report a clinical case of severe pertussis-induced respiratory failure associated to severe pulmonary hypertension in a neonate successfully treated with sildenafil and inhaled nitric oxide.Apesar da ampla cobertura vacinal, a infecção por Bordetella pertussis está longe de estar controlada. Os recém -nascidos e lactentes ainda sem imunização completa e filhos de mães com baixos títulos de anticorpos para a Bordetella pertussis são altamente susceptíveis à infecção e têm maior risco de doença grave e morte. A infecção por Bordetella pertussis associada a hipertensão pulmonar no recém -nascido é frequentemente fatal. Os autores descrevem um caso clínico de doença grave num recém -nascido com insuficiência respiratória aguda e hipertensão pulmonar grave, tratado com sucesso com sildenafil e óxido nítrico inalado.

  6. Enfermedad respiratoria grave en terapia intensiva durante la pandemia por el virus de influenza A (H1N1 2009 Severe respiratory disease in an intensive care unit during influenza A(H1N12009 pandemia

    Directory of Open Access Journals (Sweden)

    José Aquino-Esperanza

    2010-10-01

    Full Text Available Se describen pacientes hospitalizados en una unidad de terapia intensiva por enfermedad respiratoria aguda grave con características de influenza durante los primeros meses de la pandemia por influenza A(H1N1 2009 en la Argentina. Evaluamos datos clínicos, scores de gravedad, pruebas de laboratorio, microbiología y radiología torácica al ingreso, evolución y mortalidad hospitalaria, comparando pacientes con y sin confirmación de H1N1 por test de reacción de polimerasa en cadena, transcriptasa reversa (RT-PCR. Entre junio y julio de 2009 se internaron 31 pacientes adultos con una mediana de edad de 54 años (percentilo 25-75: 33-66. Presentaron test positivo para H1N1, 17 pacientes. Tenían al menos una condición concurrente 16 pacientes. La expresión radiográfica más frecuente fue infiltrados intersticio-alveolares bilaterales en 20 casos; 5 tenían consolidación lobar unilateral. La coinfección bacteriana (aislamiento de bacterias o IgM positiva para infecciones bacterianas, se demostró en 21 pacientes. Requirieron ventilación mecánica 23 pacientes y 18 desarrollaron síndrome de distrés respiratorio agudo (SDRA. La linfopenia y elevación de creatinina-fosfoquinasa fue frecuente (83% y 65%, respectivamente. Los 6 pacientes que murieron (19% eran mayores de 75 años o tenían cáncer o inmunodepresión. El tratamiento antiviral temprano (≤ 48 horas se asoció a menor necesidad de ventilación mecánica (54% vs. 89%; p: 0.043. No hubo diferencia significativa en las variables analizadas entre el grupo H1N1 positivo y el negativo, lo que sugiere tener igual enfoque terapéutico frente a una epidemia. La infección por H1N1 determinó falla respiratoria aguda y SDRA. La mortalidad ocurrió en pacientes añosos o con co-morbilidades graves.We describe characteristics of patients admitted to our intensive care unit with severe acute respiratory illness and influenza-like syndrome during the first months of the pandemic influenza

  7. Sinovitis aséptica erosiva por cuerpo extraño

    OpenAIRE

    José Félix Restrepo; Renato Guzmán; Antonio Iglesias

    2014-01-01

    La introducción de cuerpos extraños en las articulaciones, vainas tendinosas o tejidos periarticulares puede ocasionar monoartritis, tenosinovitis o dactilitis séptica o aséptica. Se presenta el caso de un hombre de 41 años en quien accidentalmente penetró una espina de arbusto a nivel de la segunda articulación interfalángica proximal derecha y originó una sinovitis aséptica erosiva. Es el primer caso de sinovitis por cuerpo extraño informado en Colombia.

  8. Graves orbitopathy: a perspective.

    Science.gov (United States)

    Perros, Petros; Krassas, Gerasimos E

    2009-06-01

    Advances in the past few years have helped clinicians understand some of the pathogenetic mechanisms of Graves orbitopathy (GO), particularly the role of receptors for TSH and insulin-like growth factor I in the orbit. Optimal treatment strategies have been formulated and published by the European Group on Graves' Orbitopathy, which are hoped to improve the management of patients with this condition. The administration of intravenous pulses of steroids has been established as a superior treatment approach compared with other steroid regimens. In addition, orbital radiotherapy was effective in a subgroup of patients with GO who had eye dysmotility. The use of immunotherapies for the treatment of GO is currently being explored; of these, rituximab has emerged as a promising new agent.

  9. Intoxicação grave por paraquat: achados clínicos e radiológicos em um sobrevivente Severe paraquat poisoning: clinical and radiological findings in a survivor

    Directory of Open Access Journals (Sweden)

    Fábio Fernandes Neves

    2010-08-01

    Full Text Available O paraquat é um herbicida não seletivo que possui grande importância toxicológica, sendo associado a altas taxas de letalidade, devidas principalmente à insuficiência respiratória. Este é o relato do caso de um homem de 22 anos admitido no departamento de emergência com queixa de dor de garganta, disfagia, hemoptise e dor retroesternal. Ele relatava a ingestão de cerca de 50 mL de uma solução de paraquat quatro dias antes da admissão hospitalar. A TC de tórax exibia opacidades pulmonares, pneumomediastino, pneumotórax e enfisema subcutâneo. O paciente foi submetido a dois ciclos de terapia imunossupressora com ciclofosfamida, metilprednisolona e dexametasona. Os parâmetros gasométricos progressivamente melhoraram, e o paciente recebeu alta hospitalar após quatro semanas. Decorridos quatro meses da alta, o paciente foi submetido a controles clínico e tomográfico, os quais confirmaram a melhora clínica. Apresentamos também uma revisão sucinta da literatura, bem como uma discussão do processo de decisão terapêutica para intoxicação grave por paraquat.Paraquat is a nonselective contact herbicide of great toxicological importance, being associated with high mortality rates, mainly due to respiratory failure. We report the case of a 22-year-old male admitted to the emergency room with a sore throat, dysphagia, hemoptysis, and retrosternal pain after the ingestion of 50 mL of a paraquat solution, four days prior to admission. Chest CT scans revealed pulmonary opacities, pneumomediastinum, pneumothorax, and subcutaneous emphysema. The patient was submitted to two cycles of immunosuppressive therapy with cyclophosphamide, methylprednisolone, and dexamethasone. The pulmonary gas exchange parameters gradually improved, and the patient was discharged four weeks later. The clinical and tomographic follow-up evaluations performed at four months after discharge showed that there had been further clinical improvement. We also

  10. Actualización en el tratamiento del síndrome urémico hemolítico endémico: Patogénesis y tratamiento de la complicación sistémica más grave de las infecciones por Escherichia coli productor de toxina Shiga

    OpenAIRE

    Fernández-Brando, Romina J.; Leticia V. Bentancor; Maria Pilar Mejías; Analía C. Panek; Gabriel G. Cabrera; Ramón A. Exeni; Palermo, Marina S.

    2011-01-01

    La forma típica o post-diarreica del síndrome urémico hemolítico (SUH) es la complicación más grave de las infecciones por cepas de Escherichia coli productoras de toxina Shiga (STEC). En la Argentina el SUH es un problema crítico de salud pública, ya que representa la principal causa de falla renal aguda en la infancia, la segunda causa de falla renal crónica, y aporta el 20% de los casos de transplante renal durante la infancia y la adolescencia. A pesar de los avances en el conocimiento de...

  11. Aes grave iz Jesenica

    OpenAIRE

    Bonačić Mandinić, Maja

    2009-01-01

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

  12. Epidemiology of Graves' orbitopathy.

    Science.gov (United States)

    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.

  13. Resultados do tratamento da pancreatite aguda grave

    Directory of Open Access Journals (Sweden)

    Franz Robert Apodaca-Torrez

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

  14. Emerging comorbidities in Graves' disease patients treated with radioiodine with more than 10 years of follow-up; Avaliacao do surgimento de comorbidades em pacientes com doenca de Graves tratados com iodo radioativo em acompanhamento por mais de 10 anos

    Energy Technology Data Exchange (ETDEWEB)

    Azevedo, Fernanda Vieira Ramalho de; Blotta, Francisco Gomes da Silva; Goirgetta, Juliana Malheiros; Vaisman, Mario [Universidade Federal do Rio de Janeiro (HUCFF/UFRJ), RJ (Brazil). Hospital Universitario Clementino Fraga Filho. Faculdade de Medicina. Servico de Endocrinologia; Noe, Rosangela [Universidade Federal do Rio de Janeiro (HUCFF/UFRJ), RJ (Brazil). Bioestatistica da Divisao de Pesquisa

    2013-05-01

    Objectives: To evaluate the occurrence of cardiovascular disease and malignant tumors and the mortality rate in patients who received radioiodine treatment for hyperthyroidism due to Graves' disease with at least ten years of follow-up. Materials and methods: The medical records of all patients who were treated with I{sup 131} for Graves' disease at Hospital Universitario Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, were reviewed retrospectively, between January, 1981 and November, 1999. Results: Data from 107 patients (14 men and 93 women), with median age of 54 years were analyzed. Comparing the group of patients who were treated with I{sup 131} therapy with a group of euthyroid patients post-treatment with antithyroid drugs, a significant increase in the occurrence of hypertension and dyslipidemia was observed, but not in mortality rate. Conclusion: To evaluate the real influence of the treatment with radioactive iodine in the occurrence of these comorbidities and the mortality rate, we need a longer follow-up. The age and time of exposure to the effects of hyperthyroidism seem to influence the occurrence of these comorbidities. (author)

  15. Animal models of Graves' disease and Graves' orbitopathy.

    Science.gov (United States)

    Nagayama, Yuji; Nakahara, Mami; Abiru, Norio

    2015-10-01

    The purpose of this article is to summarize the recent advances on experimental Graves' hyperthyroidism and orbitopathy as studied in two widely used mouse models, which involve repetitive genetic vaccinations using either adenovirus or in-vivo electroporation of the eukaryotic expression plasmid expressing the thyrotropin receptor (TSHR) as a vector. The models have been improved by using different types of antigens, including the holo receptor, the receptor A-subunit, an alternatively spliced form of variant receptor lacking a single leucine-rich repeat in the codomain, the receptors of human or mouse origin; different mice such as wild-type, TSHR knockout, TSHR transgenic and different inbred mice; and different immunization protocols. They are now useful for elucidating the pathogenic mechanisms of not only Graves' hyperthyroidism but also Graves' orbitopathy. This review summarizes the literature of mouse models of Graves' hyperthyroidism and orbitopathy published over the last 3 years.

  16. Immunosuppressive treatment of Graves' ophthalmopathy

    NARCIS (Netherlands)

    Wiersinga, W. M.

    1992-01-01

    Glucocorticoids and retrobulbar irradiation are the most employed immunosuppressive treatment modalities in Graves' ophthalmopathy. The response rate is approximately 60%. Efficacy is good for improvement of appearance and visual acuity, moderate for correction of extraocular muscle dysfunction, and

  17. Endothelial dysfunction in Graves' disease

    National Research Council Canada - National Science Library

    Popławska-Kita, A; Szelachowska, M; Modzelewska, A; Siewko, K; Dzięcioł, J; Klimiuk, P A; Górska, M

    2013-01-01

    Graves' disease (GD) is an organ-specific autoimmune thyroid disease, characterized by hyperthyroidism due to excessive production of thyroid hormone induced by thyrotropin receptor-specific stimulatory autoantibodies...

  18. From Field Grave to Comrades' Grave. The German First World War Graves on the Flanders Front

    Directory of Open Access Journals (Sweden)

    Vancoillie, Jan

    2017-07-01

    Full Text Available In the beginning of World War I, most of the fallen soldiers were buried in field graves, but as it became clear that maintaining those would not be possible, larger war cemeteries were created. During the war, the field graves were concentrated into new cemeteries which were more and more standardized. The fighting in 1917-1918 destroyed many cemeteries. After the armistice, the maintenance of German cemeteries was minimal, even if Belgium had to take care of them according to the Treaty of Versailles. In 1926 Germany took over the care for their graves after an agreement with Belgium, and until 1940 graves were concentrated in redesigned concentration cemeteries. After the Second World War, the Volksbund Deutsche Kriegsgräberfürsorge was given the task of maintaining the cemeteries. The number of World War I cemeteries was reduced further to four remaining cemeteries in West Flanders.

  19. Tenosinovitis flexora piógena de la mano: hallazgos ecográficos Pyogenic flexor tenosynovitis of the hand: sonographic findings

    Directory of Open Access Journals (Sweden)

    A. Rodríguez

    2007-09-01

    Full Text Available Los autores describen los hallazgos ecográficos en tres pacientes con tenosinovitis flexora piógena (TFP de la mano. Los hallazgos patológicos encontrados en el Eco-Doppler Color fueron un halo hipoecogénico peritendinoso y una hipervascularización de la vaina sinovial. La Ecografía es un procedimiento no invasivo que permite diagnosticar de manera eficiente y precoz la TFP y permite además realizar un estadiaje preoperatorio siendo una guía útil para planificar la cirugía en función de la cantidad y localización de la colección purulenta y de la integridad tendinosa.The authours describe the sonographic findings in three cases of pyogenic flexor tenosynovitis of the hand. Hipoechogenic peritendinous area and hipervascularization of the synovial sheath revealed as the pathologic findings. In Color Doppler US Ultrasound is a non-invasive procedure that allows to make an accurate and early diagnosis of pyogenic flexor tenosynovitis, it is an useful guide for planning surgery taking account the amount and localization of the purulence and the integrity of the tendons.

  20. Clinical presentation of Graves' ophthalmopathy

    NARCIS (Netherlands)

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

    1989-01-01

    The eye findings of Graves' ophthalmopathy were prospectively recorded in 90 consecutive untreated patients (66 females, 24 males; mean age 44.5 years) according to the 1977 NOSPECS classification. Soft-tissue involvement was observed in 90%, proptosis greater than or equal to 23 mm in 30%, eye

  1. Biologiske behandlingsmuligheder ved Graves' oftalmopati

    DEFF Research Database (Denmark)

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

    2008-01-01

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

  2. Optimal management of Graves orbitopathy: a multidisciplinary approach

    NARCIS (Netherlands)

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

    2011-01-01

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

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

    NARCIS (Netherlands)

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

    1988-01-01

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

  4. Actualización en el tratamiento del síndrome urémico hemolítico endémico: Patogénesis y tratamiento de la complicación sistémica más grave de las infecciones por Escherichia coli productor de toxina Shiga

    Directory of Open Access Journals (Sweden)

    Romina J. Fernández-Brando

    2011-08-01

    Full Text Available La forma típica o post-diarreica del síndrome urémico hemolítico (SUH es la complicación más grave de las infecciones por cepas de Escherichia coli productoras de toxina Shiga (STEC. En la Argentina el SUH es un problema crítico de salud pública, ya que representa la principal causa de falla renal aguda en la infancia, la segunda causa de falla renal crónica, y aporta el 20% de los casos de transplante renal durante la infancia y la adolescencia. A pesar de los avances en el conocimiento de su patogénesis, el único tratamiento actual de los pacientes con SUH es de sostén, y no existen terapias específicas ni preventivas. En la presente revisión expondremos los conocimientos básicos de los mecanismos patogénicos y discutiremos los enfoques terapéuticos tradicionales e innovadores, con especial foco en la situación nacional y los aportes hechos por grupos de la Argentina.

  5. Asociación del trastorno por deficit de atención con hiperactividad e impulsividad (TDAH) con accidentes graves frecuentes o unicos en el servicio de urgencias del hospital infantil de Morelia

    OpenAIRE

    García Zamora, Ivonne

    2011-01-01

    El transtorno por déficit de atención hiperactivad e impulsividad es uno de los trastornos neuroconductuales más frecuentes, empieza en la niñez temprana y puede continuar a la edad adulta, la mayoría de los casos de TDAH se diagnostican en los primeros años escolares llámese preescolar o primaria.

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

    Science.gov (United States)

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

    2015-11-25

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

  7. Efeito da hipertermia na pancreatite aguda grave experimental

    Directory of Open Access Journals (Sweden)

    Maurício Gustavo Ieri Yamanari

    Full Text Available OBJETIVO: O objetivo deste estudo é avaliar os efeitos da hipertermia na pancreatite aguda (PA grave experimental induzida por ácido taurocólico. MÉTODO: A PA grave foi induzida pela injeção retrógrada de ácido taurocólico a 2,5% ou 5% no ducto pancreático principal. Após a indução, os animais foram colocados numa gaiola contendo duas lâmpadas de 100 W. A temperatura corporal foi aumentada para 39,5ºC e mantida neste nível por 45 minutos. Foram estudados taxa de mortalidade em 72 horas, permeabilidade vascular no pâncreas, porcentagem de água no tecido pancreático, amilase sérica, histologia (edema, necrose acinar e infiltrado inflamatório e níveis séricos de IL-6 e IL-10. RESULTADOS: Não houve alteração em nenhum dos parâmetros avaliados. CONCLUSÃO: Não há benefício da hipertermia na PA grave experimental induzida por ácido taurocólico.

  8. 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.

  9. Biologiske behandlingsmuligheder ved Graves' oftalmopati

    DEFF Research Database (Denmark)

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

    2008-01-01

    The current medical treatment options for Graves' ophthalmopathy (GO) are unsatisfactory. Recent treatment of GO patients with the B-lymphocyte depleting monoclonal antibody rituximab or with the anti-tumor necrosis factor-alpha agents etanercept and infliximab has shown promising results. We...... discuss the use of these and other biological agents targeting B lymphocytes, T-lymphocyte interaction with antigen-presenting cells, or cytokines in the future treatment of GO....

  10. 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

  11. Valoración de la disminución del dolor y recuperación de la fuerza muscular en pacientes de 30 a 60 años con enfermedad de quervain, intervenidos por microcirugía en el servicio de ortopedia y traumatología del Hospital de Especialidades de las Fuerzas Armadas N° 1 Quito. 2010 - 2014

    OpenAIRE

    García Piloso, Jaime Leiberth; Urquía Lagla, Cinthia Johanna

    2014-01-01

    Contexto: La tenosinovitis de Quervain tiene una incidencia de aproximadamente 0,94 a 6.3 por 1000 personas al año. La liberación quirúrgica con técnica de microcirugía es el método de tratamiento de primera línea, ya que el paciente puede regresar a su vida diaria sin molestias, realizando actividades comunes en su trabajo y hogar. Objetivo. Valorar los resultados clínico funcionales postquirúrgicos mediante escala de DASH y EVA. Diseño.Epidemiológico analítico transversal tipo cuantitati...

  12. Tremelimumab-Induced Graves Hyperthyroidism.

    Science.gov (United States)

    Gan, Earn H; Mitchell, Anna L; Plummer, Ruth; Pearce, Simon; Perros, Petros

    2017-07-01

    Tremelimumab and ipilimumab are monoclonal antibodies directed against the extracellular domain of cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) and have been used as immunotherapies against immune checkpoints that suppress T-cell activation. Anti-CTLA-4 antibody-based therapies have been shown to be effective in treating various cancers including metastatic melanoma. However, a few immune-related adverse events including hypophysitis and thyroid disorder have been reported, mostly developed within the first year of receiving treatment. We report a case of tremelimumab-induced Graves hyperthyroidism in a 55-year-old man who was diagnosed with metastatic melanoma after 8 years of tremelimumab therapy. He had no personal or family history of thyroid or autoimmune diseases. His biochemical profile was in keeping with Graves disease, with raised serum free thyroid hormones, suppressed thyroid-stimulating hormone concentration, and raised thyrotropin receptor antibody level. He was treated with carbimazole as part of the block and replace therapy, without complications. Tremelimumab therapy was temporarily discontinued and recommenced when he was rendered biochemically euthyroid. There has been no further relapse of Graves hyperthyroidism since the discontinuation of block and replace therapy. The mechanistic profile of anti-CTLA-4-induced thyroid dysfunction and the long-term endocrine safety of this therapeutic approach remain unclear. It is important to monitor thyroid functions in patients receiving anti-CTLA-4 therapies, as their effects on endocrine systems could be more latent or prolonged than the data from current clinical trials suggest. Antithyroid drug therapy was safe and effective alongside anti-CTLA-4 therapy without compromising antitumour treatment efficacy.

  13. [Novel treatment opportunities in Graves' orbitopathy].

    Science.gov (United States)

    Erdei, Annamária; Gazdag, Annamária; Bodor, Miklós; Berta, Eszter; Katkó, Mónika; Ujhelyi, Bernadett; Steiber, Zita; Győry, Ferenc; Urbancsek, Hilda; Barna, Sándor; Galuska, László; Nagy, V Endre

    2014-08-17

    Graves' orbitopathy is the most common extrathyroidal manifestation of Graves' disease. Up to now, curative treatment modalities for the most severe sight-threatening cases have not been developed. Here the authors summarize the treatment protocol of Graves' orbitopathy and review novel therapeutic options. They review the literature on this topic and present their own clinical experience. The authors point out that anti-CD20 antibody could positively influence the clinical course of Graves' orbitopathy. Selenium is efficient in mild cases. Further prospective investigations are warranted.

  14. 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

  15. 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...

  16. Epidemiology and prevention of Graves' ophthalmopathy

    NARCIS (Netherlands)

    Wiersinga, Wilmar M.; Bartalena, Luigi

    2002-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Javier Nieto Guevara

    2008-09-01

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

  18. 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.

  19. Factores de Risco da Asma Grave

    Directory of Open Access Journals (Sweden)

    N. Adel

    1999-07-01

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

  20. Mass Graves, Landscapes of Terror

    Directory of Open Access Journals (Sweden)

    Ferrándiz, Francisco

    2009-06-01

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

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

  1. [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.

  2. Resolution of Graves' disease after renal transplantation.

    Science.gov (United States)

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

    2016-06-01

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

  3. Thyroidectomy for Graves' disease in children: Indications and complications.

    Science.gov (United States)

    Elfenbein, Dawn M; Katz, Micah; Schneider, David F; Chen, Herbert; Sippel, Rebecca S

    2016-10-01

    The utilization of thyroidectomy for Graves' disease remains controversial; we aim to evaluate the indications for and complications of thyroidectomy for Graves' in children. A retrospective analysis was performed on all Graves' patients who underwent thyroidectomy from 2009 to 2013 at a high volume academic center. Pediatric patients were Graves'. Copyright © 2016 Elsevier Inc. All rights reserved.

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

    OpenAIRE

    de las Heras Vives, Luis

    2015-01-01

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

  5. Eficacia de un programa psicoeducativo para el empoderamiento de personas con trastorno mental grave (TMG)

    OpenAIRE

    González Fajardo, Ana Maravillas

    2015-01-01

    Treball final de Màster Universitari en Rehabilitació Psicosocial en Salut Mental Comunitària. Codi: SAX014. Curs acadèmic 2014-2015 Introducción: El Trastorno Mental Grave, es un problema de primera magnitud, por el impacto que produce, en las personas, sus familias, la sociedad y el sistema sanitario. Con este proyecto se quiere ofrecer a los usuarios y a las familias, una herramienta para informar sobre empoderamiento en personas con Trastorno Mental Grave, mediante un progr...

  6. 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.

  7. 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.

  8. ¿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.

  9. [Neonatal hyperthyroidism and maternal Graves disease].

    Science.gov (United States)

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

    2015-04-01

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

  10. O mosaico patogênico da pancreatite aguda grave

    Directory of Open Access Journals (Sweden)

    Márcio Cavalcante Carneiro

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

  11. La enfermedad grave, una oportunidad Serious illness as oportunity

    Directory of Open Access Journals (Sweden)

    Óscar Alberto Beltrán Salazar

    2008-03-01

    Full Text Available Objetivo: describir el significado que tiene para los pacientes gravemente enfermos la experiencia de estar hospitalizado en una Unidad de Cuidado Intensivo. Metodología: trabajo de investigación, con enfoque fenomenológico que incluyó a nueve adultos entre 24 y 80 años de edad que estuvieron críticamente enfermos y hospitalizados en una unidad de cuidado intensivo. La entrevista en profundidad fue la técnica de recolección de la información. El análisis de los datos se realizó según el esquema propuesto por Cohen, Kahan y Steeves. El estudio se llevó a cabo en la ciudad de Medellín, Colombia entre los meses de abril y octubre de 2006. Resultados: la enfermedad grave es una experiencia en la que hay que luchar para salir, lo que permite dejar la Unidad de Cuidado Intensivo, volver al hogar y recuperar la libertad para decidir. De esta experiencia los pacientes obtienen aprendizaje, en las esferas personal, profesional y familiar. Discusión: padecer una enfermedad grave significó una situación de la que hay que "salir" y una forma de aprendizaje y crecimiento para las personas que viven la experiencia de la enfermedad y para sus familias. Conclusión: padecer una enfermedad grave, a la vez que significa enfrentar el sufrimiento, también significa un motivo para tomar decisiones respecto de la vida futura.Objective: to describe the meaning for gravely ill patients of the hospital experience in an Intensive Care Unit. Methodology: research study with phenomenological focus including nine mature people among 24 and 80 years of age who were critically ill and were hospitalized in an Intensive Care Unit. The in depth interview was the technique for gathering the information. The analysis of data was carried according to the outline proposed by Cohen, Kahan and Steeves. The study was carried in Medellín, Colombia from April to October, 2006. Results: a serious illness is an experience in which it is necessary " struggle" to leave the

  12. Preeclampsia grave: características y consecuencias

    Directory of Open Access Journals (Sweden)

    Arturo Pérez de Villa Amil Álvarez

    2015-07-01

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

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

    NARCIS (Netherlands)

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

    2008-01-01

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

  14. Smoking and risk of Graves' disease

    NARCIS (Netherlands)

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

    1993-01-01

    To assess if smoking is associated with Graves' disease and, if so, to ascertain whether this association persists when controlling for confounding factors. Consecutive entry case-control study with two age- and sex-matched control subjects from two different populations per case patient. University

  15. Sjiele sacrifices, Odin treasures and Saami graves?

    Directory of Open Access Journals (Sweden)

    Inger Zachrisson

    1987-01-01

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

  16. The microclimate within a Neolithic passage grave

    DEFF Research Database (Denmark)

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

    2017-01-01

    Microclimate measurements in a Neolithic passage grave in Denmark have shown that natural ventilation through the open entrance destabilizes the relative humidity (RH), whereas a sealed entrance gives a much more stable RH, above 90%. Episodes of condensation occur on the stone surfaces in summer...

  17. Finding the Heartbeat: Applying Donald Graves's Approaches and Theories

    Science.gov (United States)

    Koshewa, Allen

    2011-01-01

    Donald Graves's early professional books inspired Koshewa to look more deeply into student writing during the 1980s, and to value all phases of the writing process. Graves's perspective on uncovering and celebrating voice elevated Koshewa's writing instruction to a new plane. In this article, he writes about the impact that Donald Graves's work…

  18. Terapia de resgate com amiodarona em crianças com grave disfunção ventricular esquerda causada por veneno de escorpião Terapia de rescate con amiodarona en niños con severa disfunción ventricular izquierda ocasionada por veneno de escorpión Antiadrenergic rescue therapy with amiodarone in children with severe left ventricular dysfunction secondary to scorpion envenomation

    Directory of Open Access Journals (Sweden)

    Justo J. Santiago

    2010-01-01

    Full Text Available FUNDAMENTO: As crianças picadas por escorpião, pressintam ativação maciça do sistema nervoso simpática com vários graus de disfunção sistólica ventricular esquerda. OBJETIVO: Testar um protocolo de resgate em crianças com grave disfunção ventricular esquerda causada por picada de escorpião. Métodos: Quatro crianças após serem picadas por escorpião foram submetidas a: Encubação endotraqueal e suporte respiratório, eletrocardiograma, radiografia de tórax, ecocardiograma e determinação sérica da norepinefrina e troponina I. As análises foram repetidas após 12, 24 e 48 horas. As seguintes medicações intravenosas foram administradas: dobutamina 4-6 μg/kg/min; amiodarona 3 mg/kg durante duas horas, com dose de manutenção de 5 mg/kg/dia; e furosemida 0,5 mg/kg. Amiodarona, dobutamina e furosemida foram administradas durante as primeiras 48 horas. Bloqueadores beta-adrenérgicos e inibidores da enzima conversora da angiotensina foram administrados até 48 após a internação, uma vez que o estado clínico havia melhorado e a fração de ejeção ventricular esquerda encontrava-se acima de 0,35%. RESULTADOS: Na admissão, a dosagem da norepinefrina foi 1.727,50± 794,96 pg/ml, a de troponina I 24,53 ± 14,09 ng/ml e a fração de ejeção do ventrículo esquerdo foi 0,20 ± 0,056. Após 12 horas, os níveis séricos de norepinefrina e de troponina I diminuíram para a metade dos valores iniciais e a fração de ejeção aumentou para 0,32 ± 0,059. Durante as 24 e 48 horas subseqüentes, a fração de ejeção elevou-se para 0,46 ± 0,045 (pFUNDAMENTO: Los niños con picaduras de escorpión sufren activación masiva del sistema nervioso simpático con varios grados de disfunción sistólica ventricular izquierda. OBJETIVO: Probar un protocolo de rescate en niños con disfunción ventricular severa izquierda ocasionada por picadura de escorpión. MÉTODOS: Cuatro niños tras un escorpión picarlas se sometieron a: incubaci

  19. Actualización en el tratamiento del síndrome urémico hemolítico endémico: Patogénesis y tratamiento de la complicación sistémica más grave de las infecciones por Escherichia coli productor de toxina Shiga Update on the treatment of endemic hemolytic uremic syndrome: Pathogenesis and treatment of the most severe systemic complication of infections by Shiga toxin-producing Escherichia coli

    Directory of Open Access Journals (Sweden)

    Romina J. Fernández-Brando

    2011-08-01

    Full Text Available La forma típica o post-diarreica del síndrome urémico hemolítico (SUH es la complicación más grave de las infecciones por cepas de Escherichia coli productoras de toxina Shiga (STEC. En la Argentina el SUH es un problema crítico de salud pública, ya que representa la principal causa de falla renal aguda en la infancia, la segunda causa de falla renal crónica, y aporta el 20% de los casos de transplante renal durante la infancia y la adolescencia. A pesar de los avances en el conocimiento de su patogénesis, el único tratamiento actual de los pacientes con SUH es de sostén, y no existen terapias específicas ni preventivas. En la presente revisión expondremos los conocimientos básicos de los mecanismos patogénicos y discutiremos los enfoques terapéuticos tradicionales e innovadores, con especial foco en la situación nacional y los aportes hechos por grupos de la Argentina.The typical form of hemolytic uremic syndrome (HUS is the major complication of Shiga toxin-producing Escherichia coli (STEC infections. HUS is a critical health problem in Argentina since it is the main cause of acute renal failure in children and the second cause of chronic renal failure, giving account for 20% of renal transplants in children and adolescents in our country. In spite of the extensive research in the field, the mainstay of treatment for patients with HUS is supportive therapy, and there are no specific therapies preventing or ameliorating the disease course. In this review, we present the current knowledge about pathogenic mechanisms and discuss traditional and innovative therapeutic approaches, with special focus in national status and contributions made by Argentinean groups.

  20. Management of Graves Disease: A Review.

    Science.gov (United States)

    Burch, Henry B; Cooper, David S

    2015-12-15

    Graves disease is the most common cause of persistent hyperthyroidism in adults. Approximately 3% of women and 0.5% of men will develop Graves disease during their lifetime. We searched PubMed and the Cochrane database for English-language studies published from June 2000 through October 5, 2015. Thirteen randomized clinical trials, 5 systematic reviews and meta-analyses, and 52 observational studies were included in this review. Patients with Graves disease may be treated with antithyroid drugs, radioactive iodine (RAI), or surgery (near-total thyroidectomy). The optimal approach depends on patient preference, geography, and clinical factors. A 12- to 18-month course of antithyroid drugs may lead to a remission in approximately 50% of patients but can cause potentially significant (albeit rare) adverse reactions, including agranulocytosis and hepatotoxicity. Adverse reactions typically occur within the first 90 days of therapy. Treating Graves disease with RAI and surgery result in gland destruction or removal, necessitating life-long levothyroxine replacement. Use of RAI has also been associated with the development or worsening of thyroid eye disease in approximately 15% to 20% of patients. Surgery is favored in patients with concomitant suspicious or malignant thyroid nodules, coexisting hyperparathyroidism, and in patients with large goiters or moderate to severe thyroid eye disease who cannot be treated using antithyroid drugs. However, surgery is associated with potential complications such as hypoparathyroidism and vocal cord paralysis in a small proportion of patients. In pregnancy, antithyroid drugs are the primary therapy, but some women with Graves disease opt to receive definitive therapy with RAI or surgery prior to becoming pregnant to avoid potential teratogenic effects of antithyroid drugs during pregnancy. Management of Graves disease includes treatment with antithyroid drugs, RAI, or thyroidectomy. The optimal approach depends on patient

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

    Science.gov (United States)

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

    2014-04-01

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

  2. 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.

  3. 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

  4. 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.

  5. The microclimate within a Neolithic passage grave

    DEFF Research Database (Denmark)

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

    2017-01-01

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

  6. Graves hyperthyroidism and pregnancy: a clinical update.

    Science.gov (United States)

    Patil-Sisodia, Komal; Mestman, Jorge H

    2010-01-01

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

  7. Graves of Criminals in Renaissance Poland

    OpenAIRE

    Pokutta, Dalia; Obtulowicz, Lukasz

    2014-01-01

    In 2013, Mentor Consulting undertook the excavation of late medieval/early modern age cemetery located in central part of Gliwice city, Upper Silesia. The key discovery was a multi-period sequence of human activity on site dated from the Roman Iron Age until 17th century A.D. In the last chronological phases, graves of Renaissance convicts and criminals were recorded with unusual frequency within the cemetery. Particularly interesting were mortuary rituals such as decapitations and dismemberm...

  8. Grave Tending: With Mom at the Cemetery

    Directory of Open Access Journals (Sweden)

    Carolyn Ellis

    2003-05-01

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

  9. Epidemiology and prevention of Graves' ophthalmopathy.

    Science.gov (United States)

    Wiersinga, Wilmar M; Bartalena, Luigi

    2002-10-01

    Graves' ophthalmopathy is clinically relevant in approximately 50% of patients with Graves' disease, severe forms affecting 3%-5% of patients. Two age peaks of incidence are observed in the fifth and seventh decades of life, with slight differences between women and men. The disease is more frequent in women than in men, although the female-to-male ratio is only 1:4 in severe forms of eye disease. The natural history of Graves' ophthalmopathy is incompletely defined, but in many instances, especially in mild forms, the disease may remit or improve spontaneously. The onset of the ophthalmopathy is in most cases concomitant with the onset of hyperthyroidism, but eye disease may precede or follow hyperthyroidism. Cigarette smoking plays an important role in the occurrence of the ophthalmopathy, and is also associated with a higher degree of disease severity and a lower effectiveness of its medical treatment. Primary prevention (i.e., avoidance of the occurrence of the ophthalmopathy) is presently not feasible, but smoking withdrawal in relatives of patients with Graves' disease might be important. In terms of secondary prevention (i.e., avoidance of progression of subclinical eye disease into overt and severe ophthalmopathy) in addition to refraining from smoking, early and accurate control of thyroid dysfunction (both hyperthyroidism and hypothyroidism), as well as early diagnosis and treatment of mild eye disease are important. As to the role that management of hyperthyroidism may play in the course of Graves' ophthalmopathy, while antithyroid drugs and thyroidectomy are not disease-modifying treatments, radioiodine therapy causes a progression of the ophthalmopathy in approximately 15% of patients, especially high-risk patients, who smoke, have severe hyperthyroidism or uncontrolled hypothyroidism, high levels of thyrotropin (TSH)-receptor antibody, or preexisting eye disease. However, the risk of radioiodine-associated progression of the opthalmopathy can be

  10. Time-lapse resistivity surveys over simulated clandestine graves.

    Science.gov (United States)

    Jervis, John R; Pringle, Jamie K; Tuckwell, George W

    2009-11-20

    The aim of this study was to develop a better understanding of how electrical resistivity surveys can be used to locate clandestine graves. Resistivity surveys were conducted regularly over three simulated clandestine graves containing a pig cadaver, no cadaver and a pig cadaver wrapped in tarpaulin, respectively. Additionally, soil and groundwater samples were collected from two more simulated graves outside the survey area. The grave containing a pig cadaver was detectable from a low resistivity anomaly in the survey data. Groundwater data suggest that the resistivity anomaly associated with the surveyed pig grave was caused by a localised increase in groundwater conductivity. Wrapping a cadaver was found to initially change the resistivity response of a grave to a high resistivity anomaly. Resistivity surveys did not detect the disturbed soil in the grave that did not contain a cadaver. Although soil samples showed grave soil to be more porous than undisturbed soil, the lack of response from the grave that did not contain a cadaver suggests that disturbed soil was not responsible for the resistivity anomalies observed in this study. Resistivity surveys successfully detected all graves containing cadavers throughout the study, whilst also showing the potential to eliminate the need for mass excavation in a genuine search.

  11. 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...

  12. 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...

  13. 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.

  14. Ptose palpebral causada por Paquidermoperiostose

    Directory of Open Access Journals (Sweden)

    Patricia Regina de Pinho Tavares

    2014-08-01

    Full Text Available A paquidermoperiostose é uma síndrome caracterizada por acometimento cutâneo e ósseo, e em alguns casos ocorre comprometimento palpebral leve. É uma síndrome rara, idiopática ou hereditária, com provável herança autossômica dominante de penetrância variável. Descreve-se o caso de um paciente com ptose grave por paquidermoperiostose elucidando sua fisiopatologia e conduta cirúrgica aplicada.

  15. Hipoglucemia inducida por carcinoma adrenal

    OpenAIRE

    Jimena Soutelo; Melina Saban; Florencia Borghi Torzillo; Ruben Lutfi; Mariela Leal Reyna

    2013-01-01

    El carcinoma suprarrenal es una neoplasia maligna infrecuente y de mal pronóstico. La presentación clínica más común es originada por la producción hormonal excesiva, mientras que el desarrollo de hipoglucemia sintomática es excepcional. Presentamos el caso de una mujer de 37 años que ingresó al hospital por síntomas de hipoglucemias graves, hipertensión arterial, hipopotasemia y amenorrea secundaria. En el laboratorio se halló hipoglucemia con insulina inhibida y niveles de andrógenos en ran...

  16. Childhood Graves' ophthalmopathy: results of a European questionnaire study

    NARCIS (Netherlands)

    Krassas, G. E.; Segni, M.; Wiersinga, W. M.

    2005-01-01

    Objective: Evaluation of the frequency of Graves' ophthalmopathy (GO) and its management in children and adolescents up to 18 years old with Graves' hyperthyroidism. Study design: This was a questionnaire study (QS) among members of the European Thyroid Association and the European Society for

  17. Familial graves' disease among three black africa families, case ...

    African Journals Online (AJOL)

    In the African setting with improvement in iodine supplementation by iodization of salt and drinking water; Graves disease may become more prominent as the main aetiology of thyrotoxicosis as toxic nodular goitre used to rank side by side in the causation of thyrotoxicosis. A report of Graves disease is being made among ...

  18. [Student abuse and Graves-basedow's disease: about a case].

    Science.gov (United States)

    Ntyonga-Pono, Marie-Pierrette; Nsame, Daniela

    2017-01-01

    Graves-basedow's disease is an autoimmune thyreopathy which represents the most common cause of hyperthyroidism in both adults and children. This disease would be related to a genetic predisposition influenced by environmental triggers, including stress. This study aims to present a case of Graves' disease in children whose unusual trigger would be student abuse, a broad challenge with multiple implications.

  19. Riedel Thyroiditis in a Patient with Graves Disease

    Directory of Open Access Journals (Sweden)

    Doo Young Lee

    2013-06-01

    Full Text Available Riedel's thyroiditis is a rare form of infiltrative and inflammatory disease of the thyroid gland and can be associated with systemic fibrotic processes, Hashimoto thyroiditis and Graves disease. Riedel thyroiditis in combination with Graves disease however, is very rare. A 57-year-old woman with a past medical history significant for Graves disease diagnosed 30 years ago presented with an enlarging neck mass and voice changes. Due to suspicion of malignancy, thyroidectomy was performed. Histopathologic examination revealed Riedel thyroiditis. To our knowledge, the association of Riedel thyroiditis with Graves disease has not yet been reported in our country. Here we report a patient with Riedel thyroiditis evolved from antecedent Graves disease.

  20. Orbital decompression for Graves' orbitopathy in England

    Science.gov (United States)

    Perros, P; Chandler, T; Dayan, C M; Dickinson, A J; Foley, P; Hickey, J; MacEwen, C J; Lazarus, J H; McLaren, J; Rose, G E; Uddin, J M; Vaidya, B

    2012-01-01

    Aims The purpose of this study was to obtain data on orbital decompression procedures performed in England, classed by hospital and locality, to evaluate regional variation in care. Methods Data on orbital decompression taking place in England over a 2-year period between 2007 and 2009 were derived from CHKS Ltd and analysed by the hospital and primary care trust. Results and conclusions In all, 44% of these operations took place in hospitals with an annual workload of 10 or fewer procedures. Analysis of the same data by primary care trust suggests an almost 30-fold variance in the rates of decompression performed per unit population. Expertise available to patients with Graves' orbitopathy and rates of referral for specialist care in England appears to vary significantly by geographic location. These data, along with other outcome measures, will provide a baseline by which progress can be judged. PMID:22157920

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

    NARCIS (Netherlands)

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

    2016-01-01

    Graves' orbitopathy (GO) is the main extrathyroidal manifestation of Graves' disease, though severe forms are rare. Management of GO is often suboptimal, largely because available treatments do not target pathogenic mech anisms of the disease. Treatment should rely on a thorough assessment of the

  2. 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

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

    Science.gov (United States)

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

    2017-12-01

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

  4. 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...

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

    Science.gov (United States)

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

    2013-09-01

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

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

    Science.gov (United States)

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

    2016-03-01

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

  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. Management of Fetal and Neonatal Graves' Disease.

    Science.gov (United States)

    Léger, Juliane

    2017-01-01

    Fetal and neonatal autoimmune hyperthyroidism is a rare, serious but transient disorder. Early diagnosis and treatment are key objectives for an optimal prognosis and the well-being of the child. This review focuses on the management of these patients during the fetal and neonatal periods. We propose a diagnostic algorithm for high-risk pregnancies in mothers with current or past hyperthyroidism related to Graves' disease, involving repeated fetal thyroid gland assessments from 20 weeks of gestation onwards and maternal serum thyroid-stimulating hormone receptor antibody (TRAb) determination, with close monitoring if TRAb levels exceed 2 to 3 times the upper limit of the normal range. In fetuses with goiter, the main clinical issue is determining whether the cause is (1) maternal antithyroid drug (ATD) treatment that is appropriate for achieving normal maternal thyroid function but inappropriate and excessive for the fetus, resulting in hypothyroidism and necessitating a decrease in the ATD dose during pregnancy, or (2) the presence of TRAbs resulting in fetal thyroid stimulation and hyperthyroidism, requiring an increase in the maternal ATD dose. Methimazole/carbimazole treatment should be initiated as soon as possible during the neonatal period, carefully managed and maintained over a period of 1-3 months and then stopped when TRAb is no longer detectable in serum. © 2016 S. Karger AG, Basel.

  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. 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.

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

    NARCIS (Netherlands)

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

    2012-01-01

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

  12. 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.

  13. Thyroid nodules and thyroid cancer in Graves' disease.

    Science.gov (United States)

    Tam, Abbas Ali; Kaya, Cafer; Kılıç, Fevzi Balkan Mehmet; Ersoy, Reyhan; Çakır, Bekir

    2014-12-01

    The frequency of thyroid nodules accompanying Graves' disease and the risk of thyroid cancer in presence of accompanying nodules are controversial. The aim of this study was to evaluate the frequency of thyroid nodules and the risk of thyroid cancer in patients operated because of graves' disease. Five hundred and twenty-six patients in whom thyroidectomy was performed because of Graves' disease between 2006 and 2013 were evaluated retrospectively. Patients who had received radioactive iodine treatment and external irradiation treatment in the neck region and who had had thyroid surgery previously were not included in the study. While accompanying thyroid nodule was present in 177 (33.6%) of 526 Graves' patients, thyroid nodule was absent in 349 (66.4%) patients. Forty-two (8%) patients had thyroid cancer. The rate of thyroid cancer was 5.4% (n = 19) in the Graves' patients who had no nodule, whereas it was 13% (n = 23) in the patients who had nodule. The risk of thyroid cancer increased significantly in presence of nodule (p = 0.003). Three patients had recurrence. No patient had distant metastasis. No patient died during the follow-up period. Especially Graves' patients who have been decided to be followed up should be evaluated carefully during the follow-up in terms of thyroid cancer which may accompany.

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

    Directory of Open Access Journals (Sweden)

    Óscar Alberto Beltrán-Salazar

    2010-01-01

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

  15. Transición a trastorno mental grave y consumo de sustancias en primeros episodios psicóticos

    OpenAIRE

    Neyra del Rosario, Adrián

    2016-01-01

    [ES]Introducción: Pocos estudios han comparado el pronóstico y clínica de las psicosis inducidas y no inducidas. Objetivos: Evaluar la transición a trastorno mental grave en pacientes hospitalizados por un primer episodio de psicosis aguda inducida por sustancias y no inducida, en los 5 años posteriores al debut, y factores sociodemográficos, clínicos y en relación al consumo de sustancias que puedan predecir el cambio diagnóstico...

  16. Prolapso de gordura orbitária e oftalmopatia de Graves Orbital fat prolapse and Graves' ophthalmopathy

    Directory of Open Access Journals (Sweden)

    Kim-Ir-Sen Santos Teixeira

    2009-04-01

    Full Text Available Relatam-se dois casos clínicos de prolapso de gordura orbitária, sendo um associado à oftalmopatia de Graves. Os pacientes apresentavam em comum exame clínico com elevação na região temporal da órbita direita e aumento da gordura intraorbitária na tomografia computadorizada de órbitas. No caso da paciente com oftalmopatia de Graves observou-se também aumento do volume da musculatura orbital no exame de imagem. O trabalho busca incluir a oftalmopatia de Graves, quando nesta ocorre aumento da gordura orbital como diagnóstico diferencial do prolapso de gordura orbitária.We report two cases of orbital fat prolapse. One associated with Graves' ophthalmopathy. Both patients presented similar clinical exams and an increase in intraorbital fat as seen in computerized orbital tomography. The patient with Graves' ophthalmopathy also presented an increased volume in orbital muscles in the tomography. This work seeks to include Graves' ophthalmopathy as differential diagnosys for Orbital fat prolapse.

  17. Comparación de normo e hiperglucemia en sangre como factor pronóstico clínico de mortalidad en trauma craneoencefálico grave al ingreso en el servicio de emergencias del Hospital Eugenio Espejo. Enero 2010 - Diciembre 2011

    OpenAIRE

    Loor Zavala, Lynda Elizabeth; Villegas Terán, Marco Mauricio

    2015-01-01

    El trauma craneoencefálico grave es la principal causa de muerte en adultos jóvenes. En nuestro país según los últimos datos proporcionados por la Organización Mundial de la Salud (OMS 2009), la tasa de mortalidad por trauma en el Ecuador es de 16,9 por cada 100.000 habitantes, siendo en su mayor parte por trauma craneoencefálico grave. La hiperglucemia por estrés forma parte de la respuesta hormono-metabólica adaptativa a la injuria, y se le asocia con un aumento de la mortalidad en pacient...

  18. 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.

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

    Directory of Open Access Journals (Sweden)

    Sun Hwa Kim

    2013-03-01

    Full Text Available Radioactive iodine (RAI therapy has been used as a treatment option for Graves' disease, and it has been widely accepted to be safe. On the other hand, some evidence suggests that RAI therapy is possibly associated with a small increased risk of thyroid cancer. Herein, we report a rare case of anaplastic thyroid carcinoma (ATC associated with Graves' disease, following RAI treatment. A 42-year-old woman had been diagnosed with Graves' disease and although she was treated with an antithyroid drug, she remained in a hyperthyroid state, which led to two RAI treatments. More than 10 years later, the patient revisited our clinic due to hoarseness, dysphagia, and dyspnea, which had lasted for 2 months. Neck computed tomography suggested thyroid carcinoma and a lymph node biopsy showed metastatic papillary carcinoma. The patient underwent total thyroidectomy and was finally diagnosed as having an ATC. It is not clear if the occurrence of ATC reported here was influenced by the RAI therapy or alternatively, it may only represent the delayed recognition of a rare change in the natural history of Graves' disease. Nevertheless, this report is worthwhile since it presents a very rare case of ATC that occurred eleven years after the RAI therapy for Graves' disease.

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

    Science.gov (United States)

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

    2017-09-07

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

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

    Science.gov (United States)

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

    2015-05-21

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

  2. Type 2 diabetic patients with Graves' disease have more frequent and severe Graves' orbitopathy.

    Science.gov (United States)

    Le Moli, R; Muscia, V; Tumminia, A; Frittitta, L; Buscema, M; Palermo, F; Sciacca, L; Squatrito, S; Vigneri, R

    2015-05-01

    Due to the worldwide increasing prevalence of diabetes (DM), patients with both diabetes and Graves' disease (GD) have become more frequent. Sporadic reports indicate that Graves' orbitopathy (GO), a GD complication that affects orbital soft tissues, can be severe in DM patients. The relationship between these diseases is not well understood. This study aims at evaluating the association of GD and GO with autoimmune and non-autoimmune diabetes (DM) and to assess diabetic features that influence GD and GO prevalence and severity. This retrospective study evaluated GD, GO and DM association in 1211 consecutive GD patients (447 with GO and 77 with DM). A case-control study was carried out to evaluate DM relationship with GO severity by comparing at 1:2 ratio GO patients with or without DM. A strong association was found between GD and T1DM (p = 0.01) but not T2DM. Instead, the presence of GO was strongly associated with T2DM (p = 0.01). Moreover, GO was more frequently severe in GD patients with T2DM (11/30 or 36.6%) than in those without T2DM (1/60 or 1.7%, p = 0.05). T2DM was the strongest risk factor for severe GO (OR = 34.1 vs. 4.4 p < 0.049 in cigarette smokers). DM duration, obesity and vascular complications, but not metabolic control were significant determinants of GO severity. GD is associated with T1DM but not with T2DM, probably because of the common autoimmune background. GO, in contrast, is more frequent and severe in T2DM, significantly associated with obesity, diabetes duration and diabetic vasculopathy but not metabolic control. Copyright © 2015 Elsevier B.V. All rights reserved.

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

    DEFF Research Database (Denmark)

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

    2013-01-01

    with Graves' hyperthyroidism. For each patient, we recruited four age-sex-region-matched controls with normal thyroid function (n=1,088). MEASUREMENTS: Participants gave detailed information on current and previous alcohol intake as well as other factors to be used for analyses. The association between...... alcohol intake and development of hyperthyroidism was analyzed in conditional multivariate Cox regression models. RESULTS: Graves' patients had a lower reported alcohol consumption than controls (median units of alcohol (12g) per week: 2 vs. 4, p... consumption was associated with a dose-dependent reduction in risk for development of overt Graves' hyperthyroidism. Odds ratios (95% confidence interval) compared to the reference group with a recent (last year) consumption of 1-2 units of alcohol per week were: 0 units/week 1.73 (1.17-2.56), 3-10 units...

  4. Clinical efficacy of orbital decompression in patients with Graves ophthalmopathy

    Directory of Open Access Journals (Sweden)

    Shao-Zhu Hu

    2017-10-01

    Full Text Available AIM: To evaluate the efficacy and safety of orbital decompression in the treatment of Graves ophthalmopathy.METHODS: Totally 55 patients 77 eyes with Graves eye disease were selected in our hospital from February 2011 to February 2016. All eyes underwent orbital decompression, the visual acuity, exophthalmos and complications of the patients were followed up for 6mo. RESULTS:Postoperatively 6mo, the best corrected visual acuity were 0.23±0.09, which were better than that of preoperative 0.46±0.07(PPPCONCLUSION:Orbital decompression is an effective method for the treatment of Graves ophthalmopathy, but attention should be paid to postoperative complications such as diplopia.

  5. 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.

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Science.gov (United States)

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

    2017-02-01

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

  8. 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.

  9. 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.

  10. 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.

  11. 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

  12. Bilateral Inferior Rectus Muscle Recession in Patients With Graves Orbitopathy: Is It Effective?

    NARCIS (Netherlands)

    Jellema, Hinke Marijke; Saeed, Peerooz; Everhard-Halm, Yolande; Prick, Liesbeth; Mourits, Maarten

    2012-01-01

    Purpose: To evaluate the effect of bilateral inferior rectus recession regarding improvement of elevation, reduction of abnormal head tilt and vertical squint angle in patients with Graves orbitopathy. Method: Retrospective case series. Patients with Graves orbitopathy who underwent symmetric or

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

    African Journals Online (AJOL)

    ... of psychiatric disturbances in graves disease in a medical college in eastern ... the standard error of difference, the chi-square test, and paired Student's T-test. ... Fifteen patients (41.67%) were diagnosed with generalized anxiety disorders ...

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

    African Journals Online (AJOL)

    2012-06-01

    Jun 1, 2012 ... Impaired quality of life leads to a vicious cycle of greater psychological distress and poor productivity.[1] Therefore in this study we have tried to explore the symptomatology and types of psychiatric illness in Graves' disease and to evaluate therapeutic outcomes in such dysfunction. An assessment of ...

  15. Classification of the eye changes of Graves' disease

    NARCIS (Netherlands)

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

    1991-01-01

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

  16. WAft GRAVES REf.ISTERS., MONIJMENTS., HEADSTONES AND f ...

    African Journals Online (AJOL)

    games, etc. Amongst the most popular excur- sions are those to battlefields. Many of the most popular novels of our time deal with war and the aftermath of war, while ..... were absorbed into the South African War Graves. Board. Many volunteer organisations, private persons and regiments also concerned themsel- ves with.

  17. Effects of Graves' ophthalmopathy on quality of life

    NARCIS (Netherlands)

    Wiersinga, W. M.; Prummel, M. F.; Terwee, C. B.

    2004-01-01

    General health-related quality of life is markedly impaired in patients with Graves' ophthalmopathy (GO), and even worse than in patients with other chronic conditions like diabetes, emphysema or heart failure. A disease-specific quality-of-life questionnaire for GO has been developed, the so-called

  18. [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

  19. 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...

  20. RADIO-IODINE THERAPY OF HYPERTHYROID GRAVES' DISEASE ...

    African Journals Online (AJOL)

    Objectives. The aim of this study was to investigate effectiveness, action rate and eventual complications of radio- active iodine (RAJ) therapy in our patients with hyperthyroid Graves' disease. Design. Retrospective analysis of clinical results. Setting. Departments of Internal Medicine, Nuclear Medicine and Biostatistics at ...

  1. Graves' orbitopathy as a rare disease in Europe

    DEFF Research Database (Denmark)

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

    2017-01-01

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

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

    African Journals Online (AJOL)

    Background: The evaluation and management of hyperthyroidism in pregnancy is challenging to perioperative care givers. The objective of this report was to demonstrate the role of single shot spinal anaesthesia in managing the haemodynamic challenges associated with untreated Graves ' disease in pregnancy. Method: ...

  3. Sheehan's syndrome co‑existing with Graves' disease

    African Journals Online (AJOL)

    2014-01-10

    Jan 10, 2014 ... hormone (GH) are the first two hormones to be lost in patients with SS, the ... Arpaci, et al.: Sheehan's syndrome and Grave's disease. 663 .... and causes to pituitary deficiency. It usually manifests during pregnancy and the postpartum period.[13] First hormone being lost is ACTH. PRL level is high. Diabetes ...

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

    DEFF Research Database (Denmark)

    Bill, Jan; Daly, Aoife

    2012-01-01

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

  5. Preventing postoperative hypocalcemia in patients with Graves disease: a prospective study.

    Science.gov (United States)

    Oltmann, Sarah C; Brekke, Andrew V; Schneider, David F; Schaefer, Sarah C; Chen, Herbert; Sippel, Rebecca S

    2015-03-01

    Hypocalcemia occurs after total thyroidectomy (TT) for Graves disease via parathyroid injury and/or from increased bone turnover. Current management is to supplement calcium after surgery. This study evaluates the impact of preoperative calcium supplementation on hypocalcemia after Graves TT. A prospective study of patients with Graves disease undergoing TT was performed. Patients with Graves disease managed over a 9-month period took 1 g of calcium carbonate (CC) three times a day for 2 weeks before TT. Those managed the previous year without supplementation served as historic controls. Age-, gender-, and thyroid weight-matched, non-Graves TT patients were procedure controls. Patient demographics, postoperative laboratory values, complaints, and medications were reviewed. Parathyroid hormone (PTH)-based postoperative protocols dictated postoperative CC and calcitriol use. Forty-five patients with Graves disease were treated with CC before TT, and 38 patients with Graves disease were not. Forty control subjects without Graves disease were identified. Age, gender, and thyroid weight were comparable. Preoperative calcium and PTH levels were equivalent. PTH values immediately after surgery, at postoperative day 1, and at 2-week follow-up were equivalent. Postoperative use of scheduled CC (p = 0.10) and calcitriol (p = 0.60) was similar. Postoperatively, patients with untreated Graves disease had lower serum calcium levels than pretreated patients with Graves disease or control subjects without Graves disease (8.3 mg/dL vs. 8.6 vs. 8.6, p = 0.05). Complaints of numbness and tingling were more common in nontreated Graves disease (26%) than in pretreated Graves disease (9%) or in control subjects without Graves disease (10%, p Graves disease significantly reduced biochemical and symptomatic postoperative hypocalcemia. Preoperative calcium supplementation is a simple treatment that can reduce symptoms of hypocalcemia after Graves TT.

  6. Intoxicación por gases Gas poisoning

    OpenAIRE

    I Santiago

    2003-01-01

    La intoxicación por gases en nuestro medio es un problema importante debido a su alta incidencia. En el caso concreto de la intoxicación por monóxido de carbono, es la principal causa de muerte por intoxicación involuntaria en nuestro medio, muchas veces coexistiendo con una intoxicación por cianuro. Ambas intoxicaciones pueden ser de carácter grave, basándose su diagnóstico en la mera sospecha del médico. Además, su importancia radica en que ambas intoxicaciones tienen un tratamiento concret...

  7. 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.

  8. A Minor Historical Rule of GRAVE Concern in the Volta-Comoe ...

    African Journals Online (AJOL)

    A Minor Historical Rule of GRAVE Concern in the Volta-Comoe Languages. ... We maintain that this process can be accounted for naturally by positing the feature Grave proposed by Jakobson, Fant and Halle (1956) in their early work on distinctive-feature phonology. This permits one to say that a non-back grave segment ...

  9. Factores que influyen en la mortalidad en los pacientes graves con cirugía abdominal

    Directory of Open Access Journals (Sweden)

    Anabel Hernández Ruíz

    Full Text Available Introducción: los pacientes quirúrgicos se encuentran entre los más susceptibles de recibir asistencia médica intensiva. Objetivo: determinar los factores que influyen en la morbilidad y mortalidad de los pacientes quirúrgicos graves. Métodos: se realizó un estudio prospectivo descriptivo con 193 pacientes quirúrgicos que ingresaron en la Unidad de Cuidados Intensivos del Hospital "Joaquín Albarrán" durante el año 2012. Resultados: de 193 pacientes falleció el 17,6 %, entre los que predominaron los pacientes con operaciones de urgencia (14. Influyeron sobre el aumento de la mortalidad la edad mayor de 60 años, la presencia de insuficiencia renal aguda (p = 0,0011 y la necesidad de apoyo con aminas vasoactivas (p < 0,0001, con una asociación altamente significativa entre albúmina y estado al egreso (p < 0,0001. El requerimiento de líquidos por más de 5 L se asoció a una mejor supervivencia (p = 0,0002. Conclusiones: los principales factores de riesgo para la mortalidad de los pacientes quirúrgicos graves son el shock hipovolémico, la necesidad de apoyo con aminas, la hipoalbuminemia y la presencia de insuficiencia renal aguda, por lo que su prevención o detección temprana permitirá intensificar o particularizar las acciones terapéuticas en cada paciente, lo que puede contribuir a la reducción de la mortalidad en estos enfermos.

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

    NARCIS (Netherlands)

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

    2017-01-01

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

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

    NARCIS (Netherlands)

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

    2017-01-01

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

  12. Variables psicosociales y riesgo de violencia grave en parejas con abuso de sustancias tóxicas y maltrato previo

    OpenAIRE

    Amor Andrés, Pedro J.; Bohórquez, Isaura A.; Corral, Paz de; Oria, Juan Carlos

    2012-01-01

    El objetivo de esta investigación ex post facto fue investigar qué variables están relacionadas con la violencia de pareja grave, en una muestra de 90 parejas que acudieron a un programa de tratamiento comunitario por problemas con el consumo de drogas. Se analizaron múltiples variables: características sociodemográficas, relación de pareja, circunstancias del maltrato, determinadas características de las víctimas y de las personas que agredieron, así como el tipo ...

  13. Estigma internalizado en el trastorno mental grave: predictores cognitivos de la eficacia de un programa de intervención

    OpenAIRE

    Díaz Mandado, Olimpia

    2016-01-01

    El estigma internalizado en las personas con trastorno mental grave (TMG) se define por la aprobación de los estereotipos sobre su trastorno, emociones negativas y comportamientos de autodiscriminación. Trabajos previos han mostrado que el estigma internalizado aumenta la severidad de los síntomas, disminuye la adherencia al tratamiento y la percepción de recuperación en las personas con TMG. Pese a la importancia del estigma internalizado en la recuperación, los programas existentes no han r...

  14. 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

  15. [Glycosaminoglycans in the pathogenesis and diagnostics of Graves's ophthalmopathy].

    Science.gov (United States)

    Daroszewski, Jacek; Rybka, Jacek; Gamian, Andrzej

    2006-01-01

    Graves's ophthalmopathy is an extrathyroidal tissue-specific symptom of Graves's disease characterized by inflammatory infiltration of orbital tissues. In several percent of patients the course of disease is severe, leading to serious ocular complications and affecting quality of life. Progress made in understanding the pathogenesis of GO has not been followed by better outcome of treatment and it is still one of the most complex problems of clinical endocrinology. In this respect, qualification for immunosuppressive treatment based on an assessment of the disease activity is a matter of great importance. Glycosaminogycans are linear, unbranched heteropolysaccharides built of repeating disaccharide sequences. These compounds are essential for the organization and function of connective tissue. Moreover, they also take part in the initiation and regulation of immune reactions. In this paper, glycosaminogycans are described with regard to their structure, metabolism, and function, with special emphasis on the tissue specificity of the orbit. Data concerning GAG useful in the management of patients with GO are highlighted.

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

    Science.gov (United States)

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

    2015-12-28

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

  17. The relationship between Graves' ophthalmopathy and dry eye syndrome.

    Science.gov (United States)

    Selter, Jessica H; Gire, Anisa I; Sikder, Shameema

    2015-01-01

    A complex relationship between Graves' ophthalmopathy (GO) and dry eye syndrome exists. New research brings more insight into the association between these two diseases. A review of the literature was conducted using the query terms "Graves' Ophthalmopathy", "Thyroid Eye Disease", and "Dry Eye" in MedLine (PubMed) and Scopus. A total of 55 papers were reviewed. Case reports were excluded. This review paper shows the close relationship between dry eye syndrome and GO. The underlying mechanisms behind their association suggest mechanical impairment of orbital muscles and immune-mediated lacrimal gland dysfunction as the causes of dry eye in GO patients. However, there are a variety of treatment options available for patients with GO with signs of dry eye, which help combat this issue.

  18. 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.

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

    Directory of Open Access Journals (Sweden)

    Eric Paiva Vilela

    2010-10-01

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

  20. Morbidade materna grave em um hospital universitário de referência municipal em Campinas, Estado de São Paulo Severe maternal morbidity at a local reference university hospital in Campinas, São Paulo, Brazil

    Directory of Open Access Journals (Sweden)

    Adriana Gomes Luz

    2008-06-01

    Full Text Available OBJETIVO: avaliar a prevalência e os fatores de risco associados à morbidade materna grave numa maternidade terciária. MÉTODOS: trata-se de um estudo de corte transversal dos casos de morbidade materna grave atendidos no Hospital e Maternidade Celso Pierro entre outubro de 2005 e julho de 2006, identificados a partir dos livros de controle das unidades de internação, pronto atendimento e centro obstétrico. Foram estudadas gestantes e puérperas que apresentavam condições definidoras de morbidade materna grave a partir dos diagnósticos clínicos segundo critérios propostos por Waterstone. Posteriormente, os casos de maior gravidade clínica, chamados de morbidade extremamente grave, foram reclassificados utilizando-se os critérios definidores de Mantel, baseados em disfunção orgânica e manejo. RESULTADOS: foram identificadas 114 mulheres com morbidade materna grave entre 2.207 partos, com razão de outra morbidade grave e morbidade extremamente grave de 44,9 e 6,8 casos por 1.000 partos, respectivamente. A média da idade gestacional no parto foi de 35 semanas e 87% das mulheres vieram de área de cobertura da maternidade no município. A hipertensão (pré-eclâmpsia grave representou 96% de outras morbidades graves e a hemorragia esteve presente em 60% dos casos de morbidade extremamente grave, seguida de hipertensão. A prevalência de morbidade extremamente grave entre os casos de morbidade grave não se associou com estado marital, escolaridade, idade materna, tipo de parto, gestações, idade gestacional e distrito de saúde de moradia. CONCLUSÕES: as outras morbidades graves foram 6,6 vezes mais freqüentes que os casos extremamente graves, sem diferenças entre os grupos por fatores de risco epidemiológicos.PURPOSE: to assess the prevalence and risk factors associated with near miss and other severe maternal morbidity at a reference tertiary maternity. METHODS: this is a cross-sectional study on severe maternal morbidity

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

    Science.gov (United States)

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

    2017-10-01

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

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

    NARCIS (Netherlands)

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

    2015-01-01

    The epidemiology of Graves' orbitopathy (GO) may be changing. The aim of the study was to identify trends in presentation of GO to tertiary centres and initial management over time. Prospective observational study of European Group On Graves' Orbitopathy (EUGOGO) centres. All new referrals with a

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

    Science.gov (United States)

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

    2013-07-01

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

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

    Science.gov (United States)

    Xia, Nan; Ye, Xiaozhen; Hu, Xiaohao; Song, Shiyu; Xu, Hui; Niu, Mengyuan; Wang, Hongwei; Wang, Jian

    2017-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Nan Xia

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

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

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    Mónica Marcela Peláez Hernández

    2007-04-01

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

  8. Artroscopia do quadril na epifisiólise grave Hip arthroscopy in severe epiphysiolisis

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    Eiffel Tsuyoshi Dobashi

    2010-12-01

    Full Text Available Apresenta-se o caso de um indivíduo de 12 anos de idade, do sexo masculino, com diagnóstico de epifisiólise femoral proximal grau III em sua forma crônica agudizada, associada à limitação funcional grave e restrição importante do arco de movimento do quadril. O paciente foi submetido à osteotomia de ressecção de uma cunha trapezoide do colo femoral tipo Dunn por via artroscópica, seguido da redução e fixação percutânea com parafuso de 6,5mm. Houve melhora significativa do quadro clínico logo no primeiro pós-operatório, o que permitiu a reabilitação precoce. Os autores apresentam uma breve revisão de literatura e propõem esta técnica como um método adjuvante viável no tratamento da epifisiólise femoral proximal grave, encorajando o desenvolvimento de estudos sobre o tema.We present a case report of a 12-year-old boy diagnosed with slipped capital femoral epiphysis grade III, with an acute-on-chronic presentation, associated with severe functional impairment and significant reduction in hip range of motion. The patient underwent a Dunn-type trapezoidal wedge femoral neck subtraction osteotomy by hip arthroscopy, followed by closed reduction and fixation with a 6.5mm percutaneous screw. There was significant improvement of the clinical picture on the first postoperative day, allowing for early rehabilitation. After a brief review of the literature, the authors propose this novel surgical technique as a viable method to treat severe slipped capital femoral epiphysis, encouraging the development of new studies on the subject.

  9. Cuatro métodos de predicción de riesgo de infección bacteriana grave en recién nacidos febriles

    OpenAIRE

    Manuel Díaz Álvarez; Daniel Claver Isás; Heidy González Trujillo; Humberto Martínez Canalejo

    2010-01-01

    INTRODUCCIÓN. El objetivo de esta investigación fue contrastar la efectividad de 4 métodos de evaluación de riesgo de infección bacteriana grave (IBG) en recién nacidos (RN) febriles, uno de los cuales fue desarrollado por los autores del trabajo y los otros son los utilizados en la práctica internacional. MÉTODOS. Se realizó un estudio descriptivo, retrospectivo y aplicado de 1358 RN febriles sin signos de focalización evaluados y clasificados por riesgo de IBG. Fue aplicado el método propue...

  10. Evaluación funcional y estructural del nervio óptico en orbitopatía Graves mediante potenciales evocados visuales multifocales, tomografía de coherencia óptica y resonancia nuclear magnética

    OpenAIRE

    Rodríguez González, María Natividad

    2010-01-01

    La complicación más grave, aunque poco frecuente (3-5%) de la Orbitopatía Graves (OG) es la neuropatía óptica distiroidea (NOD). Su mecanismo fisiopatológico es multifactorial pero principalmente debido a la compresión del nervio óptico por unos músculos extraoculares engrosados que se hacinan en el ápex orbitario. Los criterios diagnósticos de NOD tales como la disminución de la agudeza visual, el defecto pupilar aferente relativo, la discromatopsia, el edema de papila, los defectos campimét...

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

    Science.gov (United States)

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

    2015-05-01

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

  12. Fluidoterapia de reanimación en pacientes con trauma grave: ¿Necesita cambiarse?

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    Mario Miguel Morales Wong

    Full Text Available El acceso venoso en los pacientes politraumatizados ha sido tradicionalmente una medida de suma importancia que permite la administración de líquidos, analgésicos, anestésicos y drogas reanimadoras. Convencionalmente en un paciente exanguinado, la administración vigorosa de cristaloides o coloides estuvo encaminada a restablecer de forma «empecinada» los valores de tensión arterial cercanos a la normalidad, en un intento por lograr la oxigenación tisular adecuada desde el preoperatorio. Sin embargo, se ha demostrado que tal estrategia de reanimación en este tipo de paciente aumenta la morbilidad y mortalidad de este debido a las graves anormalidades metabólicas que provoca, entre ellas la hipotermia, la acidosis, la coagulopatía y el resangrado de las lesiones vasculares previamente autocontroladas por los mecanismos fisiológicos de la coagulación. Hacemos una revisión de la literatura que refleja los relativamente nuevos puntos de vistas en la fluidoterapia de reanimación del paciente politraumatizado exanguinado

  13. Necrose tubular aguda e anemia grave após uso intermitente de rifampicina

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    Eduardo Santos

    2013-03-01

    Full Text Available A rifampicina (RFP pode ser administrada diariamente ou num esquema intermitente. Quando é administrada de forma intermitente pode produzir reações imuno-alérgicas graves. Apresentamos o caso clínico de um pa-ciente que, após tratamento com RFP de forma intermitente para uma infeção por Mycobacterium intracellulare, desenvolveu quadro de necrose tubular aguda, anemia, prolongamento dos tempos de coagulação e citó-lise hepática ligeira. Após suspensão do fármaco houve recuperação em 24h das alterações da coagulação e da citólise hepática, tendo tido no entanto necessidade de hemodiálise por persistência de anúria e uremia, e transfusão de concentrados de eritrócitos pela gravidade da anemia. Teve alta com recuperação de todas as disfunções.

  14. Calidad de vida en personas con discapacidad grave y muy grave

    OpenAIRE

    Verdugo, Z.Y.

    2017-01-01

    En Ecuador las personas con discapacidad constituyen un grupo prioritario de atención integral tendiente a mejorar su calidad de vida, la misma que está influenciada por varios factores; siendo el objetivo de este estudio establecer la relación que existe entre la calidad de vida y el grado de discapacidad de las personas con discapacidad en la provincia de Loja para lo cual se diseñó un estudio descriptivo, analítico transversal disponiendo de una muestra de 397 personas con discapacidad gra...

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

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    André Luciano Baitello

    2013-06-01

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

  16. Marcadores séricos de trombofilias hereditárias e anticorpos antifosfolípides em gestantes com antecedentes de pré-eclâmpsia grave

    OpenAIRE

    Figueiró-Filho,Ernesto Antonio; Oliveira, Vanessa Marcon de; Coelho,Lílian Rezende; Breda, Ili

    2012-01-01

    OBJETIVO: Verificar a frequência e a associação de marcadores séricos para trombofilias hereditárias e adquiridas em gestantes com histórico de pré-eclâmpsia grave em gestação anterior. MÉTODOS: Estudo tipo caso-controle composto por 81 gestantes com histórico de pré-eclâmpsia grave em gestação anterior (grupo de estudo) e 32 gestantes sem antecedente de pré-eclâmpsia grave em gestação anterior (grupo controle). Foi rastreada a presença de anticorpos antifosfolípides e trombofilias hereditári...

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

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    Hae Sang Lee

    2014-09-01

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

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

    Science.gov (United States)

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

    2016-02-18

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

  19. Graves' disease and coeliac disease: screening and treatment dilemmas.

    Science.gov (United States)

    Joshi, Ameya S; Varthakavi, Premlata K; Bhagwat, Nikhil M; Thiruvengadam, Narendhran Ramaswamy

    2014-10-23

    The association between autoimmune thyroid disorders (AITD) and coeliac disease (CD) is well known, however, most of the literature concentrates on hypothyroidism and CD. We report a case of a 37-year-old woman with Graves' disease (GD) who presented with thyrotoxicosis that was not responsive to medical management. The screening for coeliac autoimmunity (CA) was positive. After initiation of a gluten-free diet the patient's thyrotoxicosis responded to medical management. She was given radioiodine therapy and is currently hypothyroid on a stable dose of thyroxine. 2014 BMJ Publishing Group Ltd.

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

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    Alessandra Alves

    2007-06-01

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

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

    Science.gov (United States)

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

    2017-01-01

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

  2. 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.

  3. Graves' Patient with Thymic Expression of Thyrotropin Receptors and Dynamic Changes in Thymic Hyperplasia Proportional to Graves' Disease Activity.

    Science.gov (United States)

    Song, Young Shin; Won, Jae-Kyung; Kim, Mi Jeong; Lee, Ji Hyun; Kim, Dong-Wan; Chung, June-Key; Park, Do Joon; Park, Young Joo

    2016-05-01

    Thymic hyperplasia is frequently observed in Graves' disease. However, detectable massive enlargement of the thymus is rare, and the mechanism of its formation has remained elusive. This case showed dynamic changes in thymic hyperplasia on serial computed tomography images consistent with changes in serum thyrotropin receptor (TSH-R) antibodies and thyroid hormone levels. Furthermore, the patient's thymic tissues underwent immunohistochemical staining for TSH-R, which demonstrated the presence of thymic TSH-R. The correlation between serum TSH-R antibody levels and thymic hyperplasia sizes and the presence of TSH-R in her thymus suggest that TSH-R antibodies could have a pathogenic role in thymic hyperplasia.

  4. Raising awareness of Graves' orbitopathy with early warning cards.

    Science.gov (United States)

    Mitchell, Anna L; Hickey, Janis; Vaidya, Bijay; Mason, Rhianne; Ajjan, Ramzi; Zammitt, Nicola; Perros, Petros; Dayan, Colin

    2017-12-01

    Clinically significant Graves' orbitopathy (GO) develops in about 25% of those with Graves' disease (GD); most cases of GD in the UK are managed by endocrinologists. Despite this, patients report significant delays before a diagnosis of GO is made. Measures to increase awareness of the early signs of GO and establishing a fast-track referral pathway to specialist care should overcome these delays and potentially improve outcomes. We aimed to determine whether issuing a "GO early warning card" to all GD patients raises awareness of GO and facilitates early diagnosis, what percentage of cards result in a telephone contact, the number of "false reports" from card carriers and patient perceptions of the cards. We designed cards, detailing common GO symptoms and a telephone number for patients developing symptoms. Cards were distributed to 160 GD patients, without known GO, attending four endocrine clinics in the UK (December 2015-March 2016). We recorded telephone contacts over twelve months from when the last card was distributed and gathered patient feedback. The early warning cards were well received by patients in general. Over twelve months, ten telephone contacts from nine patients, all related to ocular symptoms, were received (6% of cards issued). Nine calls resulted in an additional clinic review (for eight patients), and four diagnoses of GO were made. This pilot study demonstrates that it is feasible to distribute GO early warning cards in clinic, and that they can be used to facilitate an early diagnosis of GO. © 2017 John Wiley & Sons Ltd.

  5. [Polish doctors graves at the cemeteries in Edinburgh].

    Science.gov (United States)

    Gebertt, S

    1994-01-01

    The first part of the text reviews the cultural links between Poland and Scotland. These links were originated in the 14th century and were created by scottish students travelling to Poland to seek learning in the then polish centre of excellence Jagiellonian University in Cracow. There were also some learned Scots who ventured to Poland, seeking work. Some of them achieved positions of distinction. The first Polish medical men attended the University of Edinburgh in the 18th century. In the 19th century, following the suppression of the polish uprising against Russia, there were a small group of Poles seeking asylum in Scotland. A few of them enlisted at the University of Edinburgh at the medical faculty. The above history is described in detail in Annotations. In the second part of the paper all the polish medical and veterinary doctors whose graves are located in various cemeteries in Edinburgh are listed in chronological order of their deaths. As full as possible personal data, the kind of medical work, and location of their graves are given. Greater details, whenever obtainable, are dealt with in Annotations. The total of thirty deceased between 1942 and 1993 are described.

  6. Hipoglucemia inducida por carcinoma adrenal

    Directory of Open Access Journals (Sweden)

    Jimena Soutelo

    2013-08-01

    Full Text Available El carcinoma suprarrenal es una neoplasia maligna infrecuente y de mal pronóstico. La presentación clínica más común es originada por la producción hormonal excesiva, mientras que el desarrollo de hipoglucemia sintomática es excepcional. Presentamos el caso de una mujer de 37 años que ingresó al hospital por síntomas de hipoglucemias graves, hipertensión arterial, hipopotasemia y amenorrea secundaria. En el laboratorio se halló hipoglucemia con insulina inhibida y niveles de andrógenos en rango tumoral. La tomografía computarizada (TC de abdomen y pelvis mostró voluminosa formación heterogénea de aspecto sólido sin plano de clivaje con respecto al parénquima hepático e intenso realce con contraste. Luego de la extirpación de la masa retroperitoneal, evolucionó con valores de glucemia y potasemia normales, estabilizó la presión arterial y recuperó los ciclos menstruales.

  7. Peracute bovine mastitis caused by Klebsiella pneumoniae Mastite bovina hiperaguda causada por Klebsiella pneumoniae

    Directory of Open Access Journals (Sweden)

    M.G. Ribeiro

    2008-04-01

    Full Text Available Relata-se a ocorrência de graves sintomas de mastite hiperaguda em vaca, causada por Klebsiella pneumoniae, na terceira semana de lactação. Descrevem-se aspectos epidemiológicos, sintomas clínicos, procedimentos de diagnóstico microbiológico, conduta terapêutica e medidas de controle.

  8. Choque cardiogênico por dissulfiram

    OpenAIRE

    Jerónimo, Ana; Meira, Carla; Amaro,Augusta; Campello,Glória Cabral; Granja, Cristina

    2009-01-01

    A intoxicação medicamentosa por dissulfiram é uma situação rara, mas, que pode se apresentar com manifestações cardiovasculares graves e potencialmente fatais, como choque cardiogênico. É apresentado o caso de uma paciente com choque refratário, após intoxicação voluntária por dissulfiram. A avaliação clínica e bioquímica, junto à avaliação ecocardiográfica e à monitorização invasiva, confirmaram tratar-se de um choque cardiogênico associado a esse fármaco. São discutidos os mecanismos de açã...

  9. 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.; Adamidou, Fotini; Anagnostis, Panagiotis; Ayvaz, Goksun; Azzolini, Claudio; Boschi, Antonella; Bournaud, Claire; Clarke, Lucy; Currò, Nicola; Daumerie, Chantal; Dayan, Colin; Fuhrer, Dagmar; Konuk, Onur; Marinò, Michele; Morris, Daniel; Nardi, Marco; Pearce, Simon; Pitz, Susanne; Rudovsky, Gottfried; Vannucchi, Guia; Vardanian, Christine; von Arx, Georg

    2016-01-01

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

  10. 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.

  11. Responsabilidad del empleador por accidentes de trabajo y enfermedades profesionales

    Directory of Open Access Journals (Sweden)

    Cristina Mangarelli

    2014-01-01

    Full Text Available Introducción. 1. Responsabilidad del “empleador” por accidentes de trabajo y enfermedades profesionales. Noción. 2. La indemnización “tarifada”. Fundamento de su procedencia 3. Responsabilidad del empleador por accidentes de trabajo o enfermedades profesionales en la ley uruguaya (ley Nº 16.074. 4. La “ampliación” de la responsabilidad del empleador por el derecho común en el derecho uruguayo (artículo 7 ley Nº 16.074. 5. Requisitos para la ampliación de la responsabilidad patronal: culpa grave en el incumplimientode normas de seguridad y prevención. 6. La culpa grave. Concepto. 7. El modelo del hombre a tener en cuenta en la “culpa grave” no es el del buen padre de familia. 8. El grado de la culpa no puede ser medido por el resultado del accidente. 9. Se aplican las eximentes de la responsabilidad civil. 10. Distintos ámbitos de la responsabilidad patronal por accidentes de trabajo o enfermedades profesionales: A ante la víctima o los derecho-habientes; B ante el Banco de Seguros del Estado; C ante el Ministerio de Trabajo ySeguridad Social. 11. Recupero del BSE en caso de culpa grave en el incumplimiento de normas de seguridad y prevención. Requisitos 12. Responsabilidad del empleador en caso de accidente de trabajo o enfermedad profesional sufrido por un adolescente. Conclusiones.

  12. Observancia de las guías internacionales de manejo temprano en sepsis grave y choque séptico

    Directory of Open Access Journals (Sweden)

    Ricardo Andrés Quintero

    2012-05-01

    Full Text Available Introducción. La observancia completa del tratamiento temprano dirigido por objetivos, disminuyesignificativamente la mortalidad a 28 días, mientras que la observancia parcial no tiene ningúnbeneficio. Objetivos. Determinar la observancia de las guías internacionales en sepsis grave y choque séptico,mediante el conjunto de medidas (bundle de reanimación de las primeras seis horas en pacientesmayores de 16 años de edad, en un centro de referencia de alta complejidad. Materiales y métodos. Se presenta un estudio de cohorte, prospectivo y descriptivo, llevado acabo durante un período de seis meses, en pacientes con sepsis grave o choque séptico admitidosa los servicios de urgencias, unidades de cuidados intensivos y cuidados especiales. Se midió laobservancia del conjunto de medidas mediante ocho intervenciones: 1 medición del lactato sérico, 2inicio temprano de antibióticos, 3 toma de hemocultivos, 4 infusión de líquidos intravenosos, 5 uso demedicamentos vasopresores, 6 inserción de catéter venoso central, 7 presión venosa central mayorde 8 mm Hg, y 8 saturación venosa central de oxígeno mayor de 70 %. Resultados. Se tamizaron 723 pacientes; 16 % (n=116 cumplieron los criterios de inclusión, 92,2% (n=107 cumplieron los criterios para sepsis grave y 37,9 % (n=44 para choque séptico. El 62,9% (n=73 fue subdiagnosticado. La observancia completa de las 8 intervenciones del conjunto demedidas fue de 0 %; de 6 a 7, 19 % (n=22; de 3 a 5, 67,2 % (n=78, y de 0 a 2, 98,3 % (n=114. Conclusión. La completa observancia de las guías internacionales de manejo en sepsis grave ychoque séptico en las primeras seis horas es nula y solo se cumple de manera parcial. doi: http://dx.doi.org/10.7705/biomedica.v32i3.349

  13. Rectus extraocular muscle paths and decompression surgery for Graves orbitopathy: mechanism of motility disturbances

    NARCIS (Netherlands)

    Abràmoff, Michael D.; Kalmann, Rachel; de Graaf, Mieke E. L.; Stilma, Jan S.; Mourits, Maarten P.

    2002-01-01

    PURPOSE: To study possible causes of motility disturbances that may result from orbital decompression surgery in patients with Graves orbitopathy and especially the role of rectus extraocular muscle paths. METHODS: Sixteen patients with Graves orbitopathy were studied before and 3 to 6 months after

  14. 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.

  15. Combined thyroid eye clinic: the importance of a multidisciplinary health care in patients with Graves' orbitopathy

    NARCIS (Netherlands)

    Wiersinga, Wilmar M.

    2010-01-01

    A multidisciplinary approach to the management of Graves' orbitopathy is widely recommended. The optimal model for health care delivery to patients with Graves' orbitopathy is combined thyroid-eye clinics. Joint clinics by ophthalmologists and endocrinologists are likely to improve the quality of

  16. L'haptoglobine chez les enfants atteints de paludisme grave a ...

    African Journals Online (AJOL)

    SARAH

    30 avr. 2014 ... Hiens et al. J. Appl. Biosci. 2014. L'haptoglobine chez les enfants atteints de paludisme grave a. Plasmodium falciparum : Relations avec l'âge, la parasitemie et le taux d'hémoglobine. 6425. L'haptoglobine chez les enfants atteints de paludisme grave a Plasmodium falciparum de 0 à 15 ans : relations.

  17. Guidelines for the treatment of childhood-onset Graves' disease in Japan, 2016.

    Science.gov (United States)

    Minamitani, Kanshi; Sato, Hirokazu; Ohye, Hidemi; Harada, Shohei; Arisaka, Osamu

    2017-01-01

    Purpose behind developing these guidelines: Over one decade ago, the "Guidelines for the Treatment of Graves' Disease with Antithyroid Drug, 2006" (Japan Thyroid Association (JTA)) were published as the standard drug therapy protocol for Graves' disease. The "Guidelines for the Treatment of Childhood-Onset Graves' Disease with Antithyroid Drug in Japan, 2008" were published to provide guidance on the treatment of pediatric patients. Based on new evidence, a revised version of the "Guidelines for the Treatment of Graves' Disease with Antithyroid Drug, 2006" (JTA) was published in 2011, combined with the "Handbook of Radioiodine Therapy for Graves' Disease 2007" (JTA). Subsequently, newer findings on pediatric Graves' disease have been reported. Propylthiouracil (PTU)-induced serious hepatopathy is an important problem in pediatric patients. The American Thyroid Association's guidelines suggest that, in principle, physicians must not administer PTU to children. On the other hand, the "Guidelines for the Treatment of Graves' Disease with Antithyroid Drug, 2011" (JTA) state that radioiodine therapy is no longer considered a "fundamental contraindication" in children. Therefore, the "Guidelines for the Treatment of Childhood-Onset Graves' Disease with Antithyroid Drug in Japan, 2008" required revision.

  18. 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.

  19. Fatal and non-fatal adverse events of glucocorticoid therapy for Graves' orbitopathy

    DEFF Research Database (Denmark)

    Marcocci, Claudio; Watt, Torquil; Altea, Maria Antonietta

    2012-01-01

    The objective of this study was to investigate the side effects of glucocorticoid (GC) therapy observed by European thyroidologists during the treatment of Graves' orbitopathy (GO).......The objective of this study was to investigate the side effects of glucocorticoid (GC) therapy observed by European thyroidologists during the treatment of Graves' orbitopathy (GO)....

  20. Demência como fator de risco para fraturas graves em idosos

    Directory of Open Access Journals (Sweden)

    Carvalho Aline de Mesquita

    2002-01-01

    Full Text Available INTRODUÇÃO: As quedas entre pessoas idosas constituem importante problema de saúde pública devido à sua alta incidência, às complicações para a saúde e aos altos custos assistenciais. O estudo realizado visa a estimar a associação entre demência e ocorrência de quedas e fraturas entre idosos. MÉTODOS: Foi conduzido estudo caso-controle de 404 indivíduos com 60 ou mais anos de idade, da cidade do Rio de Janeiro, Brasil. Casos e controles foram pareados por idade, sexo e hospital. Os dados foram coletados por meio de entrevista estruturada com os idosos. Foram considerados portadores de quadro demencial idosos cuja pontuação no questionário BOAS fosse superior a dois. Foram obtidos odds ratios (OR ajustados por fatores potenciais de confusão, utilizando-se regressão logística condicional. RESULTADOS: As quedas distribuíram-se igualmente entre os períodos da manhã, tarde e noite, havendo uma redução em sua freqüência durante a madrugada. Acidentaram-se dentro de casa 78% dos idosos com demência, contra 55% daqueles sem essa doença. O OR não-ajustado para a associação entre demência e fratura grave foi de 2,0 (IC95%, 1,23-3,25. Após o ajuste por fatores de confusão, houve uma pequena redução dessa associação (OR=1,82, 1,03-3,23. CONCLUSÃO: Idosos com quadro demencial apresentam maior risco de caírem e ser hospitalizados por fratura do que idosos sem demência. Tal fato implica a necessidade de cuidados especiais com esses indivíduos, visando a minimizar o risco desses acidentes.

  1. Demência como fator de risco para fraturas graves em idosos

    Directory of Open Access Journals (Sweden)

    Aline de Mesquita Carvalho

    2002-08-01

    Full Text Available INTRODUÇÃO: As quedas entre pessoas idosas constituem importante problema de saúde pública devido à sua alta incidência, às complicações para a saúde e aos altos custos assistenciais. O estudo realizado visa a estimar a associação entre demência e ocorrência de quedas e fraturas entre idosos. MÉTODOS: Foi conduzido estudo caso-controle de 404 indivíduos com 60 ou mais anos de idade, da cidade do Rio de Janeiro, Brasil. Casos e controles foram pareados por idade, sexo e hospital. Os dados foram coletados por meio de entrevista estruturada com os idosos. Foram considerados portadores de quadro demencial idosos cuja pontuação no questionário BOAS fosse superior a dois. Foram obtidos odds ratios (OR ajustados por fatores potenciais de confusão, utilizando-se regressão logística condicional. RESULTADOS: As quedas distribuíram-se igualmente entre os períodos da manhã, tarde e noite, havendo uma redução em sua freqüência durante a madrugada. Acidentaram-se dentro de casa 78% dos idosos com demência, contra 55% daqueles sem essa doença. O OR não-ajustado para a associação entre demência e fratura grave foi de 2,0 (IC95%, 1,23-3,25. Após o ajuste por fatores de confusão, houve uma pequena redução dessa associação (OR=1,82, 1,03-3,23. CONCLUSÃO: Idosos com quadro demencial apresentam maior risco de caírem e ser hospitalizados por fratura do que idosos sem demência. Tal fato implica a necessidade de cuidados especiais com esses indivíduos, visando a minimizar o risco desses acidentes.

  2. Identification process in mass graves from the Spanish Civil War II.

    Science.gov (United States)

    Ríos, Luis; García-Rubio, Almudena; Martínez, Berta; Alonso, Andrea; Puente, Jorge

    2012-06-10

    The identification process of a mass grave from the Spanish Civil War (1936-1939) is presented. The presumed location of the grave, as well as the presumed number and identities of the persons buried in the grave were obtained exclusively from witnesses' and relatives' testimonies. In agreement with the testimonies, the grave was located at the indicated location and five skeletons were exhumed. Also in agreement with the testimonies, the osteological and DNA study led investigators to propose the identification of two kin groups, a father and his son and a pair of brothers. But the genetic study did not support the identification of a fifth man presumed to have been buried in the grave. The differences and similarities between this case and another case reported earlier are discussed. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

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

    Science.gov (United States)

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

    2016-04-01

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

  4. Síndrome hemofagocítico secundario a infecciones graves en un quemado

    Directory of Open Access Journals (Sweden)

    Carolina V. Mahuad

    2013-06-01

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

  5. Enfermedad Graves-Basedow. Fisiopatología y Diagnóstico

    Directory of Open Access Journals (Sweden)

    Hernando Vargas-Uricoechea

    2013-03-01

    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, causa de cerca del 80% de todos los casos de 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 describimos la metodología usada para elaborar un estado del arte del bocio difuso tóxico presente en adultos, en relación con sus antecedentes históricos, fisiopatología y diagnóstico, tanto semiológico como imagenológico, patológico y por laboratorio. Los aspectos –tanto del manejo de hipertiroidismo como el de problemas especiales- son motivo de otra publicación.

  6. Glucocorticoid administration for Graves' hyperthyroidism treated by radioiodine. A questionnaire survey among members of the European Thyroid Association

    NARCIS (Netherlands)

    Lazarus, J. H.; Bartalena, L.; Marcocci, C.; Kahaly, G. J.; Krassas, G.; Wiersinga, W. M.; Baldeschi, L.; Boboridis, K.; Boschi, A.; Currò, N.; Daumerie, C.; Dickinson, A. J.; Eckstein, A.; Kendall-Taylor, P.; Lane, C. M.; Ludgate, M. E.; Mann, K.; Marinò, M.; Mourits, M. P.; Nardi, M.; Neoh, C.; Orgiazzi, J.; Pearce, S.; Perros, P.; Pinchera, A.; Pitz, S.; Salvi, M.; Sivelli, P.; Stahl, M.; von Arx, G.

    2010-01-01

    Background: Glucocorticoid prophylaxis is required in some instances after radioiodine (RAI) treatment for Graves' hyperthyroidism to prevent progression of Graves' orbitopathy (GO). However, no randomized clinical trial has been performed to ascertain the optimum glucocorticoid therapy. Aim and

  7. Characteristics of patients with graves disease and intrathyroid hypovascularity compared to painless thyroiditis.

    Science.gov (United States)

    Uchida, Toyoyoshi; Shigihara, Nayumi; Takeno, Kageumi; Komiya, Koji; Goto, Hiromasa; Abe, Hiroko; Sato, Junko; Honda, Akira; Fujitani, Yoshio; Watada, Hirotaka

    2014-10-01

    The purpose of this study was to assess the frequency and sonographic and laboratory characteristics of Graves disease with intrathyroid hypovascularity in Japanese patients and to compare these characteristics in patients with painless thyroiditis. A total of 194 consecutive patients with Graves disease and 21 patients with painless thyroiditis were enrolled. The patients underwent thyroid volume measurement, mean superior thyroid artery peak systolic velocity (PSV) measurement, power Doppler sonography, and proper blood testing to discriminate between Graves disease and painless thyroiditis. Based on the power Doppler sonographic findings, they were divided into 4 groups: from pattern 0 (most hypovascular thyroid) to pattern III (most hypervascular thyroid). Comparisons of multiple thyroid parameters were made among the groups. The prevalence of Graves disease with pattern 0 (n = 27) was 13.9% among the patients with Graves disease. The sonographic and laboratory data for patients with Graves disease and pattern 0 were compared to those of the 21 patients with painless thyroiditis, which typically shows intrathyroid hypovascularity. Free triiodothyronine and thyroxine levels and the superior thyroid artery PSV were significantly lower in patients with Graves disease and pattern 0 than those with patterns I, II, and III (P Graves disease and pattern 0 than those with pattern III. In the comparison between patients with Graves disease and pattern 0 and those with painless thyroiditis and pattern 0, apart from thyrotropin receptor antibody, only the superior thyroid artery PSV was different. Although the clinical features of patients with Graves disease and intrathyroid hypovascularity were similar to those patients with painless thyroiditis, the superior thyroid artery PSV showed a moderate ability to discriminate these patients. © 2014 by the American Institute of Ultrasound in Medicine.

  8. 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.......21--0.50) for MZ pairs and 0.03 (95% CI, 0.01--0.12) for DZ pairs (P development of GD is attributable to genetic factors. Individual specific environmental factors not shared by the twins could explain the remaining 21...... contributions of the genetic and environmental factors remain to be clarified. In this study we report probandwise concordance rates for GD in a new cohort of same sex twin pairs born between 1953 and 1976 (young cohort), ascertained from the nationwide population-based Danish Twin Register. To elucidate...

  9. 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. Copyright © 2012 Elsevier Ltd. All rights reserved.

  10. [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.

  11. Ações do enfermeiro na identificação precoce de alterações sistêmicas causadas pela sepse grave

    Directory of Open Access Journals (Sweden)

    Felipe Garrido

    2017-04-01

    Full Text Available Introdução: As unidades de terapia intensiva (UTIs têm sido organizadas como setores estratégicos para o suporte especializado de assistência ao paciente grave. Objetivo: Verificar as ações do enfermeiro para a identificação precoce das alterações sistêmicas causadas pela sepse grave relacionadas às alterações hemodinâmicas, neurológicas, respiratórias, renais e nutricionais dos pacientes internados em UTIs adulto. Métodos: Estudo descritivo com 24 enfermeiros. Os dados foram coletados por meio de formulário composto de questões estruturadas. Resultados: Apenas 36% dos enfermeiros possuem especialização em UTI adulto; verificou-se que os profissionais identificam parcialmente os sinais e sintomas apresentados pelo paciente séptico. Conclusão: Os enfermeiros encontram dificuldade na identificação precoce das alterações sistêmicas causadas pela sepse grave relacionada às alterações hemodinâmicas, neurológicas, respiratórias, renais e nutricionais dos pacientes internados em UTI adulto, o que pode estar relacionado com a falta de treinamento e de protocolos estabelecidos pelas instituições.

  12. Subsídios para a diversificação de moradias destinadas a pessoas com transtorno mental grave no Brasil: uma revisão

    Directory of Open Access Journals (Sweden)

    Juarez Pereira Furtado

    2013-09-01

    Full Text Available Com as críticas ao chamado manicômio, diversas iniciativas de moradia para egressos de hospitais psiquiátricos precisaram ser implementadas em diferentes países. Neste artigo, a partir de revisão narrativa, analisamos os antecedentes e a constituição de moradias para pessoas com transtorno mental grave implementadas no Brasil, pelo Sistema Único de Saúde. Identificamos pouca discussão sobre os limites do programa de Serviços Residenciais Terapêuticos (SRTs e a quase inexistência de discussões sobre alternativas para as necessidades de moradia de pacientes graves ligados aos Centros de Atenção Psicossocial (Caps. Subsidiados por reflexões oriundas da experiência canadense, discutimos a necessidade e os caminhos possíveis de ampliação não só quantitativa, mas, sobretudo, qualitativa, das formas de apoio às moradias de pessoas com transtorno mental grave no Brasil.

  13. 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... useful in treating hyperthyroidism and Graves' disease, an autoimmune disease that is commonly associated... Patent License Agreement may be worldwide and the field of use may be limited to: Treatment of Graves...

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

    Directory of Open Access Journals (Sweden)

    Roseliane de Souza Araújo Alves

    2008-09-01

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

  15. Tratamento da miastenia grave mediante imunossupressão medicamentosa não esteróide

    Directory of Open Access Journals (Sweden)

    José Lamartine de Assis

    1986-06-01

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

  16. Eficácia do sulfato de aminosidine na leishmaniose visceral grave, resistente ao tratamento com antimonial pentavalente

    Directory of Open Access Journals (Sweden)

    Cleudson Castro

    1995-09-01

    Full Text Available Descreve-se um caso de calazar grave resistente a dez cursos de antimonial petitavalente (glucantime à base de 20mg de Sb5/kg/dia, que respondeu favoravelmente ao sulfato de aminosidine intramuscular na dose de 20mg/kg/dia por 20 dias, repetido após 20 dias. O parasitismo esplénico passou de 50 parasitos por campo a 3 parasitos em 10 campos logo após a primeira série de sulfato de aminosidine, tornando-se negativo depois de sete meses. A melhora clínica foi imediata, com redução gradual da hepatoesplenomegalia, e desaparecimento 26 meses após. Neste período aumentou 13 kg. Após o uso de aminosidine a reação de Monténégro tornou-se positiva e as células mononucleares responderam quando estimuladas com antígenos de leishmânia.A grave kala-azar infection in a 14 years old boy is described. The leishmanial infection failed to respond to ten interrupted courses of glucantime of variable duration (14-56 days at a dose of 20mg Sb5/kg/day. However a favorable response ocurred to intramuscular aminosidine sulphate (20mg/kg/day for 20 days. This same regimen was repeated 20 days later. After the first treatment splenic puncture parasite density fell from 50 amastigotes per oil immersion field to 3 amastigotes in 10 fields. A further splenic puncture 7 months after treatment was negative. The marked hepatoesplenomegaly gradually resolved over 26 months follow up and he gained 13 kilogramas in weight. After aminosidine sulphate therapy his Montenegro reaction become positive and his lymphocytes responded to leishmania antigens.

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

    Directory of Open Access Journals (Sweden)

    Diego R.G. Tudela

    2012-06-01

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

  18. Osteosíntesis y artrolisis en el tratamiento de las fracturas supra e intercondíleas graves del codo en el adulto

    OpenAIRE

    Fernández Sabaté, Alfons; Ferrer Escobar, Humberto; Alvarez Gonzalez, A.; Latorre Marti, J.; Orduña Serra, Modesto

    1982-01-01

    Los autores estudian la evoluciónen el tratamiento de las fracturas graves de la extremidad distal del hiimero hasta llegar a la técnica actual de la osteosíntesis estable. Presentan y analizan una serie de 21 fracturas condíleas, supracondíleas y supraintercondíleas tratadas quirtirgicamente mediante abordaje por vía transolecraniana, osteosíntesis con placas y tornillos y fijación del olécranon con compresión. La movilización precoz postoperatoria favorece la obtención de un buen arco móvil...

  19. Mujer joven con hipertiroidismo asociado a insuficiencia tricuspídea grave Young woman with hyperthyroidism associated with severe tricuspid regurgitation

    OpenAIRE

    Ariel K. Saad; Ana A. Pisarevsky; Diego R. González; Manuel Vázquez Blanco; Enrique Petrucci

    2008-01-01

    Las manifestaciones cardiovasculares del hipertiroidismo son frecuentes, y en ocasiones dominan el cuadro clínico. Con frecuencia, la enfermedad se manifiesta por un estado circulatorio hiperdinámico, con disminución de la resistencia vascular periférica, aumento de la volemia y del volumen minuto cardíaco. La dilatación de las cavidades cardíacas con insuficiencia tricuspídea grave e insuficiencia cardíaca derecha sin hipertensión pulmonar constituye una forma inusual de presentación. Se pre...

  20. Tratamiento endovascular simultáneo de la estenosis aórtica grave y aneurisma de aorta abdominal. Reporte de dos casos

    OpenAIRE

    Zaefferer, Patricio; Darío S. Chikiar; Castelli, Mariano A.; Ignacio J. de Luca; Cura, Fernando; Belardi, Jorge

    2017-01-01

    Introducción: Los pacientes con estenosis aórtica grave y aneurisma de la aorta abdominal con alto riesgo quirúrgico pueden beneficiarse del abordaje endovascular. El tratamiento de la estenosis valvular aórtica aumenta el riesgo de rotura del aneurisma de aorta abdominal, por lo que retrasar la reparación del mismo puede poner en riesgo la vida del paciente. El enfoque endovascular simultáneo de ambas patologías es una alternativa posible. Material y método: Presentamos dos casos de impla...

  1. Enhancement of soluble CD28 levels in the serum of Graves' disease.

    Science.gov (United States)

    Sun, Zhongwen; Yi, Lixian; Tao, Hong; Huang, Jingfang; Jin, Zhenghong; Xiao, Yang; Feng, Caiyun; Sun, Jing

    2014-01-01

    Graves' disease is an autoimmune disease of the thyroid gland mediated by T cells. CD28, a member of costimulatory molecules, plays a pivotal role in regulating T-cell responses. Plasma-soluble CD28 is one form of CD28 in peripheral blood. To investigate the concentrations of soluble CD28 in patients with Graves' disease, we used a sensitive dual monoclonal antibody sandwich enzyme-linked immunosorbent assay (ELISA) to detect the soluble form of CD28. Our results suggested that mean concentrations of soluble CD28 in plasma of patients with Graves' disease were 1.79 ±1.52 ng/ml, and levels of soluble CD28 in healthy subjects were only 0.83 ±1.35 ng/ml. Concentrations of soluble CD28 detected in patients with Graves' disease were significantly higher than those of healthy subjects (p Graves' disease. Therefore, aberrant elevation of plasma-soluble CD28 in patients with Graves' disease may reflect the dysregulation of immune system, and may serve as a useful biomarker in Graves' disease diagnosis.

  2. A USE-WEAR ANALYSIS OF THE KNAPPED LITHIC GRAVE GOODS FROM GRUTA DO MORGADO SUPERIOR (TOMAR, PORTUGAL

    Directory of Open Access Journals (Sweden)

    Ana Cruz

    2015-12-01

    Full Text Available The Morgado Superior cave is a karst cave located in the municipality of Tomar (Santarém, Portugal. As other caves of the same area, it has provided stratigraphic data and votive deposits falling within the Holocene, more precisely in a diachronic time range that extends from the Neolithic to the early Bronze Age. In the Morgado Superior cave there are multiple burials with a few votive objects like jars, bone artefacts and lithic tools (blades, arrowheads etc., beads, pendants, and other decorative items in association with more than 8,000 human bones: the number of the grave goods elements is low if compared with the number of individuals buried in the cave. Concerning the use-wear study, we analyzed the grave goods in order to understand both their meaning in this funerary context and their function in the economy of this prehistoric society. We focused on the most representative elements of the grave goods: arrowheads and knapped lithic artefacts. This study led us to understand that the majority of the grave goods were everyday objects but with a strong symbolic value. Since in the Morgado Superior Cave there are a lot of grave goods showing prior breaks, their symbolic value does not seem to be lost even if the objects were broken. Thus, the use-wear analysis of the grave goods from the Morgado Superior Cave allowed us to identify the strong symbolic value of these elements for that human community, but at the same time to hypothesize a funerary practice that did not provide a special respect for the body and the grave goods of those dead previously buried in the cave. For these reasons we hypothesize a progressive spoliation (probably ritual of the previous grave goods. Through the use-wear study of the knapped lithic assemblage of the Morgado Superior Cave it was possible to reconstruct part of the ritual activities that were carried out in the site: the 90% of the lithic artefacts are used objects, all of the artefacts have been

  3. Cytomegalovirus ileitis in an immunocompetent patient Ileítis por citomegalovirus en paciente inmunocompetente

    Directory of Open Access Journals (Sweden)

    María Auxiliadora Tejedor-Cerdeña

    2011-03-01

    Full Text Available Cytomegalovirus (CMV is a virus that belongs to the family of Herpesviridae. Infection can cause a serious disease in immunocompromised patients, but it can also affect immunocompetent patients, creating generally self limiting symptoms. However, in some cases it can be fatal. We present a case of CMV ileitis with serious clinical symptoms that led to an operation in an immunocompetent patient.El citomegalovirus (CMV es un virus perteneciente a la familia de los Herperviridae. La infección puede causar una enfermedad grave en inmunodeprimidos, sin embargo también puede afectar a inmunocompetentes, y da lugar a cuadros clínicos generalmente autolimitados, aunque se han descrito casos graves que pueden llevar a la muerte. Presentamos un caso de ileítis por CMV con manifestaciones clínicas graves que motivaron intervención quirúrgica urgente en un paciente inmunocompetente.

  4. [The corneal biomechanical properties of patients with Graves' orbitopathy].

    Science.gov (United States)

    Zhang, Y; She, X X; Yu, X J; Chen, L F; Shen, L J

    2016-04-11

    This study aims to compare the corneal biomechanical properties of patients with Graves'orbitopathy (GO) with normal people and analysis the correlated factors. Retrospective case series study. 34 eyes of 20 patients (6 eyes are unilateral) diagnosed with inactive Graves' orbitopathy and 25 eyes of 14 patients (3 eyes are unilateral) diagnosed with active Graves' orbitopathy were recruited as study group. 30 eyes of 28 healthy volunteers with age and sex-matched were enrolled as control group in the affiliated eye hospital of Wenzhou medical university from December 2013 to June 2014. Central corneal thickness (CCT) measured with A ultrasound, corneal hysteresis (CH) measured with Ocular Response Analyser (ORA), corneal resistance factor (CRF), Goldman-corrected IOP value (IOPg) and Cornea-Compensated Intraocular Pressure(IOPcc) were collected. An ANONA and Kruskal-Wallis Test was used to compare the indexes mentioned above. The mean age of inactive group was (47.3±12.8)y (23 eyes were female, 11 eyes were male), the mean age of active group was (51.9±9.6)y (16 eyes were female, 9 eyes were male) , the mean age of normal group was (47.2±10.4)y (19 eyes were female, 9 eyes were male). CH of inactive group was (9.68±1.45) mmHg, (1 mmHg=0.133 kPa), CH of active group was (9.82±1.53) mmHg, lower than the CH of (10.67±1.68) mmHg in control group, which was statistically significant different (t1=-2.51,P1=0.014,t2=-2.01,P2=0.048). IOPcc of inactive group was (17.91±3.67) mmHg, IOPcc of active group was (17.88±5.44) mmHg, which were higher than the IOPcc of (13.90±3.39) mmHg in the control group, which was statistically significant different (t1=3.76,P1=0.001;t2= 3.461,P2=0.001). There were no significant difference between study and control group in CRF, that was in inactive group (10.19±1.73)mmHg, active group (10.36±1.01)mmHg, normal group (10.08±1.40)mmHg respectively (t1=0.31,P=0.761;t2=0.69,P2=0.491). CCT of inactive group was (531.41±37.60) μm, CCT of

  5. 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...

  6. Postoperative Outcomes in Graves' Disease Patients: Results from the Nationwide Inpatient Sample Database.

    Science.gov (United States)

    Rubio, Gustavo A; Koru-Sengul, Tulay; Vaghaiwalla, Tanaz M; Parikh, Punam P; Farra, Josefina C; Lew, John I

    2017-06-01

    Current surgical indications for Graves' disease include intractability to medical and/or radioablative therapy, compressive symptoms, and worsening ophthalmopathy. Total thyroidectomy for Graves' disease may be technically challenging and lead to untoward perioperative outcomes. This study examines outcomes in patients with Graves' disease who underwent total thyroidectomy and assesses its safety for this patient population. A retrospective cross-sectional analysis was performed using the Nationwide Inpatient Sample database from 2006 to 2011. Total thyroidectomy performed in patients with Graves' disease, benign multinodular goiter (MNG), and thyroid cancer was identified. Demographic factors, comorbidities, and postoperative complications were evaluated. Chi-square, one-way analysis of variance, and risk-adjusted multivariable logistic regression were performed. Of 215,068 patients who underwent total thyroidectomy during the study period, 11,205 (5.2%) had Graves' disease, 110,124 (51.2%) MNG, and 93,739 (43.6%) thyroid malignancy. Patients with Graves' disease were younger than MNG and thyroid cancer patients (Mage = 42.8 years vs. 55.5 and 51.0 years; p Graves' disease group included a higher proportion of women (p Graves' patients had significantly higher rates of hypocalcemia (12.4% vs. 7.3% and 10.3%; p Graves' disease was independently associated with a higher risk of vocal-cord paralysis (odds ratio [OR] = 1.36 [confidence interval (CI) 1.08-1.69]), tracheostomy (OR = 1.35 [CI 1.1-1.67]), postoperative hypocalcemia (OR = 1.65 [CI 1.54-1.77]), and hematoma requiring reoperation (OR = 2.79 [CI 2.16-3.62]) compared to MNG patients. High-volume centers for total thyroidectomy were independently associated with lower risk of postoperative complications, including in patients with Graves' disease. Despite low overall morbidity following total thyroidectomy, Graves' disease patients are at increased risk of postoperative complications

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

    Directory of Open Access Journals (Sweden)

    Patrícia Grativol Costa

    2008-06-01

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

  8. Avaliação hemodinâmica como critério de prescrição de oxigénioterapia de longo termo na insuficiência respiratória crónica grave secundária a bronquite crónica e enfisema

    OpenAIRE

    Moita, Joaquim; Santos, Moutinho Dos; Arrobas, Ana M.; Marques, Leitão; Pato, Rui

    1995-01-01

    RESUMO: A presença e magnitude da hipertensão da hipertensão da artéria pulmonar (HTAP) tem um impacto negativo no prognóstico dos doentes com Insuficiência Respiratória Crónica Grave (IRCG), definida por PaO2

  9. 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).

  10. 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.

  11. Association study between methylenetetrahydrofolate reductase gene polymorphisms and Graves' disease.

    Science.gov (United States)

    Mao, Renfang; Fan, Yihui; Zuo, Lulu; Geng, Dongfeng; Meng, Fantao; Zhu, Jing; Li, Qiang; Qiao, Hong; Jin, Yan; Bai, Jing; Fu, Songbin

    2010-10-01

    5,10-Methylenetetrahydrofolate reductase (MTHFR) catalyzes the metabolism of folate and nucleotides, which are essential for DNA synthesis and methylation. It is highly polymorphic, and its variant genotypes result in lower enzymatic activity and higher plasma homocysteine. Previous studies have provided evidence that a high prevalence of MTHFR gene polymorphisms is frequently detected in patients with autoimmune disease, suggesting a novel genetic association with autoimmune disorders. However, the genetic association between MTHFR and Graves' disease (GD), one of the most common autoimmune diseases, has not been studied. Here, we designed a clinic-based case-control study including 199 GD cases and 235 healthy controls to examine the associations between three common MTHFR polymorphisms (i.e., C677T, A1298C, and G1793A) and GD. Surprisingly, logistic regression analysis shows MTHFR 677CT + TT genotypes are associated with an approximately 42% reduction in the risk of GD in women (adjusted OR = 0.58, 95% CI = 0.3-0.9), compared to the CC genotype, indicating a significant protective effect of 677CT + TT genotypes. Our result provides epidemiological evidence that MTHFR mutation (C677T) protects women from GD. The protective effect, possibly obtained by influencing DNA methylation, should be confirmed in a large number of cohorts. Copyright © 2010 John Wiley & Sons, Ltd.

  12. [Management of Graves' disease and hypothyroidism in pregnancy].

    Science.gov (United States)

    Momotani, Naoko; Iwama, Saika

    2012-11-01

    In the treatment of pregnant patients with Graves' disease, propylthiouracil is preferred over methimazole in early pregnancy because of a possible teratogenicity of methimazole. Methimazole is preferable to propylthiouracil in other time of pregnancy on the basis of severe liver dysfunction occasionally caused by propylthiouracil. Fetal hypothyroidism can be avoided when maternal free T4 levels are maintained at or above the upper normal limit for non-pregnant subjects. However, maternal free T4 should be kept normal for pregnant reference range when pregnancy complications develop. Fetal hypothyroidism in this setting will not affect the infant's development as long as mothers are euthyroid and the infants recover from hypothyroid state within a short time after birth. In hypothyroid women, 1-T4 dose often needs to be increased in pregnancy. Maternal T4 deficiency in early pregnancy has been suggested to affect normal brain development in the offspring. However, it has recently been shown in iodine rich area that no adverse effect on neuropsychological development was seen irrespective of the severity of maternal T4 deficiency. Insufficient iodine intake in the mother can cause low T4 in pregnancy and also inadequate production of T4 in breast-fed infants when sufficient T4 is essential for normal brain development.

  13. TSHR as a therapeutic target in Graves' disease.

    Science.gov (United States)

    Smith, Terry

    2017-04-01

    Graves' disease (GD) and thyroid-associated ophthalmopathy (TAO) are thought to result from actions of pathogenic antibodies mediated through the thyrotropin receptor (TSHR). This leads to the unregulated consequences of the antibody-mediated receptor activity in the thyroid and connective tissues of the orbit. Recent studies reveal antibodies that appear to be directed against the insulin-like growth factor-I receptor (IGF-IR). Areas covered: In this brief article, I attempt to review the fundamental characteristics of the TSHR, its role in GD and TAO, and its relationship to IGF-IR. Strong evidence supports the concept that the two receptors form a physical and functional complex and that IGF-IR activity is required for some of the down-stream signaling initiated through TSHR. Recently developed small molecules and monoclonal antibodies that block TSHR and IGF-IR signaling are also reviewed in the narrow context of their potential utility as therapeutics in GD and TAO. The Pubmed database was searched from its inception for relevant publications. Expert opinion: Those agents that can interrupt the TSHR and IGF-IR pathways possess the potential for offering more specific and better tolerated treatments of both hyperthyroidism and TAO. This would spare patients exposure to toxic drugs, ionizing radiation and potentially hazardous surgeries.

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

    Directory of Open Access Journals (Sweden)

    Tânia Mara Baraky Bittar

    2012-03-01

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

  15. Important considerations in the management of Graves' disease in pregnant women.

    Science.gov (United States)

    Okosieme, Onyebuchi E; Lazarus, John H

    2015-01-01

    Graves' disease is an autoimmune disorder in which autoantibodies to the thyroid-stimulating hormone receptor cause hyperthyroidism through unregulated stimulation of the thyroid-stimulating hormone receptor. Effective management of Graves' disease in pregnancy must address the competing fetal and maternal priorities of controlling hyperthyroidism in the mother on the one hand, and on the other, minimizing the impact of maternal disease and antithyroid drugs on the well-being of the fetus. Optimal strategies for achieving this intricate balance are currently a source of continued debate among thyroid experts and studies in recent decades are now providing greater clarity into the risk posed to the unborn baby by the combination of biochemical, immunological and pharmacological hazards arising from Graves' disease and its therapy. This review summarizes the current best practice and highlights important considerations and areas of uncertainty in the management of Graves' disease in pregnant women.

  16. Modified lateral orbital wall decompression in Graves' orbitopathy using computer-assisted planning.

    Science.gov (United States)

    Spalthoff, S; Jehn, P; Zimmerer, R; Rana, M; Gellrich, N-C; Dittmann, J

    2018-02-01

    Graves' orbitopathy, a condition seen in the autoimmune syndrome Graves' disease, affects the fatty tissue and muscles inside the orbit. Graves' orbitopathy is associated with increasing exophthalmos and sometimes leads to compressive dysthyroid optic neuropathy, resulting in progressive vision loss. Dysthyroid compressive optic neuropathy, functional problems, and cosmetic problems are the main indications for surgical decompression of the orbit, especially if conservative treatment has not led to a reduction in symptoms. Many surgical techniques are described in the literature. This article presents a modification of the lateral orbital wall osteotomy, involving the rotation and reduction of the osteotomized bone segment using preoperative planning, intraoperative computed navigation, and piezoelectric surgery. This new method combines the advantages of different techniques and appears to be a valid approach to the treatment of severe cases of Graves' orbitopathy. Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  17. Refinements to the Graves and Pitarka (2010) Broadband Ground-Motion Simulation Method

    Energy Technology Data Exchange (ETDEWEB)

    Graves, R.; Pitarka, A.

    2014-12-17

    This brief article describes refinements to the Graves and Pitarka (2010) broadband ground-motion simulation methodology (GP2010 hereafter) that have been implemented in version 14.3 of the Southern California Earthquake Center (SCEC) Broadband Platform (BBP).

  18. A questionnaire survey on the management of Graves' orbitopathy in Europe

    NARCIS (Netherlands)

    Perros, P.; Baldeschi, L.; Boboridis, K.; Dickinson, A. J.; Hullo, A.; Kahaly, G. J.; Kendall-Taylor, P.; Krassas, G. E.; Lane, C. M.; Lazarus, J. H.; Marcocci, C.; Marino, M.; Mourits, M. P.; Nardi, M.; Orgiazzi, J.; Pinchera, A.; Pitz, S.; Prummel, M. F.; Wiersinga, W. M.

    2006-01-01

    OBJECTIVE: To determine management patterns among clinicians who treat patients with Graves' orbitopathy (GO) in Europe. DESIGN AND METHODS: Questionnaire survey including a case scenario of members of professional organisations representing endocrinologists, ophthalmologists and nuclear medicine

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

    NARCIS (Netherlands)

    A.D.A. Paridaens (Dion); K. Verhoeff; D. Bouwens; W.A. van den Bosch (Willem)

    2000-01-01

    textabstractAIMS: A modified surgical technique is described to perform a one, two, or three wall orbital decompression in patients with Graves' ophthalmopathy. METHODS: The lateral wall was approached ab interno through a "swinging eyelid" approach (lateral canthotomy

  20. Ejercicio y la detección del mal agudo de montaña grave Exercise and the detection of severe acute mountain sickness

    Directory of Open Access Journals (Sweden)

    Adrián Garófoli

    2010-02-01

    Full Text Available El mal agudo de montaña (MAM es un conjunto de síntomas inespecíficos padecidos por sujetos que ascienden rápidamente desde baja a alta altura sin adecuada aclimatación. Usualmente es autolimitado, pero las formas graves (edema pulmonar y cerebral pueden causar la muerte. La hipoxemia exagerada en reposo está relacionada con el desarrollo de MAM pero su valor predictivo es limitado. Dado que el ejercicio en altura se acompaña de mayor hipoxemia y síntomas, postulamos el valor predictivo de un simple test de ejercicio para pronosticar MAM grave. Se estudió el valor predictivo de la saturación de oxígeno en reposo y ejercicio submáximo a 2.700 m y 4 300 m en 63 sujetos que ascendían al cerro Aconcagua (6 962 m. Se consideró desaturación de oxígeno con ejercicio a una disminución = 5% respecto al reposo. Se utilizó la escala de Lake-Louise para establecer la presencia de MAM grave. Seis sujetos presentaron MAM grave (9.5% y requirieron evacuación. La saturación de oxígeno en reposo a 2.700 m no fue significativa para clasificar sujetos que luego desarrollaron MAM grave. Por el contrario, la asociación de desaturación durante el ejercicio a 2.700 m más la saturación inapropiada en reposo a 4.300 m fue significativa para clasificar a los sujetos que desarrollaron MAM grave con un valor predictivo positivo de 80% y un valor predictivo negativo del 97%. Nuestros resultados son relevantes para el montañismo y sugieren la adición de un simple test de ejercicio en la predicción del MAM grave.Acute mountain sickness (AMS is a group of non-specific symptoms, seen in subjects that ascend from low to high altitude too quickly, without allowing sufficient time to acclimatize. Usually it is self-limiting, but the severe forms (pulmonary and cerebral edema can be fatal. Exaggerated hypoxemia at rest is related to later development of AMS but its predictive value is limited. Since exercise at altitude induces greater hypoxemia and

  1. Une mucormycose faciale compliquant une angiocholite grave: ? propos d?un cas

    OpenAIRE

    Lakhdar, Karim; Houari, Naoufal; Elbouazzaoui, Abderrahim; Ameuraoui, Taoufik; Boukatta, Brahim; Sbai, Hicham; Kanjaa, Nabil

    2016-01-01

    Les mucormycoses sont des infections fongiques opportunistes survenant chez des patients immunod?prim?s. C?est une affection grave compromettant le pronostic vital. M?me diagnostiqu?e pr?cocement, la mortalit? des mucormycoses atteint 50%. Nous rapportons le cas d?une mucormycose chez une patiente diab?tique hospitalis?e en r?animation pour angiocholite grave. L??volution ?tait fatale.

  2. Paludisme grave en milieu rural Camerounais: Problématique d'un ...

    African Journals Online (AJOL)

    Le Paludisme grave est souvent cause d'importants déficits moteurs, sensoriels et intellectuels en Afrique. Un enfant de 15 mois a été hospitalisé pour paludisme grave à Plasmodium falciparum avec des convulsions répétées, coma et anémie. Traité en première intention et sans succès avec la quinine, il a présenté des ...

  3. Brulures graves chez l'enfant : Aspects épidémiologiques et ...

    African Journals Online (AJOL)

    Les brûlures représentent 70% des accidents domestiques des enfants. Les brûlures graves sont responsables d'importantes perturbations mettant en jeu le pronostic vital. Cette étude s'est proposée de définir les caractéristiques épidémiologiques et les modalités thérapeutiques des brûlures graves chez les enfants ...

  4. Análise do filme lacrimal e sua relação com a largura da fenda palpebral e a exoftalmia na oftalmopatia de Graves Tear film analysis and its relation with palpebral fissure height and exophthalmos in Graves' ophthalmopathy

    Directory of Open Access Journals (Sweden)

    Maria Vitoria Oliveira Moura Brasil

    2005-10-01

    Full Text Available OBJETIVO: Avaliar qualidade do filme lacrimal pelo corante rosa bengala e sua estabilidade por meio do tempo de ruptura, relacionando com a largura da fenda palpebral e a exoftalmia em pacientes com oftalmopatia de Graves. MÉTODOS: Foram estudados 54 olhos de 27 pacientes com oftalmopatia de Graves, tanto em fase inflamatória quanto em fase crônica. A avaliação consistiu de análise qualitativa do filme lacrimal pelo corante rosa bengala por meio da classificação de van Bijsterveld, análise da estabilidade do filme lacrimal pelo tempo de ruptura, medida da largura da fenda palpebral e exoftalmometria. A análise estatística foi realizada com o teste do Qui-quadrado. RESULTADOS: Entre os 27 pacientes estudados, 77,8% eram do sexo feminino e 22,2% do masculino. A idade média foi de 44,26 anos (DP 12,67. O tempo médio de doença foi de 5,85 anos (DP 4,47 e o de oftalmopatia foi de 5,81 anos (DP 5,37. Dos 54 olhos em estudo, 37% apresentaram teste positivo pela escala de graduação de van Bijsterveld, 33,3% tempo de ruptura do filme lacrimal menor que 5 segundos, 57,4% largura da fenda palpebral maior que 11 mm e 55,6% exoftalmometria maior que 19 mm. Quando relacionamos o tempo de ruptura do filme lacrimal menor que 5 segundos com a largura da fenda palpebral maior que 11 mm encontramos odds ratio igual a 11,2 (p=0,0008. As demais relações estudadas não mostraram significância estatística. CONCLUSÕES: O olho seco diagnosticado pela coloração com rosa bengala e pelo tempo de ruptura do filme lacrimal ocorre com freqüência na oftalmopatia de Graves. A largura da fenda palpebral correlaciona-se com o tempo de ruptura do filme lacrimal na oftalmopatia de Graves. Seu aumento pode levar à instabilidade do filme lacrimal.PURPOSE: To evaluate tear film quality by rose bengal staining and its stability by breakup time, relating with palpebral fissure height and exophthalmos in patients with Graves' ophthalmopathy. METHODS: We studied

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

    Science.gov (United States)

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

    2015-12-01

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

  6. Pooled genome wide association detects association upstream of FCRL3 with Graves' disease.

    Science.gov (United States)

    Khong, Jwu Jin; Burdon, Kathryn P; Lu, Yi; Laurie, Kate; Leonardos, Lefta; Baird, Paul N; Sahebjada, Srujana; Walsh, John P; Gajdatsy, Adam; Ebeling, Peter R; Hamblin, Peter Shane; Wong, Rosemary; Forehan, Simon P; Fourlanos, Spiros; Roberts, Anthony P; Doogue, Matthew; Selva, Dinesh; Montgomery, Grant W; Macgregor, Stuart; Craig, Jamie E

    2016-11-18

    Graves' disease is an autoimmune thyroid disease of complex inheritance. Multiple genetic susceptibility loci are thought to be involved in Graves' disease and it is therefore likely that these can be identified by genome wide association studies. This study aimed to determine if a genome wide association study, using a pooling methodology, could detect genomic loci associated with Graves' disease. Nineteen of the top ranking single nucleotide polymorphisms including HLA-DQA1 and C6orf10, were clustered within the Major Histo-compatibility Complex region on chromosome 6p21, with rs1613056 reaching genome wide significance (p = 5 × 10-8). Technical validation of top ranking non-Major Histo-compatablity complex single nucleotide polymorphisms with individual genotyping in the discovery cohort revealed four single nucleotide polymorphisms with p ≤ 10-4. Rs17676303 on chromosome 1q23.1, located upstream of FCRL3, showed evidence of association with Graves' disease across the discovery, replication and combined cohorts. A second single nucleotide polymorphism rs9644119 downstream of DPYSL2 showed some evidence of association supported by finding in the replication cohort that warrants further study. Pooled genome wide association study identified a genetic variant upstream of FCRL3 as a susceptibility locus for Graves' disease in addition to those identified in the Major Histo-compatibility Complex. A second locus downstream of DPYSL2 is potentially a novel genetic variant in Graves' disease that requires further confirmation.

  7. Comparative analysis of radioactive iodine versus thyroidectomy for definitive treatment of Graves disease.

    Science.gov (United States)

    Wu, Vincent T; Lorenzen, Allison W; Beck, Anna C; Reid, Vincent J; Sugg, Sonia L; Howe, James R; Pollard, Janet H; Lal, Geeta; Weigel, Ronald J

    2017-01-01

    Management of Graves disease includes antithyroid drugs, 131I therapy, or thyroidectomy. Our aim was to review our institutional experience with definitive treatments for Graves disease. This was a retrospective review of patients undergoing 131I therapy (n = 295) or thyroidectomy (n = 103) for Graves disease (2003-2015). Demographic, clinical, pathology, and outcome data were collected from institutional databases. 131I therapy patients were older (39.1 years vs 33.4 years, P = .001). There was no difference in the presence of ophthalmopathy between groups. A larger proportion of children received thyroidectomy than 131I therapy (17.1% vs 9.2%, P = .026). The success rate of the first 131I therapy dose was 81.4%. Overall success rate, including additional doses, was 90.1%. Rapid turnover of iodine correlated with 131I therapy failure (58.3% rapid turnover failure vs 14.9% non-rapid turnover failure, P Graves disease among surgical patients. A higher proportion of pediatric Graves disease patients underwent thyroidectomy than 131I therapy. Rapid turnover suggested more effective initial management with operation than 131I therapy. Although transient operative complications were high, 131I therapy complications included worsening of Graves orbitopathy among those with pre-existing orbitopathy. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. The role of diffusion weighted MR imaging for differentiation between Graves' disease and Hashimoto thyroiditis.

    Science.gov (United States)

    Ozturk, T; Bozgeyik, Z; Ozturk, F; Burakgazi, G; Akyol, M; Coskun, S; Ozkan, Y; Ogur, E

    2015-08-01

    The aim of this study was to evaluate the usefulness of diffusion-weighted magnetic resonance imaging (DWMRI) for differentation between Graves' disease and Hashimoto's thyroiditis. Fifty patients (27 Graves diseases and 23 Hashimoto thyroiditis) and twenty healthy volunteers were examined using T1, T2 and DWMRI. The patients were diagnosed on the basis of physical findings and the results of thyroid function tests and serological tests. Circular ROIs were positioned on the bilateral thyroid lobes and isthmus. All measurements were repeated three different b values including 100, 600 and 1000 s/mm2 in all cases. ADC (Apparent diffusion coefficient) maps were calculated automatically with the MR system. Mean ADC values were 2.93 × 10-3, 1.97 × 10-3 and 1.62 × 10-3 mm2/s in the healthy volunteers; 3.47 × 10-3, 2.25 × 10-3 and 1.64 × 10-3 mm2/s in Graves' disease; 2.53 × 10-3, 1.76 × 10-3, 1.28 × 10-3 mm2/s in Hashimoto thyroiditis for b100, b600 and b1000, respectively. The ADC values of the Graves diseases were higher than healty volunteers and Hashimoto thyroiditis. ADC values were statistically significant for differentation between Hashimoto thyroiditis and Graves' disease all b values (p Hashimoto thyroiditis and Graves' disease.

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

    Directory of Open Access Journals (Sweden)

    Lucas Lima Ferreira

    2013-12-01

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

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

    Directory of Open Access Journals (Sweden)

    Ariel Karolinski

    2015-05-01

    Full Text Available La mortalidad materna es un importante problema de salud pública y de derechos humanos y refleja los efectos de los determinantes sociales sobre la salud de las mujeres. El conocimiento de la magnitud y las causas de las muertes maternas ha sido insuficiente para intervenir efectivamente en el alcance de los Objetivos de Desarrollo del Milenio. Por ello, se plantea un modelo para abordar integralmente la mortalidad materna, con siete campos: priorización y definición del problema, caracterización contextual, amplitud metodológica, gestión del conocimiento, innovación, implementación, y un sistema de monitoreo y evaluación. Este modelo permite abordar los problemas asociados con la mortalidad materna y la morbilidad materna grave mediante la integración, desde una perspectiva anticipatoria, de las complicaciones potencialmente fatales asociadas con el proceso reproductivo y su vigilancia. Se destaca la importancia de la gestión del conocimiento para la reorientación de políticas, programas y la atención sanitaria. Se debe mejorar la interacción y explotar las sinergias entre las personas, las comunidades y los actores del sistema de salud para potenciar los resultados de los programas sanitarios. Se requiere más información científica validada sobre la forma en que las intervenciones deben aplicarse en diferentes entornos. Para ello, es esencial fortalecer la articulación entre los centros de investigación, las agencias de cooperación y los organismos del Estado y su incorporación a las acciones programáticas y a la definición de una nueva agenda de salud de la mujer para la Región de las Américas.

  11. Características de los exámenes de laboratorio en pacientes con dengue grave en un hospital de Puerto Maldonado - Perú

    Directory of Open Access Journals (Sweden)

    Jesús Rojas-Jaimes

    2014-07-01

    Full Text Available Introducción: Puerto Maldonado, capital del Departamento de Madre de Dios, es catalogado como zona endémica de dengue. La clasificación de dengue considera al dengue grave (hemorrágico cuando se produce shock, distrés respiratorio o compromiso de órgano blanco. Objetivos: Determinar las características de los exámenes de laboratorio en pacientes con dengue grave hospitalizados en la Unidad de Cuidados Intermedios del Hospital Santa Rosa de Puerto Maldonado, Madre de Dios, Perú. Diseño: Estudio retrospectivo de corte transversal. Institución: Laboratorio Central y Departamento de Epidemiología del Hospital Santa Rosa, Madre de Dios, Perú. Materiales: Cincuenta y cinco historias clínicas de pacientes con diagnóstico de dengue grave hospitalizados en la Unidad de Cuidados Intermedios, en el periodo junio de 2010 a noviembre de 2011. Métodos: Se analizó los resultados de exámenes de laboratorio solicitados durante la hospitalización. Principales medidas de resultados: Valores de transaminasas, creatinina, hemograma completo y examen de orina. Resultados: El mayor número de pacientes con dengue grave procedió de Puerto Maldonado (84%. El grupo etario mayormente afectado fue el de 40 a 49 años (32%. En 83% de los pacientes hospitalizados se presentó elevación de las transaminasas y de la creatinina sérica. El recuento de plaquetas estuvo dentro de rangos normales, excepto en el grupo de 10 a 19 años (11%, en quienes se halló concentraciones séricas de plaquetas menores a 150 000/mL. Conclusiones: En la mayoría de pacientes hospitalizados por dengue grave en Puerto Maldonado existió elevación sérica de transaminasas y creatinina. El recuento de plaquetas fue normal, pero existió plaquetopenia en el grupo de 10 a 19 años.

  12. Cuatro métodos de predicción de riesgo de infección bacteriana grave en recién nacidos febriles Four methods to predict the severe bacterial infection risk in the febrile newborns

    OpenAIRE

    Manuel Díaz Álvarez; Daniel Claver Isás; Heidy González Trujillo; Humberto Martínez Canalejo

    2010-01-01

    INTRODUCCIÓN. El objetivo de esta investigación fue contrastar la efectividad de 4 métodos de evaluación de riesgo de infección bacteriana grave (IBG) en recién nacidos (RN) febriles, uno de los cuales fue desarrollado por los autores del trabajo y los otros son los utilizados en la práctica internacional. MÉTODOS. Se realizó un estudio descriptivo, retrospectivo y aplicado de 1358 RN febriles sin signos de focalización evaluados y clasificados por riesgo de IBG. Fue aplicado el método propue...

  13. 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.

  14. Prise en charge des traumatismes graves du rein

    Science.gov (United States)

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

    2015-01-01

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

  15. 347. Insuficiencia tricuspídea grave 13 años tras traumatismo torácico: una causa infrecuente de reparación valvular

    OpenAIRE

    Arroyo, J; S. Di Stéfano; Maroto, L; Valenzuela, H.; G. Laguna; Pareja, M.; Arnold, R.J.; Fernández, M; S. Flórez; J.R. Echevarría; N. Arce; Y. Carrascal; Fulquet, E.

    2012-01-01

    La insuficiencia tricuspídea postraumática es una complicación poco frecuente. Presentamos un caso de reparación valvular exitosa por insuficiencia grave de varios años de evolución tras traumatismo cerrado de tórax. Métodos: Paciente de 31 años de edad, asintomático, es-tudiado por soplo cardíaco como hallazgo casual. Sin factores de riesgo cardiovascular conocidos. Accidente de tráfico a los 18 años con politraumatismo. Al examen físico tenía ingurgitación yugular a 45° y un soplo holosi...

  16. Multi-center study on the characteristics and treatment strategies of patients with Graves' orbitopathy: the first European Group on Graves' Orbitopathy experience

    NARCIS (Netherlands)

    Prummel, Mark F.; Bakker, Annemieke; Wiersinga, Wilmar M.; Baldeschi, Lelio; Mourits, Maarten P.; Kendall-Taylor, Pat; Perros, Petros; Neoh, Chris; Dickinson, A. Jane; Lazarus, John H.; Lane, Carol M.; Heufelder, Armin E.; Kahaly, George J.; Pitz, Suzanne; Orgiazzi, Jacques; Hullo, Alain; Pinchera, Aldo; Marcocci, Claudio; Sartini, Maria S.; Rocchi, Roberto; Nardi, Marco; Krassas, Gerry E.; Halkias, A.

    2003-01-01

    To improve management of patients with Graves' orbitopathy, a multi-center collaborative approach is necessary in order to have large enough sample sizes for meaningful randomized clinical trials. This is hampered by a lack of consensus on how to investigate the eye condition. The European Group on

  17. Derrame pericárdico grave. Ventana pericárdica percutánea con balón

    Directory of Open Access Journals (Sweden)

    Carlos A. Bruno

    2008-01-01

    Full Text Available La mayoría de los pacientes con derrame pericárdico crónico son mujeres y mayores de 50 años. En esta presentación se describe el caso de una paciente de 63 años con derrame pericárdico crónico grave, con antecedente de carcinoma de mama izquierda irradiado, diagnóstico presuntivo no confirmado de tuberculosis pulmonar e hipotiroidea sustituida. Ante la recurrencia del derrame luego de pericardiocentesis y el fracaso del tratamiento antiinflamatorio con AINE se decidió realizar una ventana pericárdica percutánea, sin que se presentaran complicaciones técnicas. Se inició tratamiento con colchicina y se evaluaron las posibles causas: tuberculosa, oncológica, secundaria a hipotiroidismo o por radiación. Por exclusión se llegó a la etiología radiante. Al mes de la realización de la ventana pericárdica no se observaba derrame pericárdico en el ecocardiograma.

  18. Revisión y recomendaciones sobre la prevención, diagnóstico y tratamiento de la infección posnatal por citomegalovirus

    National Research Council Canada - National Science Library

    Alarcón Allen, A; Baquero-Artigao, F

    2011-01-01

    ... maternas, la cual ocurre principalmente después de las 28 semanas de gestación. Estos niños son susceptibles a la infección posnatal por CMV, que puede tener un curso sintomático, en ocasiones grave 1–21 . El presente documento se centra en la infección adquirida por CMV en el RN, desde el momento del parto (por contacto con las secreciones cervicales ma...

  19. Mujer joven con hipertiroidismo asociado a insuficiencia tricuspídea grave Young woman with hyperthyroidism associated with severe tricuspid regurgitation

    Directory of Open Access Journals (Sweden)

    Ariel K. Saad

    2008-02-01

    Full Text Available Las manifestaciones cardiovasculares del hipertiroidismo son frecuentes, y en ocasiones dominan el cuadro clínico. Con frecuencia, la enfermedad se manifiesta por un estado circulatorio hiperdinámico, con disminución de la resistencia vascular periférica, aumento de la volemia y del volumen minuto cardíaco. La dilatación de las cavidades cardíacas con insuficiencia tricuspídea grave e insuficiencia cardíaca derecha sin hipertensión pulmonar constituye una forma inusual de presentación. Se presenta el caso de una joven paciente, portadora de enfermedad de Graves Basedow, sin antecedentes cardiovasculares, que evoluciona en el transcurso de un mes con edema de miembros inferiores, palpitaciones, diarrea, pérdida de peso y fiebre. Al examen clínico se evidencian taquicardia con pulso irregular, signos de insuficiencia cardíaca derecha acompañado de un intenso soplo regurgitante que aumentaba con la inspiración. Por radiografía de tórax y ecocardiograma se constata cardiomegalia e insuficiencia tricuspídea grave sin hipertensión pulmonar. El cuadro se resuelve en forma rápida luego del tratamiento con propranolol, corticoides y diuréticos, con reversión de la arritmia y franca mejoría de los signos y síntomas. Se analizan en forma breve los efectos de las hormonas tiroideas en el aparato cardiovascular y se postulan probables mecanismos fisiopatológicos de la insuficiencia cardíaca en el hipertiroidismo.Cardiovascular manifestations of hyperthyroidism are frequent and sometimes are relevant in the clinical picture. Usually an hyperdynamic circulatory state hallmarks the disease with low peripheral resistance, increased intravascular volume and cardiac output. However, right chamber dilatation with tricuspid valve regurgitation and cardiac failure are unusual. We present the case of a young woman with Graves-Basedow disease without cardiovascular history who complained about palpitations, peripheral edemas, weight loss and

  20. Identification process in mass graves from the Spanish Civil War I.

    Science.gov (United States)

    Ríos, Luis; Ovejero, José Ignacio Casado; Prieto, Jorge Puente

    2010-06-15

    The identification process of human skeletal remains exhumed from a mass grave from the Spanish Civil War (1936-1939) is presented. Information regarding the presumptive location of the grave and the presumptive number and identities of the persons buried in the grave was collected from interviews and written records from relatives and witnesses, as well as from research at the penitentiary archive. Antemortem individual data were collected from testimonies, and from research from penitentiary, army and civil archives. The consistency between data obtained from testimonies, archives, archaeology and osteology allowed a targeted approach to DNA typing based on the assumption of the finding of a closed synchronic group. Two were the first genetic studies requested: the first study focused in the identification of a family group presumptively buried in the grave, compatible with a group of four skeletons that were associated on the basis of dental non-metric traits; the second study focused on the identification of the youngest person presumptively buried at the grave, compatible with the biologically youngest skeleton exhumed. A complete match between 16 Y-STR loci was observed for the four skeletons, as well as a match between mtDNA profiles of the biologically youngest skeleton and the sister of the youngest person presumptively known to be buried in the grave. These results, together with the accumulated evidence, led to propose the identification of these five persons. To date, identifications have been proposed for 17 out of 46 skeletons exhumed from the grave. (c) 2010 Elsevier Ireland Ltd. All rights reserved.

  1. Comparison of Bilateral Axillo-Breast Approach Robotic Thyroidectomy with Open Thyroidectomy for Graves' Disease.

    Science.gov (United States)

    Kwon, Hyungju; Yi, Jin Wook; Song, Ra-Yeong; Chai, Young Jun; Kim, Su-jin; Choi, June Young; Lee, Kyu Eun

    2016-03-01

    There is an ongoing debate about whether robotic thyroidectomy (RT) is appropriate for Graves' disease. The aim of this study was to compare the safety of bilateral axillo-breast approach (BABA) RT with that of open thyroidectomy (OT) in patients with Graves' disease. From January 2008 to June 2014, 189 (44 BABA RT and 145 OT) patients underwent total thyroidectomy for Graves' disease. Recurrence of Graves' disease, intraoperative blood loss, hospital stay, and complication rates including recurrent laryngeal nerve (RLN) palsy and hypoparathyroidism were analyzed between BABA RT and OT groups, after propensity score matching according to age, gender, body mass index, surgical indication, the extent of operation, excised thyroid weight, and follow-up period. No patient experienced recurrence of Graves' disease after median follow-up of 35.0 months. Intraoperative blood loss (151.8 ± 165.4 mL vs. 134.5 ± 75.4 mL; p = 0.534) and hospital stay (3.4 ± 0.7 day vs. 3.3 ± 0.7 day; p = 0.564) were not different between BABA RT and OT groups. Complication rates including transient RLN palsy (11.4 vs. 11.4%; p = 1.000), transient hypoparathyroidism (18.2 vs. 20.5%; p = 0.787), permanent RLN palsy (0 vs. 2.3%; p = 0.315), and permanent hypoparathyroidism (2.3 vs. 2.3%; p = 1.000) were also comparable between groups. BABA RT for Graves' disease showed comparable surgical completeness and complications to conventional OT. BABA RT can be recommended as an alternative surgical option for patients with Graves' disease who are concerned about cosmesis.

  2. Respuesta al entrenamiento en EPOC: Diferencia entre limitación por fatiga muscular y por disnea

    OpenAIRE

    Martín Sívori; Laura Bustamante; Alejandro Martínez Fraga; Marta Almeida; César Saenz

    2011-01-01

    Este estudio comparó la respuesta post entrenamiento al ejercicio en pacientes limitados por fatiga muscular (LF) vs. disnea (LD). Se incluyeron pacientes con EPOC moderada y grave (definición GOLD), clasificándolos en LF si la respuesta a cicloergometría máxima tenía ≥ 2 puntos en la escala de Borg para fatiga muscular vs. disnea; LD a la inversa. Se realizaron ergometría submáxima, 6 minutos y pruebas de calidad de vida mediante cuestionario. Fueron entrenados 3 veces/semana, 90 min/sesión ...

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

    Directory of Open Access Journals (Sweden)

    Douglas, Lee

    2014-12-01

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

  4. Graves disease in children: thyroid-stimulating hormone receptor antibodies as remission markers.

    Science.gov (United States)

    Gastaldi, Roberto; Poggi, Elena; Mussa, Alessandro; Weber, Giovanna; Vigone, Maria Cristina; Salerno, Mariacarolina; Delvecchio, Maurizio; Peroni, Elena; Pistorio, Angela; Corrias, Andrea

    2014-05-01

    To evaluate clinical and biochemical features of 115 children (98 female, mean age 11.3 ± 3.5 years) with Graves disease to identify possible determinants of remission. We defined as positive outcome the improvement of clinical features and restoration of euthyroidism or induction of hypothyroidism after antithyroid drug (ATD) therapy and as negative outcome hyperthyroidism persistent over 2 years of ATD therapy or relapsed after ATD withdrawal. Thirty-eight children (33%) had remission after 2 years of ATD therapy. The absence of goiter at diagnosis was correlated with a better outcome. Median thyroid-stimulating hormone receptor antibody (TRAb) values at diagnosis were significantly lower in patients with a positive outcome (P = .031). We found a significant relationship between the time required for TRAb normalization and the patient outcome; TRAb normalization within 1 year from time of Graves disease diagnosis was significantly more common among patients with a positive outcome (P Graves disease outcome was serum level; TRAb at time of Graves disease diagnosis less than 2.5 times the upper reference limit, TRAb normalization during ATD, and TRAb normalization timing each may predict positive outcomes. These results may have a role in the empiric clinical management of pediatric patients with Graves disease. Copyright © 2014 Elsevier Inc. All rights reserved.

  5. Sustained long-term improvement with clozapine in schizophrenia Clozapina na esquizofrenia grave: melhora duradoura e sustentada

    Directory of Open Access Journals (Sweden)

    RICARDO DE OLIVEIRA-SOUZA

    1999-03-01

    Full Text Available The present paper reports the long-term use of clozapine in a prospective sample of 46 chronic schizophrenics. In six months, 21 subjects had been excluded for a number of reasons. In four of them the reasons for exclusion were related to lack of response or adverse effects. The median daily clozapine dose was 400 mg in the remaining 25 patients. As a whole, there were remarkable improvements in core dimensions of psychopathology, global cognitive status, and level of functioning. We confirmed that clozapine is effective in a subgroup of schizophrenics with the severest forms of the disease. If tolerated after the first few months it leads to progressive gains in several domains of behavior. Clozapine should be tried in every patient with schizophrenia in whom positive symptoms, disorganization, or bizarre behavior are a matter of incapacitation despite efforts to keep them under control with other drugs.O presente estudo, prospectivo, relata o uso de longo-prazo da clozapina em 46 esquizofrênicos graves, com mais de cinco anos de doença. Com seis meses de uso da droga, 21 indivíduos haviam sido excluídos por diversas razões. Em quatro, a exclusão se deveu a efeitos adversos ou ausência de resposta. A dose mediana de clozapina foi de 400 mg nos demais 25 pacientes. No todo, observamos melhora em dimensões de psicopatologia, estado cognitivo global, e nível funcional. Concluímos que a clozapina é eficaz em um subgrupo de esquizofrênicos com formas graves da doença. Se tolerada depois dos primeiros meses, produz benefícios progressivos em diversos domínios do comportamento. Clozapina deve ser tentada em todo paciente com esquizofrenia incapacitado por sintomas positivos, desorganização, e/ou comportamentos bizarros, que persistem a despeito de esforços para mantê-los sob controle com outras drogas.

  6. Politraumatizados com trauma craniencefálico grave: importância das lesões abdominais associadas

    Directory of Open Access Journals (Sweden)

    José Gustavo Parreira

    Full Text Available OBJETIVO: Analisar as lesões abdominais dos politraumatizados com trauma craniencefálico (TCE grave. MÉTODO: Realizou-se avaliação retrospectiva dos prontuários das vítimas de TCE no período de 1996 a 1997. Foram selecionados para o estudo os com Escala de Coma de Glasgow (ECG < 8 à admissão. Cinquenta e dois politraumatizados foram incluídos, com média etária de 37 anos, sendo 44 do sexo masculino. Avaliamos os dados demográficos, índices de trauma (RTS, ISS, exames complementares, tratamento e evolução. A análise estatística foi realizada com os testes qui quadrado, t de Student, exato de Fisher e cálculo do odds ratio, considerando-se p < 0,05 como estatisticamente significante. RESULTADOS: A média do RTS foi 5,18 e do ISS foi 27. O mecanismo de trauma mais freqüente foi o atropelamento, em 25 casos. Nenhum destes doentes teve diagnóstico de lesão abdominal apenas pelo exame físico. Quarenta e quatro doentes foram avaliados por lavagem peritoneal diagnóstica e 8 por ultra-sonografia ou tomografia computadorizada abdominal. Oito doentes (15% apresentaram lesões abdominais, havendo 5 lesões hepáticas, 4 esplênicas e uma em cólon. Realizou-se 17 craniotomias e 8 laparotomias (4 não terapêuticas. As lesões abdominais estiveram relacionadas à pressão arterial sistólica menor que 90mmHg (p=0,05 à admissão e à presença de lesões ortopédicas de tratamento operatório (p<0,001. A letalidade foi 71%. CONCLUSÃO: Uma parcela considerável dos traumatizados com TCE grave apresenta lesões abdominais e o exame físico contribui pouco para o seu diagnóstico. Justifica-se a investigação objetiva do abdome com métodos complementares em todos estes casos.

  7. Efeito rebote dos fármacos modernos: evento adverso grave desconhecido pelos profissionais da saúde

    Directory of Open Access Journals (Sweden)

    Marcus Zulian Teixeira

    2013-12-01

    Full Text Available OBJETIVO: Apoiado no aforismo hipocrático primum non nocere, o princípio bioético da não maleficência roga que o ato médico cause o menor dano ou agravo à saúde do paciente, incumbindo ao médico avaliar os riscos de determinada terapêutica por meio do conhecimento dos possíveis eventos adversos das drogas. Dentre esses, o efeito rebote representa um efeito colateral comum a inúmeras classes de fármacos modernos, podendo causar transtornos graves e fatais nos pacientes. Esta revisão tem o objetivo de esclarecer os profissionais da saúde sobre os aspectos clínicos e epidemiológicos do fenômeno rebote. MÉTODOS: Uma revisão qualitativa, exploratória e bibliográfica foi realizada na base de dados PubMed utilizando os unitermos 'rebound', 'withdrawal', 'paradoxical', 'acetylsalicylic acid', 'anti-inflammatory', 'bronchodilator', 'antidepressant', 'statin', 'proton pump inhibitor' and 'bisphosphonate' RESULTADOS: O efeito rebote ocorre após a descontinuação de inúmeras classes de fármacos com ação contrária aos distúrbios da doença, exacerbando-os a níveis superiores aos anteriores do tratamento. Independente da doença,dadrogaedaduração do tratamento, o fenômeno se manifesta numa pequena proporção de indivíduos suscetíveis. No entanto, pode causar eventos adversos graves e fatais, devendo ser considerado um problema de saúde pública em vista do enorme consumo de fármacos pela população CONCLUSÃO: Reunindo um corpo de evidências crescente e inquestionável, o médico precisa ter conhecimento das consequências do efeito rebote e de como minimizá-lo, aumentando a segurança no manejo das drogas modernas. Por outro lado, este efeito rebote pode ser utilizado de forma curativa, ampliando o espectro da terapêutica moderna.

  8. Tratamento conservador de trauma renal grave após litotripsia extracorpórea por ondas de choque

    Directory of Open Access Journals (Sweden)

    Giovanni Scala Marchini

    Full Text Available Subcapsular and perinephric hematomas are relatively common after shock-wave lithotripsy, but high-grade kidney injuries are extremely rare. We present the first case of a high-grade kidney injury after shock-wave lithotripsy managed conservatively. A 57-year-old white female patient with left 1.5cm superior ureteral calculi was submitted to shock-wave lithotripsy.

  9. Infecciones genitales por VPH tratadas por microinmunoterapia

    National Research Council Canada - National Science Library

    Jacques Grauwet, Diego

    2011-01-01

    ... genitales por VPH tratadas por microinmunoterapia Diego Jacques Grauwet Médico ginecólogo y homeópata, Madrid, España Recibido el 30 de mayo de 2010; aceptado el 10 de septiembre de 2011 Correo...

  10. Análise da prevenção e tratamento das úlceras por pressão propostos por enfermeiros

    OpenAIRE

    Medeiros, Adriana Bessa Fernandes; Lopes, Consuelo Helena Aires de Freitas; Jorge, Maria Salete Bessa

    2009-01-01

    A úlcera por pressão ainda é considerada um problema grave, especialmente em pessoas idosas e nas situações de adoecimento crônico-degenerativo. O objetivo do estudo consistiu em identificar as produções bibliográficas sobre ações de prevenção e tratamento realizadas por enfermeiros publicadas no período de 1999 a 2004, descrevendo o conhecimento produzido na temática. Trata-se de levantamento bibliográfico descritivo de periódicos de enfermagem indexados na LILACS e MEDLINE, acerca da temáti...

  11. 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

    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...... 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...... relations, belonging and coherence that are both individual and relational and that are made possible by ritually establishing online memorials and graves as heterotopic interfaces that opens certain communicational flows and accesses specific communicative spaces concerning most prominently the ongoing...

  12. 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...... patients with Graves' thyrotoxicosis. A control group of 34 individuals matched for age, education and premorbid intelligence was also included. At baseline all patients and control subjects were examined with psychiatric rating scales and a comprehensive neuropsychological battery. The effect of treatment...... of cognitive deficits) had decreased significantly, with further normalisation 1-year after treatment initiation. In conclusion, patients had subjective reports of cognitive deficits in the toxic phase of Graves' thyrotoxicosis but comprehensive neuropsychological testing revealed no cognitive impairment...

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

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    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.

  14. Pericarditis as the Presenting Feature of Graves Disease in a Pediatric Patient.

    Science.gov (United States)

    Cullen, Danielle; Munjal, Neil; Chalal, Hannah; Ramgopal, Sriram; Tas, Emir; Witchel, Selma

    2017-04-01

    Pericarditis is a rare presentation of thyrotoxicosis associated with Graves disease. This association has not been previously described in the pediatric literature. We report a 17-year-old male patient who presented with chest pain, dyspnea, and tachycardia. He was found to have diffuse ST-segment elevation consistent with pericarditis. At presentation, he was noted to have bilateral proptosis. Abnormal thyroid function studies and an elevated thyroid-stimulating hormone receptor antibody level confirmed the diagnosis of Graves thyrotoxicosis. The patient was treated with anti-inflammatory and antithyroid agents and improved in time. We discuss previously reported cases of Graves disease-associated pericarditis in adults, potential etiologies, and management strategies.

  15. Colchicine in the treatment of the inflammatory phase of Graves' ophthalmopathy: a prospective and randomized trial with prednisone Colchicina no tratamento da fase inflamatória da oftalmopatia de Graves: um estudo prospectivo e randomizado com prednisona

    Directory of Open Access Journals (Sweden)

    Francisco José da Cunha Stamato

    2006-12-01

    Full Text Available PURPOSE: To investigate if colchicine is valuable in the treatment of Graves' ophthalmopathy (GO, we compared its effect with prednisone in 22 patients during the inflammatory phase of GO. METHODS: All patients, similar in age, sex and smoking habits, were euthyroid for at least 3 months and randomly divided into two groups, one treated with colchicine (1.5 mg/day and the other treated with prednisone (0.75 mg/kg/day. They were monitored with ophthalmologic assessment (clinical activity score-CAS and magnetic resonance imaging, using a signal intensity ratio (SIR of the recti muscles in comparison to the cerebral substantia alba. RESULTS: Amelioration of CAS was seen in 68% of the orbits in both groups. SIR also had a significant reduction after treatment: the initial median of 1.14 in G1 and 1.27 in G2, evolved, after treatment, to 1.07 in G1 and 0.69 in G2. The variation between both groups after treatment was not significant (p=0.22. None of the patients treated with colchicine had side effects; on the other hand, side effects in G2 were weight gain, edema, gastric complaints, hirsutism, weakness, depression, and alterations in blood pressure. CONCLUSION: Colchicine had a beneficial effect on the inflammatory phase of GO without the side effects of prednisone.OBJETIVO: Investigar se a colchicina é eficaz no tratamento da oftalmopatia de Graves, nós comparamos o seu efeito com a prednisona em 22 pacientes tratados na fase inflamatória da doença. MÉTODOS: Todos os pacientes, similares quanto à idade, sexo e hábitos de tabagismo, estavam em eutiroidismo por pelo menos três meses e foram randomizados em dois grupos. O grupo 1 (G1 recebeu colchicina (1,5 mg/dia e o grupo 2 (G2 foi tratado com prednisona (0,75 mg/kg/dia. Os pacientes foram acompanhados com avaliação oftalmológica (escore de atividade clínica - CAS e de imagem por meio da ressonância magnética, usando a relação da intensidade de sinal (SIR dos músculos reto em

  16. Empleo del parche valvado en el tratamiento de la comunicación interauricular en pacientes con hipertensión arterial pulmonar grave. Estudio cuasi-experimental

    Directory of Open Access Journals (Sweden)

    Horacio Márquez-González

    2015-10-01

    Full Text Available Introducción: La comunicación interauricular detectada en la adultez se acompaña de hipertensión arterial pulmonar. El procedimiento quirúrgico correctivo en estas condiciones presenta mayor morbilidad y mortalidad. El empleo del parche valvado evita la aparición de complicaciones tempranas.Objetivos: Analizar el comportamiento a dos años de la presión pulmonar estimada por ecocardiograma, y la función ventricular derecha en pacientes operados de cierre de comunicación interauricular con hipertensión arterial pulmonar grave con parche valvado.Método: Se realizó un estudio cuasi-experimental en 12 pacientes con comunicación interauricular de malos bordes e hipertensión arterial pulmonar grave. Se incluyeron sujetos con pruebas de reactividad positiva a oxígeno u óxido nítrico, que brindaron su consentimiento informado y se excluyeron enfermos con síndromes genéticos o hipertensión arterial pulmonar primaria. Los pacientes fueron seguidos en el posquirúrgico inmediato clínicamente, por laboratorio y por ecocardiografía a los 2, 4, 6, 12, 18 y 24 meses del posquirúrgico. Se registraron las complicaciones agregadas.Resultados: En los 12 pacientes que fueron analizados no se presentaron defunciones tempranas o tardías, la mediana de ventilación mecánica fue de 2 (1-4 días. En el seguimiento se constató mejoría significativa en: la clase funcional, las variables ecocardiográficas y la utilización de medicamentos.Conclusiones: El parche valvado unidireccional es una opción terapéutica que evita las complicaciones posquirúrgicas responsables de la mortalidad temprana.

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

    Science.gov (United States)

    Bové, Kira Bang; Watt, Torquil; Vogel, Asmus; Hegedüs, Laszlo; Bjoerner, Jakob Bue; Groenvold, Mogens; Bonnema, Steen Joop; Rasmussen, Åse Krogh; Feldt-Rasmussen, Ulla

    2014-01-01

    Background and Objective Graves' disease has been associated with an increased psychiatric morbidity. It is unclarified whether this relates to Graves' disease or chronic disease per se. The aim of our study was to estimate the prevalence of anxiety and depression symptoms in patients with Graves' disease compared to patients with another chronic thyroid disease, nodular goitre, and to investigate determinants of anxiety and depression in Graves' disease. Methods 157 cross-sectionally sampled patients with Graves' disease, 17 newly diagnosed, 140 treated, and 251 controls with nodular goitre completed the Hospital Anxiety and Depression Scale (HADS). The differences in the mean HADS scores between the groups were analysed using multiple linear regression, controlling for socio-demographic variables. HADS scores were also analysed dichotomized: a score >10 indicating probable ‘anxiety’/probable ‘depression’. Determinants of anxiety and depression symptoms in Graves' disease were examined using multiple linear regression. Results In Graves' disease levels of anxiety (p = 0.008) and depression (p = 0.014) were significantly higher than in controls. The prevalence of depression was 10% in Graves' 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. PMID:25538899

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

    Science.gov (United States)

    Bové, Kira Bang; Watt, Torquil; Vogel, Asmus; Hegedüs, Laszlo; Bjoerner, Jakob Bue; Groenvold, Mogens; Bonnema, Steen Joop; Rasmussen, Åse Krogh; Feldt-Rasmussen, Ulla

    2014-09-01

    Graves' disease has been associated with an increased psychiatric morbidity. It is unclarified whether this relates to Graves' disease or chronic disease per se. The aim of our study was to estimate the prevalence of anxiety and depression symptoms in patients with Graves' disease compared to patients with another chronic thyroid disease, nodular goitre, and to investigate determinants of anxiety and depression in Graves' disease. 157 cross-sectionally sampled patients with Graves' disease, 17 newly diagnosed, 140 treated, and 251 controls with nodular goitre completed the Hospital Anxiety and Depression Scale (HADS). The differences in the mean HADS scores between the groups were analysed using multiple linear regression, controlling for socio-demographic variables. HADS scores were also analysed dichotomized: a score >10 indicating probable 'anxiety'/probable 'depression'. Determinants of anxiety and depression symptoms in Graves' disease were examined using multiple linear regression. In Graves' disease levels of anxiety (p = 0.008) and depression (p = 0.014) were significantly higher than in controls. The prevalence of depression was 10% in Graves' 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. 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.

  19. Epidemiology, management and outcomes of Graves' disease-real life data.

    Science.gov (United States)

    Hussain, Y S; Hookham, J C; Allahabadia, A; Balasubramanian, S P

    2017-06-01

    Treatment options in Graves' disease are clearly defined, but management practices and the perceptions of success are varied. The outcomes of treatment in large consecutive cohorts of Graves' disease have not been well characterised. The study describes the epidemiology, management strategies and medium term outcomes following anti-thyroid drug treatment, radio-iodine ablation and surgery in Graves' disease. All patients (n = 659) who received treatment for a new diagnosis of Graves' disease in secondary care over a 5 year period were included with a median (interquartile range) follow-up of 42.9 (29-57.5) months. The age adjusted incidence of adult onset Graves' disease in Sheffield, UK was 24.8 per 100,000 per year. Excluding 35 patients lost to follow-up, 93.1% (n = 581) were controlled on anti-thyroid drug treatment. Of these, 73.6% went into remission following withdrawal of anti-thyroid drugs; 5.2% were still undergoing initial therapy; 13.3% lost control whilst on anti-thyroid drugs; and 7.9% went on to have either surgery or radio-iodine ablation whilst controlled on anti-thyroid drugs. Of the 428 patients who achieved remission, 36.7% relapsed. Of 144 patients who had radio-iodine ablation treatment, 5.6% relapsed and needed further treatment. Of 119 patients having surgery, 5.2% had long-term hypoparathyroidism and none had documented long-term recurrent laryngeal nerve palsy. In the follow-up, 39.9% of patients underwent surgery or radio-iodine ablation with little morbidity. Up to two-thirds of patients who achieved remission did not relapse. Data on effectiveness and risks of treatments for Graves' disease presented in this study will help clinicians and patients in decision making.

  20. Thyrotropin-producing pituitary adenoma simultaneously existing with Graves' disease: a case report.

    Science.gov (United States)

    Arai, Nobuhiko; Inaba, Makoto; Ichijyo, Takamasa; Kagami, Hiroshi; Mine, Yutaka

    2017-01-06

    Thyrotropin-producing pituitary tumor is relatively rare. In particular, concurrent cases associated with Graves' disease are extremely rare and only nine cases have been reported so far. We describe a case of a thyrotropin-producing pituitary adenoma concomitant with Graves' disease, which was successfully treated. A 40-year-old Japanese woman presented with mild signs of hyperthyroidism. She had positive anti-thyroid-stimulating hormone receptor antibody, anti-thyroglobulin antibody, and anti-thyroid peroxidase antibody. Her levels of serum thyroid-stimulating hormone, which ranged from low to normal in the presence of high levels of serum free thyroid hormones, were considered to be close to a state of syndrome of inappropriate secretion of thyroid-stimulating hormone. Magnetic resonance imaging showed a macropituitary tumor. The coexistence of thyrotropin-producing pituitary adenoma and Graves' disease was suspected. Initial therapy included anti-thyroid medication, which was immediately discontinued due to worsening symptoms. Subsequently, surgical therapy for the pituitary tumor was conducted, and her levels of free thyroid hormones, including the thyroid-stimulating hormone, became normal. On postoperative examination, her anti-thyroid-stimulating hormone receptor antibody levels decreased, and the anti-thyroglobulin antibody became negative. The coexistence of thyrotropin-producing pituitary adenoma and Graves' disease is rarely reported. The diagnosis of this condition is complicated, and the appropriate treatment strategy has not been clearly established. This case suggests that physicians should consider the coexistence of thyrotropin-producing pituitary adenoma with Graves' disease in cases in which thyroid-stimulating hormone values range from low to normal in the presence of thyrotoxicosis, and the surgical treatment of thyrotropin-producing pituitary adenoma could be the first-line therapy in patients with both thyrotropin-producing pituitary adenoma

  1. Radioiodine therapy in patients with Graves' disease and the effects of prior carbimazole therapy.

    Science.gov (United States)

    Karyampudi, Arun; Hamide, Abdoul; Halanaik, Dhanapathi; Sahoo, Jaya Prakash; Kamalanathan, Sadishkumar

    2014-09-01

    The use of radioiodine as the first line of treatment in Graves' disease is restricted in India because of its limited availability and an unrealistic risk perception associated with it. Additionally, the effectiveness of radioiodine ablation in Graves' disease is influenced by many factors. Prior medical antithyroid therapy is one such important factor. To analyze the efficacy of low dose radioiodine therapy (5 mCi) in treatment of naive patients of Graves' disease in comparison to that in which it was already primed with an antithyroid drug, carbimazole. A non-randomized, interventional study conducted in the Department of Medicine and Endocrinology of a tertiary care institute in South India. The study had two groups; Group A (36 treatment naive, uncomplicated Graves' disease patients) and B (34 Graves' disease patients on carbimazole prior to radioiodine therapy). Both groups had baseline clinical, biochemical evaluation and were reassessed at 3 and 6 months for evaluating the clinical status for possible documentation of cure. The cure rate was 61.1% in drug naive group and 58.8% in pretreated group at 6 months following radioiodine (P = 0.845). Higher baseline 999m technicium (99m Tc) uptake, male gender, BMI and higher baseline free thyroxine (fT4) level predicted treatment failure following radioiodine therapy. Administration of carbimazole prior to low dose radioiodine therapy does not alter the efficacy of radioiodine. Low fixed dose (5 mCi) of radioactive iodine may be a safe and effective primary therapeutic option in Graves' disease patients pretreated with antithyroid drugs.

  2. 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.

  3. 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

  4. Quality of Life of Severe Sepsis Survivors After Hospital Discharge Calidad de vida de sobrevivientes de sepsis grave después del alta hospitalar Qualidade de vida de sobreviventes de sepse grave após alta hospitalar

    Directory of Open Access Journals (Sweden)

    Ligia Marcia Contrin

    2013-06-01

    ño comparado con los pacientes en estado crítico pero sin sepsis en el grupo control. Los pacientes ancianos (>60 años con sepsis tuvieron una prevalencia significativamente mayor de problemas. No hubo diferencias en EQ-VAS entre los entrevistados de ambos grupos. CONCLUSIONES: Después del alta de la UCI, los pacientes que sobrevivieron a la sepsis tuvieron una tasa de mortalidad más alta que los pacientes sin enfermedad crítica. Pacientes ancianos con sepsis tuvieron problemas moderados y graves en todas las cinco dimensiones de calidad de vida evaluadas. OBJETIVOS: avaliar a qualidade de vida em sobreviventes de sepse grave, utilizando os instrumentos EuroQol-5 Dimensions e Escala Analógica Visual. MÉTODO: caso controle aninhado, realizado em pacientes que receberam alta da unidade de terapia intensiva de um hospital de ensino, após admissão com sepse grave. A seleção foi feita a partir do cadastro sepse, contendo 349 prontuários. Cada paciente com sepse foi considerado como um sujeito e o paciente internado após foi considerado controle, desde que não tivesse sepse e tivesse sobrevivido à internação, totalizando 100 sujeitos. RESULTADOS: o grupo sepse apresentou mortalidade mais elevada em 1 ano comparado com pacientes críticos, porém, sem sepse no grupo controle. Pacientes mais velhos (>60 anos de idade no grupo sepse tiveram prevalência significativamente maior de problemas. Não houve diferença na Escala Visual Análoga entre os entrevistados de ambos os grupos. CONCLUSÕES: após alta da unidade de terapia intensiva, os pacientes que sobreviveram à sepse tiveram taxa de mortalidade mais elevada do que os pacientes críticos sem a doença. Pacientes idosos com sepse tiveram problemas variando de moderado a grave, em todas as cinco dimensões de qualidade de vida avaliadas.

  5. [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. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  6. Hyperthyroidism during pregnancy due to coexistence of struma ovarii and Graves' disease.

    Science.gov (United States)

    Kung, A. W.; Ma, J. T.; Wang, C.; Young, R. T.

    1990-01-01

    A patient with hyperthyroid Graves' disease and struma ovarii is described. She had pre-existing Graves' disease and positive thyrotrophin receptor antibody. She was treated with radioactive iodine 5 months before she became pregnant. Paripartum she had torsion of an ovarian cyst with histological evidence of a functional struma ovarii. Immediate exacerbation of her thyrotoxic state was observed after operation as a result of release of thyroid hormone from the tumour. It is postulated that the tumour was stimulated by circulating thyrotrophin receptor antibody. PMID:2349185

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

    OpenAIRE

    Tomislav M. Pavlović

    2016-01-01

    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 c...

  8. 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...

  9. 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.

  10. 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.

  11. Circulating microRNA-1a is a biomarker of Graves' disease patients with atrial fibrillation.

    Science.gov (United States)

    Wang, Fang; Zhang, Sheng-Jie; Yao, Xuan; Tian, Dong-Mei; Zhang, Ke-Qin; She, Dun-Min; Guo, Fei-Fan; Zhai, Qi-Wei; Ying, Hao; Xue, Ying

    2017-07-01

    It has been increasingly suggested that specific microRNAs expression profiles in the circulation and atrial tissue are associated with the susceptibility to atrial fibrillation. Nonetheless, the role of circulating microRNAs in Graves' disease patients with atrial fibrillation has not yet been well described. The objective of the study was to identify the role of circulating microRNAs as specific biomarkers for the diagnosis of Graves' disease with atrial fibrillation. The expression profiles of eight serum microRNAs, which are found to be critical in the pathogenesis of atrial fibrillation, were determined in patients with Graves' disease with or without atrial fibrillation. MicroRNA expression analysis was performed by real-time PCR in normal control subjects (NC; n = 17), patients with Graves' disease without atrial fibrillation (GD; n = 29), patients with Graves' disease with atrial fibrillation (GD + AF; n = 14), and euthyroid patients with atrial fibrillation (AF; n = 22). Three of the eight serum microRNAs,i.e., miR-1a, miR-26a, and miR-133, had significantly different expression profiles among the four groups. Spearman's correlation analysis showed that the relative expression level of miR-1a was positively correlated with free triiodothyronine (FT3) and free thyroxine (FT4), and negatively related to thyroid stimulating hormone. Spearman's correlations analysis also revealed that the level of miR-1a was negatively correlated with a critical echocardiographic parameter (left atrial diameter), which was dramatically increased in GD + AF group compared to GD group. Furthermore, the receiver-operating characteristic curve analysis indicated that, among the eight microRNAs, miR-1a had the largest area under the receiver-operating characteristic curves not only for discriminating between individuals with and without Graves' disease, but also for predicting the presence of atrial fibrillation in patients with Graves' disease. Our findings

  12. Association of Primary Biliary Cirrhosis-autoimmune Hepatitis Overlap Syndrome with Immune Thrombocytopenia and Graves' Disease.

    Science.gov (United States)

    Koyamada, Ryosuke; Higuchi, Takakazu; Kitada, Ayako; Nakagawa, Tomoko; Ikeya, Takashi; Okada, Sadamu; Fujita, Yoshiyuki

    2015-01-01

    A 54-year-old woman suffering from pruritus for five years was diagnosed to have Graves' disease and immune thrombocytopenia (ITP) associated with primary biliary cirrhosis (PBC)-autoimmune hepatitis (AIH) overlap syndrome, which was confirmed histologically after a prompt recovery in the platelet count number following steroid therapy. The association between PBC-AIH overlap syndrome and ITP has been rarely reported and the additional association with Graves' disease has not yet been reported. An underlying global derangement of autoimmunity or shared genetic susceptibility was suspected.

  13. P05.01. Case Report: Dysconjugate Gaze in a Patient With Graves' Orbitopathy

    OpenAIRE

    Taw, Malcolm; Basurco, Danielle

    2013-01-01

    Focus Area: Integrative Approaches to Care Moderate-to-severe Graves' orbitopathy (GO) at baseline is an uncommon finding with a new diagnosis of Graves' disease (GD). Patients with baseline GO usually have mild symptoms or are asymptomatic. The natural history and prevalence of GO are poorly documented. Current standard of care is to treat with IV methylprednisolone pulses. This is a case report of a 63-year-old woman with a 1-year diagnosis of moderate-to-severe GO. Six months prior to diag...

  14. Inmunomonitorización de la infección grave

    OpenAIRE

    Rodríguez Fernández, Ana

    2016-01-01

    La infección grave supone un problema de salud pública mundial con un importante impacto tanto en términos de morbilidad como de mortalidad. Las condiciones sociodemográficas actuales han generado una población cada vez más envejecida que presenta numerosas comorbilidades y que requieren en muchos casos de atención sanitaria continuada. Las estrategias actuales para la prevención y control de la infección grave están basadas en la búsqueda de nuevas herramientas que mejoren el diagnóstico y p...

  15. ENFOQUE EN LA ATENCIÓN INTEGRAL A LOS PACIENTES CON TRASTORNO MENTAL GRAVE TREINTA AÑOS DESPUÉS DE LA REFORMA PSIQUIÁTRICA

    Directory of Open Access Journals (Sweden)

    Agustín Madoz-Gúrpide

    2017-01-01

    Full Text Available Han pasado más de 30 años desde el inicio de los procesos de reforma psiquiátrica, periodo además de importantes e intensos cambios sociales, científicos y culturales que afectan de manera directa a la enfermedad mental grave y a su manejo. Las mejoras del tratamiento farmacológico, un nuevo modelo de relación médico-paciente, el empoderamiento del paciente como elemento clave y la lucha contra el estigma social de la enfermedad, los cambios en la gestión de los recursos, el incremento de la carga que suponen los pacientes con patología menor en los centros de salud mental, las mejoras en el trabajo en equipo y en la coordinación de los recursos implicados… son algunas de las modificaciones importantes que condicionan el escenario de la atención en salud mental comunitaria. Se nos antoja, por tanto, como un buen momento para revisar el estado de los programas de gestión del trastorno mental grave en el adulto y de los centros de salud mental, y plantear dos cuestiones sencillas a la par que relevantes: dónde estamos y hacia dónde nos dirigimos.

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

    Science.gov (United States)

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

    2016-01-01

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

  17. Isolated primary amyloidosis of the inferior rectus muscle mimicking Graves' orbitopathy.

    Science.gov (United States)

    Monteiro, Mário Luiz Ribeiro; Gonçalves, Allan Christian Pieroni; Bezerra, Alanna Mara Pinheiro Sobreira

    2016-01-01

    The diagnosis of Graves' orbitopathy is usually straightforward. However, orbital diseases that mimick some clinical signs of Graves' orbitopathy may cause diagnostic confusion, particularly when associated to some form of thyroid dysfunction. This report describes the rare occurrence of localized inferior rectus muscle amyloidosis in a patient with autoimmune hypothyroidism, who was misdiagnosed as Graves' orbitopathy. A 48-year-old man complained of painless progressive proptosis on the left side and intermittent vertical diplopia for 6 months. The diagnosis of Graves' orbitopathy was entertained after magnetic resonance imaging revealing a markedly enlarged, tendon-sparing inferior rectus enlargement on the left side, and an autoimmune hypothyroidism was disclosed on systemic medical workup. After no clinical improvement with treatment, the patient was referred to an ophthalmologist and further investigation was performed. The presence of calcification in the inferior rectus muscle on computed tomography, associated with the clinical findings led to a diagnostic biopsy, which revealed amyloid deposition. This report emphasizes that a careful evaluation of atypical forms of Graves' orbitopathy may be crucial and should include, yet with rare occurrence, amyloidosis in its differential diagnosis. RESUMO O diagnóstico de orbitopatia de Graves usualmente é fácil de ser estabelecido. No entanto, doenças da órbita que simulam alguns sinais clínicos da orbitopatia de Graves podem levar à confusão diagnóstica, particularmente quando associada à alguma forma de disfunção tireoidiana. Relatamos a ocorrência rara de amiloidose localizada no músculo reto inferior em paciente com hipotireoidismo autoimune, que recebeu inicialmente o diagnóstico errôneo de orbitopatia de Graves. Paciente masculino, 48 anos, com queixa de proptose progressiva e indolor do lado esquerdo e diplopia vertical intermitente há 6 meses. O diagnóstico de orbitopatia de Graves foi

  18. Maximinus Daia, a Roman emperor who may have had Graves' disease and died of a thyrotoxic crisis.

    Science.gov (United States)

    Papapetrou, Peter D

    2013-01-01

    Evidence is presented that the Roman emperor Maximinus Daia had Graves' disease and died of severe thyrotoxicosis. The information about this emperor's terminal illness is drawn from the writings of the 4th century writers Eusebius and Lactantius. An existing statue indicates that the emperor had bilateral Graves' ophthalmopathy.

  19. "Why Didn't I Know about This Book When I Started?": In Memory of Donald Graves and Arthur Applebee

    Science.gov (United States)

    Petrosky, Anthony; Mihalakis, Vivian

    2016-01-01

    This essay explores Donald Graves' groundbreaking research of the 1980s. We show how Graves' approach to the teaching of writing built on his sensitive appreciation of the ways children actually engage in the composing process when they are given the opportunity to produce writing that is meaningful to them. However, the issue for us is not simply…

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

    DEFF Research Database (Denmark)

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

    2012-01-01

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

  1. Age and stress as determinants of the severity of hyperthyroidism caused by Graves' disease in newly diagnosed patients

    NARCIS (Netherlands)

    Vos, Xander G.; Smit, Natalie; Endert, Erik; Brosschot, Jos F.; Tijssen, Jan G. P.; Wiersinga, Wilmar M.

    2009-01-01

    Objective: The evidence that stress may provoke Graves' hyperthyroidism in genetically susceptible subjects is substantial. Whether exposure to stress is related to the severity of thyrotoxicosis has not been studied. Advancing age is associated with not only less severe Graves' hyperthyroidism but

  2. Effectiveness and Mechanism of Preoperative Lugol Solution for Reducing Thyroid Blood Flow in Patients with Euthyroid Graves' Disease.

    Science.gov (United States)

    Huang, Shih-Ming; Liao, Wei-Ting; Lin, Chiou-Feng; Sun, H Sunny; Chow, Nan-Haw

    2016-03-01

    To reduce intraoperative and postoperative complications, using Lugol solution to preoperatively prepare patients with Graves' disease has (1) rapidly reduced the severity of thyrotoxicosis and (2) reduced the vascularity of the thyroid gland. The vascularity reduction normally accompanies reducing the severity of thyrotoxicosis. However, the effects and mechanism of Lugol solution for reducing blood flow have not been well investigated in the patients with euthyroid (normally functioning thyroid) Graves' disease. Twenty-five patients with euthyroid Graves' disease being preoperatively treated with Lugol solution for 10 days were measured, at baseline and on the operative day, for (1) superior thyroid artery blood flow; (2) systemic angiogenic factor (VEGF); and (3) systemic inflammatory factor [interleukin (IL)-16]. All three parameters were significantly (p Graves' disease. We recommend routine preoperative Lugol solution treatment for all patients with Graves' disease.

  3. Tratamiento ortodóntico interceptivo para paciente pediátrico con problema periodontal ocasionado por trauma oclusal primario. Reporte de caso

    National Research Council Canada - National Science Library

    Johana Maldonado-Villamizar

    2016-01-01

    ... pediátrico a padecer de problemas graves en el futuro. Este diagnóstico junto con un tratamiento interceptivo a tiempo, puede ayudar a resolver problemas de tipo periodontal causado por el inadecuado posicionamiento dental o injurias oclusales...

  4. Manejo quirúrgico de la orbitopatía de graves

    Directory of Open Access Journals (Sweden)

    Dr. S. Rodrigo Poblete

    2010-11-01

    Este artículo está destinado a mostrar las alternativas quirúrgicas en el tratamiento de las complicaciones oculares de la Orbitopatía de Graves orientado principalmente hacia el exoftálmo y la patología palpebral.

  5. 78 FR 21410 - Native American Graves Protection and Repatriation Review Committee: Meetings

    Science.gov (United States)

    2013-04-10

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF THE INTERIOR National Park Service Native American Graves Protection and Repatriation Review Committee: Meetings AGENCY... or organizations lying within the scope of work of the Committee; consulting with the Secretary of...

  6. 75 FR 70028 - Native American Graves Protection and Repatriation Review Committee: Meeting 2253-665

    Science.gov (United States)

    2010-11-16

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF THE INTERIOR National Park Service Native American Graves Protection and Repatriation Review Committee: Meeting 2253-665... lying within the scope of work of the Committee; consulting with the Secretary of the Interior on the...

  7. 76 FR 12132 - Native American Graves Protection and Repatriation Review Committee: Meeting

    Science.gov (United States)

    2011-03-04

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF THE INTERIOR National Park Service Native American Graves Protection and Repatriation Review Committee: Meeting AGENCY... matters affecting such tribes or organizations lying within the scope of work of the Committee; consulting...

  8. 78 FR 16295 - Native American Graves Protection and Repatriation Review Committee: Meeting

    Science.gov (United States)

    2013-03-14

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF THE INTERIOR National Park Service Native American Graves Protection and Repatriation Review Committee: Meeting AGENCY... on matters affecting such tribes or organizations lying within the scope of work of the Review...

  9. 77 FR 53228 - Native American Graves Protection and Repatriation Review Committee: Meeting

    Science.gov (United States)

    2012-08-31

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF THE INTERIOR National Park Service Native American Graves Protection and Repatriation Review Committee: Meeting AGENCY... matters affecting such tribes or organizations lying within the scope of work of the Committee; consulting...

  10. 77 FR 7180 - Native American Graves Protection and Repatriation Review Committee: Meeting

    Science.gov (United States)

    2012-02-10

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF THE INTERIOR National Park Service Native American Graves Protection and Repatriation Review Committee: Meeting AGENCY... or organizations lying within the scope of work of the Committee; consulting with the Secretary of...

  11. 76 FR 69282 - Native American Graves Protection and Repatriation Review Committee: Meeting

    Science.gov (United States)

    2011-11-08

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF THE INTERIOR National Park Service Native American Graves Protection and Repatriation Review Committee: Meeting AGENCY... organizations lying within the scope of work of the Committee; consulting with the Secretary of the Interior on...

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

    Science.gov (United States)

    2012-12-18

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF THE INTERIOR National Park Service Native American Graves Protection and Repatriation Review Committee: Meeting AGENCY... organizations and museums on matters affecting such tribes or organizations lying within the scope of work of...

  13. Soilwater Conductivity Analysis to Date and Locate Clandestine Graves of Homicide Victims.

    Science.gov (United States)

    Pringle, Jamie K; Cassella, John P; Jervis, John R; Williams, Anna; Cross, Peter; Cassidy, Nigel J

    2015-07-01

    In homicide investigations, it is critically important that postmortem interval and postburial interval (PBI) of buried victims are determined accurately. However, clandestine graves can be difficult to locate; and the detection rates for a variety of search methods (ranging from simple ground probing through to remote imaging and near-surface geophysics) can be very low. In this study, simulated graves of homicide victims were emplaced in three sites with contrasting soil types, bedrock, and depositional environments. The long-term monthly in situ monitoring of grave soil water revealed rapid increases in conductivity up to 2 years after burial, with the longest study evidencing declining values to background levels after 4.25 years. Results were corrected for site temperatures and rainfall to produce generic models of fluid conductivity as a function of time. The research suggests soilwater conductivity can give reliable PBI estimates for clandestine burials and therefore be used as a grave detection method. © 2015 American Academy of Forensic Sciences.

  14. 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 receiv...

  15. Introduction to Special Issue "War Graves / Die Bauaufgabe Soldatenfriedhof, 1914-1989"

    Directory of Open Access Journals (Sweden)

    Fuhrmeister, Christian

    2017-07-01

    Full Text Available Commemoration of the dead is intricately linked to the history of civilization itself. Consequently, art history (understood in a broad sense, encompassing architectural history, social history of art, aesthetics, political iconography, etc. is characterized by a long tradition of paying minute attention to Christian and profane iconography of chapels, epitaphs, and death dances; and to memorials, tombs, and other manifestations, particularly with regard to the Middle Ages and Early Modern Times. Twentieth century war graves, war cemeteries, memorial shrines, and burial sites of the fallen, however, have received only little attention. This assessment was the starting point of our joint endeavor: If the history of conflicts and wars, and the history of war death in particular, is such a major topic for the humanities at large, and especially for contemporary and cultural history, memory studies, etc., then the question arises to what degree art history can contribute to that ongoing discourse. Sketching a Potentially Global Field of Research Table of Contents Acknowledgements Sources and Materials Basic Research on War Graves and War Cemeteries in The Political Archive of the Federal Foreign Office in Berlin / Kriegsgräber im Politischen Archiv des Auswärtigen Amtes in Berlin The Archive of the German War Graves Commission in Kassel / Das Archiv des Volksbundes Deutsche Kriegsgräberfürsorge e. V. in Kassel War Graves, War Cemeteries, and Memorial Shrines since 1914: A Selected Bibliography Selected Printed Source Material

  16. Craniotomia descompressiva no edema cerebral grave: a propósito de 30 casos operados

    Directory of Open Access Journals (Sweden)

    José A. Gonçalves da Silva

    1976-09-01

    Full Text Available Craniotomia descompressiva uni ou bilateral foi empregada como tratamento paliativo em 30 casos de edema cerebral grave de etiologia predominantemente traumática. Coma, midríase e descerebração caracterizaram o quadro clínico na maioria dos casos. A sobrevida foi de 46,6%.

  17. 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....

  18. Deep lateral wall orbital decompression following strabismus surgery in patients with Type II ophthalmic Graves' disease.

    Science.gov (United States)

    Ellis, Michael P; Broxterman, Emily C; Hromas, Alan R; Whittaker, Thomas J; Sokol, Jason A

    2018-01-10

    Surgical management of ophthalmic Graves' disease traditionally involves, in order, orbital decompression, followed by strabismus surgery and eyelid surgery. Nunery et al. previously described two distinct sub-types of patients with ophthalmic Graves' disease; Type I patients exhibit no restrictive myopathy (no diplopia) as opposed to Type II patients who do exhibit restrictive myopathy (diplopia) and are far more likely to develop new-onset worsening diplopia following medial wall and floor decompression. Strabismus surgery involving extra-ocular muscle recession has, in turn, been shown to potentially worsen proptosis. Our experience with Type II patients who have already undergone medial wall and floor decompression and strabismus surgery found, when additional decompression is necessary, deep lateral wall decompression (DLWD) appears to have a low rate of post-operative primary-gaze diplopia. A case series of four Type II ophthalmic Graves' disease patients, all of whom had already undergone decompression and strabismus surgery, and went on to develop worsening proptosis or optic nerve compression necessitating further decompression thereafter. In all cases, patients were treated with DLWD. Institutional Review Board approval was granted by the University of Kansas. None of the four patients treated with this approach developed recurrent primary-gaze diplopia or required strabismus surgery following DLWD. While we still prefer to perform medial wall and floor decompression as the initial treatment for ophthalmic Graves' disease, for proptosis following consecutive strabismus surgery, DLWD appears to be effective with a low rate of recurrent primary-gaze diplopia.

  19. Natural course of mild Graves' orbitopathy: is it a chronic remitting or a transient disease?

    Science.gov (United States)

    Anagnostis, P; Boboridis, K; Adamidou, F; Kita, M

    2017-03-01

    The natural course of Graves' orbitopathy (GO) has been poorly documented. The aim of this review is to provide current knowledge regarding the natural course of mild GO, trying to address the issue of whether and to what extent it constitutes a chronic remitting or transient disease. We systematically searched PubMed for English language publications until August 2016 under the following terms: "Graves' orbitopathy" OR "Graves' ophthalmopathy" OR "thyroid eye disease" AND "natural course" OR "natural history". Few studies have investigated the course of mild orbital disease in patients with GO. Large controlled trials are lacking and data can be extracted mainly from small retrospective and some prospective studies, after excluding patients who had received radioiodine for thyrotoxicosis or surgical treatment for GO. In general, more than half of GO patients may show spontaneous improvement in their clinical features, whereas no safe conclusions can be drawn with regard to complete resolution, with percentages ranging from 6 to 58 %. The question whether mild GO is a remitting, albeit chronic disease, or even a transient event in the course of Graves' disease, remains currently unanswered.

  20. 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...

  1. Comparison of three competitive immunoassays for measurement of TSH receptor antibodies in patients with Graves' disease

    DEFF Research Database (Denmark)

    Doroudian, Sara; Pedersen, Inge Bülow; Knudsen, Cindy Soendersoe

    2017-01-01

    Thyrotropin (TSH) receptor antibodies (TRAb) mediate the hyperthyroidism of Graves' disease (GD). The aim of the study was to compare the diagnostic performance and assay agreement between three immunoassays for the measurement of TRAb in patients with newly diagnosed GD. TRAb was measured...

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

    DEFF Research Database (Denmark)

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

    2007-01-01

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

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

    DEFF Research Database (Denmark)

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

    2008-01-01

    Treatment of Graves' disease (GD) with the B-lymphocyte depleting agent rituximab in addition to standard methimazole-therapy prolongs remission. Paradoxically, it does not mediate a reduction in thyrotropin receptor antibody (TRAb) levels over that of methimazole monotherapy. Using a bioassay...

  4. Impact of potassium iodide on thyroidectomy for Graves' disease: Implications for safety and operative difficulty.

    Science.gov (United States)

    Randle, Reese W; Bates, Maria F; Long, Kristin L; Pitt, Susan C; Schneider, David F; Sippel, Rebecca S

    2018-01-01

    Potassium iodide often is prescribed prior to thyroidectomy for Graves' disease, but the effect of potassium iodide on the ease and safety of thyroidectomy for Graves' is largely unknown. We conducted a prospective, cohort study of patients with Graves' disease undergoing thyroidectomy. For the first 8 months, no patients received potassium iodide; for the next 8 months, potassium iodide was added to the preoperative protocol for all patients. Outcomes included operative difficulty (based on the Thyroidectomy Difficulty Scale) and complications. We included a total of 31 patients in the no potassium iodide group and 28 in the potassium iodide group. According to the Thyroidectomy Difficulty Scale, gland vascularity decreased in the potassium iodide group (mean score 2.6 vs 3.3, P = .04), but there were no differences in friability, fibrosis, or size of the thyroid or in overall difficulty of operation (P = not significant for all). Despite similar operative difficulty, patients prescribed potassium iodide were less likely to experience transient hypoparathyroidism (7% vs 26%, P = .018) and transient hoarseness (0% vs 16%, P = .009) compared with the no potassium iodide group. Potassium iodide administration decreases gland vascularity, but does not change the overall difficulty of thyroidectomy. Preoperative use of potassium iodide solution was, however, associated with less transient hypoparathyroidism and transient hoarseness, suggesting that potassium iodide improves the safety of thyroidectomy for Graves' disease. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. 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...

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

    Science.gov (United States)

    Yu, Jing; Tian, Ai-Juan; Yuan, Xin; Cheng, Xiao-Xin

    2016-01-01

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

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

    DEFF Research Database (Denmark)

    Nygaard, Birte; Kristensen, Lars Østergaard

    2015-01-01

    Objective: Graves' ophthalmopathy (GO) is an inflammatory disease in the orbital region. The first-line medical treatment is glucocorticoids. An important potential side effect of glucocorticoid treatment is suppression of the hypothalamic-pituitary-adrenal (HPA) axis with impairment of endogenous...

  8. A case of metastatic follicular thyroid carcinoma complicated with Graves' disease after total thyroidectomy.

    Science.gov (United States)

    Aoyama, Mariko; Takizawa, Hiromitsu; Tsuboi, Mitsuhiro; Nakagawa, Yasushi; Tangoku, Akira

    2017-12-28

    Thyroid cancer and Graves' disease may present simultaneously in one patient. The incidence of the development of hyperthyroidism from metastatic differentiated thyroid carcinoma is rare. We herein report a case of metastatic follicular carcinoma complicated with Graves' disease after total thyroidectomy. A 57-year-old woman underwent right hemithyroidectomy for follicular carcinoma. Metastatic lesions appeared in the lungs and skull two years after the first surgery, and remnant thyroidectomy was performed for radioactive iodine-131 (RAI) therapy, during which the TSH receptor antibody (TRAb) was found to be negative. The patient was treated with RAI therapy four times for four years and was receiving levothyroxine suppressive therapy. Although radioiodine uptake was observed in the lesions after the fourth course of RAI therapy, metastatic lesions had progressed. Four years after the second surgery, she had heart palpitations and tremors. Laboratory data revealed hyperthyroidism and positive TRAb. She was diagnosed with Graves' disease and received a fifth course of RAI therapy. 131I scintigraphy after RAI therapy showed strong radioiodine uptake in the metastatic lesions. As a result, the sizes and numbers of metastatic lesions decreased, and thyroid function improved. Metastatic lesions produced thyroid hormone and caused hyperthyroidism. RAI therapy was effective for Graves' disease and thyroid carcinoma.

  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...

  10. Review of Mouse Models of Graves' Disease and Orbitopathy-Novel Treatment by Induction of Tolerance.

    Science.gov (United States)

    Ungerer, Martin; Faßbender, Julia; Li, Zhongmin; Münch, Götz; Holthoff, Hans-Peter

    2017-04-01

    Various approaches have been used to model human Graves' disease in mice, including transfected fibroblasts, and plasmid or adenoviral immunisations with the extracellular A subunit of the human thyrotropin receptor (TSHR). Some of these models were only observed for a short time period or were self-limiting. A long-term model for human Graves' disease was established in mice using continuing immunisations (4-weekly injections) with recombinant adenovirus expressing TSHR. Generation of TSHR binding cAMP-stimulatory antibodies, thyroid enlargement and alterations, elevated serum thyroxin levels, tachycardia and cardiac hypertrophy were maintained for at least 9 months in all Ad-TSHR-immunised mice. Here, we show that these mice suffer from orbitopathy, which was detected by serial orbital sectioning and histomorphometry. Attempts to treat established Graves' disease in preclinical mouse model studies have included small molecule allosteric antagonists and specific antagonist antibodies which were isolated from hypothyroid patients. In addition, novel peptides have been conceived which mimic the cylindrical loops of the TSHR leucine-rich repeat domain, in order to re-establish tolerance toward the antigen. Here, we show preliminary results that one set of these peptides improves or even cures all signs and symptoms of Graves' disease in mice after six consecutive monthly injections. First beneficial effects were observed 3-4 months after starting these therapies. In immunologically naïve mice, administration of the peptides did not induce any immune response.

  11. 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...

  12. Extraocular muscle surgery for Graves' ophthalmopathy: does prior treatment influence surgical outcome?

    NARCIS (Netherlands)

    Mourits, M. P.; Koorneef, L.; van Mourik-Noordenbos, A. M.; van der Meulen-Schot, H. M.; Prummel, M. F.; Wiersinga, W. M.; Berghout, A.

    1990-01-01

    We analysed the results of extraocular muscle surgery in 38 patients with stable Graves' ophthalmopathy. Fixed sutures were used in all patients. A useful field of binocular single vision was achieved in 27 patients (71%) after one operation and in seven patients (18%) after more than one, whereas

  13. 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

    of ownership of land in attempts to create permanence. Both new and old authorities use material tokens and spiritual principles concerning the dead to establish evidence and trust in their authority to govern. The perceived material qualities of cement for graves and land markers as endurable and modern play...

  14. Serum 25-hydroxyvitamin D might be an independent prognostic factor for Graves disease recurrence.

    Science.gov (United States)

    Ahn, Hwa Young; Chung, Yun Jae; Cho, Bo Youn

    2017-08-01

    Graves disease is the most common cause of thyrotoxicosis. Although medical intervention with antithyroid drugs (ATDs) is commonly the first choice of treatment in Korea, the remission rate associated with this approach is not satisfactory. During ATD therapy, low or undetectable serum levels of thyroid-stimulating hormone (TSH) receptor antibodies (TRAbs) have been reported to affect the incidence of Graves disease remission. This study evaluated the correlation between serum 25-hydroxyvitamin D levels and TRAb levels, as well as the effect of 25-hydroxyvitamin D on the recurrence of Graves disease.A total of 143 patients, who were diagnosed with Graves disease and treated with ATDs, were retrospectively included in our observational study. These patients were followed for more than 1 year after ATD discontinuation. The levels of serum 25-hydroxyvitamin D and TRAb (ie, thyroid-stimulating antibody [TSAb], as detected by bioassay, and TSH-binding inhibitory immunoglobulins [TBIIs]) were measured, and a thyroid function test was performed upon ATD discontinuation. Recurrence was evaluated every 3 months, and was defined as an occurrence of overt thyrotoxicosis during the follow-up period.A total of 95 patients (66.4%) experienced recurrence with a median latency period of 182 days (ranging 28-1219 days). The serum 25-hydroxyvitamin D levels at the time of ATD discontinuation were not correlated with either TBII or TSAb. In the Cox proportional hazard regression analysis, higher free T4 levels (>1.4 ng/dL; hazard ratio [HR], 3.252; 95% confidence interval [CI], 1.022-10.347) and low levels of 25-hydroxyvitamin D (≤14.23 ng/mL) were associated with a higher probability of Graves disease recurrence (HR, 3.016; 95% CI, 1.163-7.819).Lower serum 25-hydroxyvitamin D levels were associated with a higher incidence of Graves disease recurrence. Therefore, serum 25-hydroxyvitamin D might be an independent risk factor for predicting Graves disease recurrence after ATD

  15. Feelings and Perceptions of Women in the Pregnancy-Puerperal Cycle Who Survived Severe Maternal Morbidity Sentimientos y percepciones de mujeres en el ciclo embarazo-puerperio que sobrevivieron a una morbosidad materna grave Sentimentos e percepções de mulheres no ciclo gravídico puerperal que sobreviveram à morbidade materna grave

    Directory of Open Access Journals (Sweden)

    Ana Paula Pinho Carvalheira

    2010-12-01

    Full Text Available This study aimed to understand severe maternal morbidity from the perspective of women who experienced it. The methodological precepts of qualitative research were adopted and the Collective Subject Discourse was the methodological framework chosen. A total of 16 women who experienced severe maternal morbidity were interviewed. Results were discussed based on four themes: describing the desire and plan for having a child; acknowledging the health problem and its influence on pregnancy and on the conceptus; overcoming the initial shock postpartum, and experiencing the risk situation: desires, frustration, and overcoming. This study will contribute to qualifying nursing care, specifically acknowledging the diversity and breadth of the needs presented by women in situations of severe morbidity during the pregnancy-puerperal cycle.Se tuvo por objetivo comprender la experiencia relativa a morbosidad materna grave, a partir de un grupo de mujeres que experimentó ese problema. Se adoptaron los preceptos metodológicos de la investigación cualitativa, siendo el Discurso del Sujeto Colectivo el referencial metodológico. Fueron entrevistadas 16 mujeres que experimentaron morbosidad materna grave. Los resultados fueron discutidos a partir de cuatro temas: describiendo el deseo y la planificación para tener un hijo; percibiendo su problema de salud, su influencia en la gestación y en el concepto; pasando por el choque inicial del post-parto; y, experimentando la situación de riesgo: deseos, frustraciones y superación. Se espera que este trabajo pueda contribuir para calificar la asistencia de enfermería, especialmente reconocer la diversidad y amplitud de las necesidades que las mujeres presentan en situaciones de morbosidad grave durante el ciclo de embarazo y puerperio.Objetivou-se compreender a experiência relativa à morbidade materna grave, a partir de um grupo de mulheres que vivenciou esse problema. Adotaram-se os preceitos metodológicos da

  16. Análise da prevenção e tratamento das úlceras por pressão propostos por enfermeiros Análisis de la prevención y del tratamiento de las úlceras por presión propuesto por enfermeros Analysis of prevention and treatment of the pressure ulcers proposed by nurses

    OpenAIRE

    Adriana Bessa Fernandes Medeiros; Consuelo Helena Aires de Freitas Lopes; Maria Salete Bessa Jorge

    2009-01-01

    A úlcera por pressão ainda é considerada um problema grave, especialmente em pessoas idosas e nas situações de adoecimento crônico-degenerativo. O objetivo do estudo consistiu em identificar as produções bibliográficas sobre ações de prevenção e tratamento realizadas por enfermeiros publicadas no período de 1999 a 2004, descrevendo o conhecimento produzido na temática. Trata-se de levantamento bibliográfico descritivo de periódicos de enfermagem indexados na LILACS e MEDLINE, acerca da temáti...

  17. Traumatismo penetrante facial por arpón. A propósito de un caso

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    Pablo Veiga San Román

    2015-01-01

    Full Text Available Los traumatismos penetrantes causados por el disparo de un fusil de pesca submarina son extremadamente raros. El tratamiento quirúrgico está condicionado por el «mecanismo de barba», que impide una retirada segura de la flecha en sentido contrario al de su entrada, ya que la aleta del fusil provocaría graves daños. Presentamos un caso clínico y un sistema sencillo de bloqueo del retroceso de la aleta que permitió una retirada segura en sentido retrógrado.

  18. Ceratite bilateral por Acanthamoeba: relato de caso Bilateral Acanthamoeba keratitis: case report

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    Wilson Nahmatallah Obeid

    2003-12-01

    Full Text Available A ceratite por Acanthamoeba é uma infecção ocular grave que, apesar dos recentes progressos no diagnóstico e tratamento, ainda provoca prolongada morbidade e perda da acuidade visual. Relatamos um caso de ceratite bilateral por Acanthamoeba em usuário de lentes de contato, que é o primeiro caso descrito na literatura brasileira.Acanthamoeba keratitis is a severe ocular infection which even with recent progress in diagnosis and treatment still causes long morbidity and loss of visual acuity. We describe a case of bilateral Acanthamoeba keratitis in a user of contact lenses, which is the first case discussed in Brazilian literature.

  19. O abandono afetivo e a possibilidade de indenização por danos morais

    OpenAIRE

    Montenegro, Mariana Lousada Vasconcelos

    2013-01-01

    Na sociedade em que vivemos, o abandono afetivo causado pelos pais pode gerar graves consequências na vida dos seus filhos. Este artigo pretende analisar a possibilidade de reparação por danos morais por motivo de ausência de afeto em uma relação familiar. Serão apresentadas as noções gerais sobre responsabilidade civil, seu conceito e os pressupostos do dever de indenizar. Em seguida, serão expostas as questões relacionadas ao dever social e moral da família, bem como os conceitos desse inst...

  20. A grave of a Cuman noble woman in the Kislyakovsky 13 kurgan cemetery (Krasnodar kray

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    Boris Raev

    2017-12-01

    Full Text Available The Kislyakovskiy 13 kurgan cemetery was excavated in 2008 by an expedition of the Southern Scientific Center, RAS. Kurgan 2 contained two graves – one dated to the first centuries AD, the other to the Middle Ages, when the North Black Sea steppes were inhabited by the nomadic Polovеts tribes. This article discusses grave 2. The burial was made in a chamber in the form of a niche. Robbers destroyed one of the grave’s walls but the burial remained undisturbed. The buried woman of 35-40 years old was laying extended on back, head to west. Decayed wood from the funerary stretchers preserved under the skeleton. The rich grave goods included a bronze cauldron, an iron knife, two silver torques, hair rings, and a mirror. Fragments of the wooden frame, felt, textile, and gilded silver foil from a headdress preserved in area of the woman’s chest. The kurgan was encircled by a ditch; its northern part had two ledged niches made in the outer wall. Animal bones and ceramic shards with remains of the funerary feast were unearthed on the ditch bottom. The ditch was thoroughly made and has unique construction features. Judging by its lower layers, the dug-out soil was stacked not only on the kurgan’s surface but also round the ditch’s outer perimeter. The ditch remained opened for a long time and was gradually filled with flooded soil. Grave goods are typical for the Cuman graves of the 12th - early 13th centuries. The assemblage suggests a high social status of the buried woman. It is possible that for some time the area surrounded by the ditch was used as a sanctuary; afterwards the burial of a noble woman was performed, the kurgan was covered with a layer of soil.

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

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    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.

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

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    Denise Rossato Silva

    2012-06-01

    Full Text Available A tuberculose é uma doença curável que pode evoluir para formas graves com necessidade de tratamento dos pacientes em UTI, especialmente se essa não for diagnosticada em tempo ou se afetar pacientes idosos, aqueles em diálise e aqueles com infecção pelo HIV ou outros estados de imunossupressão, assim como nos casos de doença multirresistente. O conhecimento da apresentação radiológica dos casos pode auxiliar no diagnóstico dessas formas graves, assim como a introdução de novos testes, como a detecção rápida do agente por PCR e a TC de tórax, favorecendo o início precoce do tratamento. Além disso, o uso de esquemas sem isoniazida e rifampicina, a absorção entérica incerta e as baixas concentrações séricas das drogas antituberculose podem contribuir para a diminuição da eficácia do tratamento. O prognóstico desses pacientes geralmente é ruim, com elevadas taxas de mortalidade.Tuberculosis is a curable disease that can evolve to severe forms, requiring the treatment of the patients in an ICU, especially if there is a delay in the diagnosis or if it affects elderly patients, those on dialysis, or those with HIV infection or other states of immunosuppression, as well as in cases of multidrug resistant disease. Knowledge of the radiological presentation of the cases can help diagnose these severe forms, as can the introduction of new tests, such as the early detection of the etiological agent by PCR and chest CT, which favors the early initiation of treatment. In addition, the use of regimens without isoniazid and rifampin, as well as uncertain enteral absorption and low serum concentrations of antituberculosis drugs, can reduce the efficacy of treatment. For such patients, the prognosis is generally poor and mortality rates are high.

  3. Caso clínico: tratamiento quirúrgico de la neuropatía cubital por pseudoartrosis del gancho del hueso ganchoso

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    A. León Garrigosa

    2017-03-01

    Conclusiones: El dolor en el margen cubital de la mano, con tenosinovitis flexora de los tendones del cuarto y quinto dedos y/o manifestaciones de neuropatía cubital distal, cuando se produce en pacientes que practican deporte de empuñadura, obliga a realizar tomografía axial computerizada, y, si hay pseudoartrosis del gancho del hueso ganchoso, intentar su osteosíntesis.

  4. Herida cardiaca por arma de fuego. Presentación clínica y conducta terapéutica

    OpenAIRE

    Uceda-Galiano, Ángela; Rey-Lois, Juvenal; Balbacid-Domingo, Enrique José; Campos-García, Gema; Aroca-Peinado, Ángel; Gutiérrez-Larraya-Aguado, Federico

    2016-01-01

    Las heridas cardiacas por armas de fuego son poco frecuentes, pero constituyen una afección potencialmente grave por la gran morbimortalidad que acarrean. Se describe el caso de un paciente de 14 años que ingresa en nuestro centro en situación crítica, intubado y con compromiso hemodinámico tras haber recibido un disparo por arma de fuego en el hemitórax izquierdo. El ECG realizado mostraba elevación difusa del segmento ST. La radiografía de tórax informó de la presencia de cuerpo extraño de ...

  5. Internamentos por varicela em pediatria – casuística de um Hospital Nível 2

    OpenAIRE

    Ana Ratola; Ângela Almeida; Liliana Quaresma; Maria Manuel Flores; Ana Nordeste

    2016-01-01

    Introdução: A varicela é uma doença infeciosa frequente na infância. Embora considerada geralmente uma doença benigna e auto-limitada, pode cursar com complicações graves. O objetivo deste trabalho foi caracterizar os internamentos por varicela e suas complicações. Métodos: Análise retrospetiva dos processos clínicos das crianças com internamento no Serviço de Pediatria por varicela entre 01.01.2000 e 31.12.2012. Resultados: Foram internadas 105 crianças por varicela, nos 13 anos avalia...

  6. Vasculitis inducida por metimazol: Reporte de caso

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    Miguel Pinto

    2011-07-01

    Full Text Available Se reporta el caso de una paciente con enfermedad de Graves, que presentó vasculitis asociada al uso de metimazol. Mujer de 14 años, que acudió a consulta por presentar intolerancia al calor, tremor distal y palpitaciones. El examen físico mostró bocio difuso, y el perfil tiroideo, TSH suprimida y hormonas tiroideas elevadas. Los anticuerpos antiperoxidasa tiroidea fueron positivos. Se inició tratamiento con metimazol y beta bloqueadores. Después de 20 días, la paciente regresó por presentar malestar general, fiebre, poliartralgia, lesiones cutáneas maculopapulares y edema de miembros inferiores. Los anticuerpos antinucleares fueron negativos y los anticuerpos anticitoplasma de los neutrófilos (ANCA, positivos. Se suspendió el metimazol y se inició prednisona. Después de 10 días de tratamiento, las molestias desaparecieron y la paciente recibió I 131.Las vasculitis asociadas al uso de tionamidas son poco frecuentes, no dependen de la dosis y están asociadas a la presencia de anticuerpos tipo ANCA. Clásicamente, afectan a los vasos pequeños de la piel; sin embargo, también pueden afectar los riñones y pulmones. El cuadro clínico se caracteriza por artralgias y mialgias. En algunos casos puede ocurrir insuficiencia renal de grado variable. En la mayoría de casos, el cuadro remite con la suspensión de la droga; pero, en algunos se requiere el uso de glucocorticoides o inmunosupresores.(Rev Med Hered 2011;22:147-150.

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

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    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.

  8. Evidence that TSH Receptor A-Subunit Multimers, Not Monomers, Drive Antibody Affinity Maturation in Graves' Disease.

    Science.gov (United States)

    Rapoport, Basil; Aliesky, Holly A; Chen, Chun-Rong; McLachlan, Sandra M

    2015-06-01

    The TSH receptor (TSHR) A-subunit shed from the cell surface contributes to the induction and/or affinity maturation of pathogenic TSHR autoantibodies in Graves' disease. This study aimed to determine whether the quaternary structure (multimerization) of shed A-subunits influences pathogenic TSHR autoantibody generation. The isolated TSHR A-subunit generated by transfected mammalian cells exists in two forms; one (active) is recognized only by Graves' TSHR autoantibodies, the second (inactive) is recognized only by mouse monoclonal antibody (mAb) 3BD10. Recent evidence suggests that both Graves' TSHR autoantibodies and mAb 3BD10 recognize the A-subunit monomer. Therefore, if the A-subunit monomer is an immunogen, Graves' sera should have antibodies to both active and inactive A-subunits. Conversely, restriction of TSHR autoantibodies to active A-subunits would be evidence of a role for shed A-subunit multimers, not monomers, in the pathogenesis of Graves' disease. Therefore, we tested a panel of Graves' sera for their relative recognition of active and inactive A-subunits. Of 34 sera from unselected Graves' patients, 28 were unequivocally positive in a clinical TSH binding inhibition assay. None of the latter sera, as well as 8/9 sera from control individuals, recognized inactive A-subunits on ELISA. In contrast to Graves' sera, antibodies induced in mice, not by shedding from the TSHR holoreceptor, but by immunization with adenovirus expressing the free human A-subunit, were directed to both the active and inactive A-subunit forms. The present study supports the concept that pathogenic TSHR autoantibody affinity maturation in Graves' disease is driven by A-subunit multimers, not monomers.

  9. Nutrición parenteral precoz en el neonato grave

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    Alina González Mustelier

    2004-06-01

    Full Text Available Se realizó un estudio descriptivo en el Servicio de Terapia Intensiva Neonatal del Hospital Ginecoobstétrico "Ramón González Coro" de Ciudad de La Habana, desde enero del 2000 hasta enero del 2002, con el objetivo de valorar las ventajas del uso de nutrición parenteral (NP precoz en los neonatos críticamente enfermos, durante la primera semana de vida. Se compararon 2 grupos de 23 recién nacidos críticos, uno de ellos recibió alimentación parenteral (grupo I y el otro no (grupo II. Se encontró homogeneidad en ambos grupos en cuanto a peso, edad gestacional, valoración nutricional al nacer, sexo y morbilidad inicial. La nutrición parenteral se caracterizó por su uso precoz (menos de 72 horas, conjuntamente con alimentación enteral mínima. La media del aporte máximo de macronutrientes fue de 16 g/kg/d de dextrosa, 1,2 g/kg/d de lípidos y 2 g/kg/d de proteínas. El desarrollo nutricional fue más favorable en el grupo con NP, porque le disminuyó a la mitad el tanto por ciento de peso perdido en la primera semana de vida, le sostuvo mayor aporte energético durante ese período y recupó 7 días antes su peso del nacimiento en relación con el grupo II. Las complicaciones fueron similares en ambos grupos, para concluir en que estas no estuvieron relacionadas con el uso de NP.A descriptive study was conducted at the Neonatal Intensive Therapy Service of "Ramón Gonzalez Coro" Gynecoobstetric Hospital, in Havana City, from January 2000, to January 2002, aimed at assessing the advantages of the use of early parenteral nutrition in the critically ill neonates during the first week of life. 2 groups of 23 critical newborn infants each were compared. One of them recieved parenteral nutrition (group 1 and the other one did not (group II. Homogeneity was found in both groups as regards weight, gestational age, nutritional assessment at birth and initial morbidity. The parenteral nutrition was characterized by its early use (less than 72

  10. 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

    completed the Hospital Anxiety and Depression Scale (HADS). The differences in the mean HADS scores between the groups were analysed using multiple linear regression, controlling for socio-demographic variables. HADS scores were also analysed dichotomized: a score >10 indicating probable 'anxiety......'/probable 'depression'. Determinants of anxiety and depression symptoms in Graves' disease were examined using multiple linear regression.RESULTS: In Graves' disease levels of anxiety (p = 0.008) and depression (p = 0.014) were significantly higher than in controls. The prevalence of depression was 10% in Graves...

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

  12. Otimização hemodinâmica em trauma grave: uma revisão sistemática e metanálise

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    Carlos Corredor

    2014-12-01

    Full Text Available Objetivo: O trauma grave pode associar-se a ocorrência de importante choque hemorrágico e ao comprometimento da perfusão dos órgãos. Formulamos a hipótese de que o tratamento direcionado por objetivo conferiria benefícios em termos de morbidade e mortalidade, em casos graves de trauma. Métodos: Realizamos uma busca sistemática nas bases de dados MedLine, Embase e Cochrane Controlled Clinical Trials Register com relação a pacientes vítimas de trauma grave. A mortalidade foi o desfecho primário dessa revisão. Os desfechos secundários incluíram taxas de complicações, duração da permanência no hospital e na unidade de terapia intensiva, e o volume de fluidos administrados. A metanálise foi realizada utilizando o programa de computador RevMan, e os dados apresentados são as odds ratios (OR para desfechos dicotomizados e as diferenças médias e diferenças médias padrão para desfechos contínuos. Resultados: Foram analisados quatro estudos clínicos randomizados e controlados, que incluíram 419 pacientes. O risco de mortalidade foi significantemente reduzido nos pacientes com tratamento direcionado por objetivo, em comparação ao grupo controle (OR=0,56; IC95%: 0,34-0,92. A duração da permanência na unidade de terapia intensiva (DM: 3,7 dias; IC95%: 1,06-6,5 e no hospital (DM: 3,5 dias; IC95%: 2,75-4,25 foi significantemente mais curta no grupo de pacientes do grupo tratado conforme o protocolo. Não houve diferenças nos relatos relativos a volume total de fluidos infundidos e a transfusões sanguíneas. A heterogeneidade nos relatos entre os estudos impediu uma análise quantitativa das complicações. Conclusão: Após a ocorrência de trauma grave, o uso precoce de tratamento direcionado por objetivo se associou com mortalidade mais baixa e com menos dias de permanência na unidade de terapia intensiva e no hospital. Os achados desta análise devem ser interpretados com cautela, em razão da importante

  13. Review and hypothesis: does Graves' disease develop in non-human great apes?

    Science.gov (United States)

    McLachlan, Sandra M; Alpi, Kristine; Rapoport, Basil

    2011-12-01

    Graves' disease, caused by stimulatory thyrotropin receptor (TSHR) autoantibodies, has not been observed in animals. In contrast, Hashimoto's thyroiditis develops in chickens, rats, mice, dogs, and marmosets. Attempts to induce an immune response in mice to the luteinizing-hormone receptor suggested that autoantigen glycosylation was one parameter involved in breaking self-tolerance. Over evolution, TSHR glycosylation increased from three asparagine-linked-glycans (N-glycans) in fish to six N-glycans in humans and great apes. All other placental mammals lack one N-glycan in the shed TSHR A-subunit, the primary Graves' disease autoantigen. We hypothesized that (a) lesser TSHR A-subunit glycosylation reduces immunogenicity, accounting for the absence of Graves' disease in most placental mammals; (b) due to human-like A-subunit glycosylation, Graves' disease might arise in great apes. Here, we review and analyze the literature on this subject and report the results of a survey of veterinarians at primate centers and zoos in North America. Previous experimental data from induced TSHR antibodies in mice support a role for A-subunit glycosylation in breaking self-tolerance. An extensive search of the great-ape literature revealed five reports of noncongenital thyroid dysfunction, four with hypothyroidism and one with hyperthyroidism. The latter was a gorilla who was treated with anti-thyroid drugs but is now deceased. Neither serum nor thyroid tissue from this gorilla were available for analysis. The survey of veterinarians revealed that none of the 979 chimpanzees in primate research centers had a diagnosis of noncongenital thyroid dysfunction and among ∼1100 great apes (gorillas, orangutans, and chimpanzees) in U.S. zoos, only three were hypothyroid, and none were hyperthyroid. Graves' disease appears to be either very rare or does not occur in great apes based on the literature and a survey of veterinarians. Although the available data do not advance our hypothesis

  14. CD28/CTLA-4/ICOS haplotypes confers susceptibility to Graves' disease and modulates clinical phenotype of disease.

    Science.gov (United States)

    Pawlak-Adamska, Edyta; Frydecka, Irena; Bolanowski, Marek; Tomkiewicz, Anna; Jonkisz, Anna; Karabon, Lidia; Partyka, Anna; Nowak, Oskar; Szalinski, Marek; Daroszewski, Jacek

    2017-01-01

    Graves' disease, an autoimmune disease with heterogeneous symptoms including Graves' orbitopathy, has a combined genetic/environmental background, where variations within CD28/CTLA-4/ICOS genes are considered as disease markers.Association of CD28c.17+3T>C(rs3116496), CTLA-4g.319C>T(rs5742909), CTLA-4c.49A>G(rs231775), CTLA-4g.*642AT(8_33), CT60(rs3087243), Jo31(rs11571302), ICOSc.1554+4GT(8_15) polymorphisms with susceptibility to Graves' disease and clinical outcome was investigated. The study group comprised of 561 Polish Caucasians, including 172 unrelated Graves' disease patients. CTLA-4c.49A>G, CTLA-4g.319C>T, and CT60 were genotyped by PCR-RFLP; Jo31 and CD28c.17+3C>T by minisequencing; CTLA-4g.*642AT(8_33) and ICOSc.1554+4GT(8_15)-PCR and fluorescence-based technique. CD28c.17+3T>C(rs3116496)T/CTLA-4g.319C>T(rs5742909)C/CTLA-4c.49A>G(rs231775)G/CTLA-4g.*642AT(8_33)(AT16-21)/CT60(rs3087243)G/Jo31(rs11571302)G/ICOSc.1554+4GT(8_15)(m) and TCA(ATGraves' disease, especially in males, as well as overall Graves' orbitopathy development with severe outcome. TCG(AT16-21)GG(l) haplotype increased risk of Graves' disease and reduced the chance of successful medical treatment. Although this haplotype was mainly observed in patients without signs of Graves' orbitopathy, if Graves' orbitopathy developed it favored a Graves' orbitopathy outcome. Haplotype TCA(AT>21)GT(m) increased Graves' disease risk in women and, in all patients, was linked to Graves' disease without Graves' orbitopathy. TCG(ATGraves' orbitopathy, whereas TCA(AT16-21)GG(m) was absent in those patients. TCA(AT16-21)GG(m) occurred in patients with a mild Graves' orbitopathy outcome. The marker CTLA-4g.*642AT(8_33) was the only independent Graves' disease risk factor, whereas CT60 was an independent factor for disease progression. Sporadic Graves' disease was related to presence of CTLA-4c.49A>G[A] and the rare CTLA-4g.319C>T[T] allele variant. Familial background of the disease was exclusively associated

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

    Directory of Open Access Journals (Sweden)

    Alberto Goldenberg

    2007-10-01

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

  16. 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...... diseases before and after rituximab therapy, the authors interpret the results of the only two clinical investigations of the efficacy of rituximab in the treatment of Graves' disease and Graves' opthalmopathy reported so far. No significant effect on autoantibody levels was observed. Nonetheless, 4 out...... of 10 Graves' disease patients remained in remission 400 days after rituximab treatment versus none in the control group, and remarkable improvements in the eye symptoms of patients with Graves' ophthalmopathy were observed. This supports a role for B cells in the pathogenesis of Graves' ophthalmopathy...

  17. Impacto de la craniectomía descompresiva precoz en los resultados del tratamiento del trauma craneoencefálico grave

    Directory of Open Access Journals (Sweden)

    Henry Lopez Jimenez

    2016-01-01

    Full Text Available Fundamento: el trauma craneoencefálico (TCE constituye la primera causa de muerte y morbilidad en personas jóvenes. Actualmente es difícil conocer el real rendimiento de las craniectomías descompresivas y, el momento oportuno no está definido con claridad, especialmente en pacientes que han sufrido traumatismo craneoencefálico.Objetivo: evaluar el impacto de la craniectomía descompresiva precoz en el control de la presión intracraneal (PIC, la calidad de vida, y la mortalidad en los pacientes con trauma craneoencefálico grave, atendidos en el Hospital General Docente “Dr. Ernesto Guevara de la Serna”, en la provincia de Las Tunas, en el período comprendido entre enero de 2008 y diciembre de 2013.Métodos: se realizó un estudio analítico, longitudinal y prospectivo, en el referido hospital y período de tiempo. La investigación tuvo dos momentos, el primero del 2008 al 2011 con 202 pacientes y el segundo del 2012 al 2013 con 38 pacientes. El grupo I, de estudio, constituido por 120 casos, al que se les ofreció una Craniectomía Descompresiva como tratamiento inicial. El grupo II, control, estuvo formado por 120 pacientes que recibieron tratamiento convencional inicialmente.Resultados: en el grupo de estudio predominaron cifras de presión intracraneal por debajo de 20 mmHg (72,5%, fallecidos (17,5%, las secuelas moderadas (40,83% y la buena recuperación funcional (18,3%. En el grupo de control predominaron valores de presión intracraneal por encima de 20 mmHg, los fallecidos (35% y las secuelas graves (41,6%. El tratamiento quirúrgico precoz no tuvo un impacto significativo en la mortalidad de los pacientes.Conclusiones: la craniectomía descompresiva precoz fue eficaz para el control de la presión intracraneal (PIC, se mejoró la calidad de vida de los pacientes, y la técnica quirúrgica realizada de forma precoz no influyó en la mortalidad de los pacientes.

  18. 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.

  19. 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.

  20. [The role of adipose tissue in the pathogenesis and clinical manifestation of Graves' orbitopathy].

    Science.gov (United States)

    Janusz, Przemysław; Pawlak-Adamska, Edyta; Kochanowska, Iwona Ewa; Daroszewski, Jacek

    2013-12-02

    Graves' orbitopathy (GO) is a inflammatory disease of connective tissue with autoimmune background considered as extrathyroidal component of the Graves' disease. Despite a progress in understanding of some elements of the pathogenesis it still remains one of the most complex topics of clinical endocrinology. Clinical symptoms of the orbitopathy derive from the discrepancy between limited space of the orbit and expansion of pathologically affected orbital tissues. In present paper the current state of knowledge concerning the role of orbital adipose tissue in a multifaceted manifestation of the disease as well as its importance in the immune and inflammatory reaction have been reviewed. The role of the major orbital auto antigens (TSHR and IGF1R) as well as hypotheses concerning the putative link connecting pathology of thyroid gland and orbital tissues were discussed.

  1. Graves' hyperthyroidism accompanied with acute hepatitis B virus infection: an extrahepatic manifestation?

    Science.gov (United States)

    Cui, Wei; Deng, Baocheng; Wang, Wen; Liu, Pei

    2016-05-20

    Although hepatitis B virus (HBV) primarily affects hepatocytes, it has also been shown to cause complications in the skin, joints, muscles, and kidneys. Thyroid dysfunction is uncommon in cases of acute HBV infection. In this report, we describe a case of a 46-year-old woman with incipient acute hepatitis B virus (HBV) infection who presented clinically with Graves' hyperthyroidism. She showed typical symptoms of hyperthyroidism, and laboratory tests revealed high levels of HBV DNA and alanine transaminase (ALT). The patient was not administered with antithyroid medicine or radioiodine, but she was given antiviral therapy and symptomatic treatment with propranolol. Follow-up studies showed that as the HBV DNA levels decreased, the thyroid function recovered. Graves' disease maybe an extrahepatic manifestation of acute HBV infection. Antiviral therapy is likely to be beneficial for this condition as without severe thyrotoxicosis.

  2. Autoimmune Hepatitis with Multiple Sclerosis and Graves Disease: Coincidence or Association

    Directory of Open Access Journals (Sweden)

    Omar N. Nadhem

    2014-10-01

    Full Text Available Autoimmune hepatitis (AIH is a generally progressive, chronic hepatitis of unknown cause that occurs in children and adults of all ages. It is associated with a variety of autoimmune conditions like thyroid disorders (Hashimoto and Graves disease, celiac disease and multiple sclerosis (MS. We report the case of a 61-year-old woman with MS (untreated and a history of Graves disease who presented with fatigue and right upper quadrant abdominal pain. She was admitted to our hospital for evaluation. Clinical and laboratory workup revealed AIH. She was successfully treated with prednisone and azathioprine, with complete clinical and laboratory improvement. However, to our knowledge there have been only a few reports of a possible association between AIH and untreated MS.

  3. Graves violações de direitos humanos e desigualdade no município de São Paulo Graves violaciones de derechos humanos y desigualdad en el município de São Paulo (Sureste de Brasil Gross violation of human rights and inequality in city of São Paulo, Southeastern Brazil

    Directory of Open Access Journals (Sweden)

    Caren Ruotti

    2009-06-01

    Full Text Available OBJETIVO: Analisar o perfil de graves violações de direitos humanos e sua associação com aspectos socioeconômicos e demográficos. MÉTODOS: Estudo ecológico, de corte transversal, tendo como unidade de análise os 96 distritos censitários do município de São Paulo (SP para o ano de 2000. Foi utilizado o banco de dados sobre graves violações de direitos humanos, do Núcleo de Estudos da Violência da Universidade de São Paulo, que contém informações sobre todos os casos de execuções sumárias, linchamento e violência policial noticiados na imprensa escrita. Dados socioeconômicos e demográficos foram obtidos do Censo 2000 da Fundação Instituto Brasileiro de Geografia e Estatística. Foi testada a associação entre a variável dependente - graves violações de direitos humanos (composta pelo número de vítimas de violência policial, linchamentos e execuções sumárias - e variáveis socioeconômicas e demográficas por meio do teste de correlação de Spearman. RESULTADOS: As correlações entre as violações de direitos e os indicadores socioeconômicos e demográficos foram estatisticamente significantes, exceto em relação à taxa de urbanização e relação de leito hospitalar por 1000 habitantes. As correlações mais fortes foram encontradas entre graves violações de direitos e tamanho população residente (r=0,693, proporção de jovens de 15 a 24 anos na população (r=0,621 e proporção de chefes de família sem instrução ou com até três anos de escolaridade (r=0,590. CONCLUSÕES: Graves violações de direitos humanos atingem mais incisivamente a população que apresenta piores condições de vida. Desse modo, perpetua-se um quadro em que a desigualdade na efetivação dos direitos sociais e econômicos se sobrepõe diretamente à violação dos direitos civis, intensificando um ciclo de violência.OBJETIVO: Analizar el perfil de graves violaciones de derechos humanos y su asociación con aspectos

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

    Directory of Open Access Journals (Sweden)

    Dandung Budi Yuwono

    2015-12-01

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

  5. Approach to the Pediatric Patient with Graves’ Disease: When Is Definitive Therapy Warranted?

    Science.gov (United States)

    2011-03-01

    added benefit of de- creasing thyroid vascularity (41). The typical dose is three to five drops of concentrated iodine, 50– 150 mg/dose, taken three...symptoms, such as hematuria, proteinuria , dyspnea and hemopty- sis, purpuric rash, arthralgia, uveitis, myalgia, and oth- ers (59, 63). For years...ocular findings in pediatric patients with Graves disease. Trans Am Ophthalmol Soc 105:146– 150 ; discussion 150 –151 55. Gogakos AI, Boboridis K, Krassas

  6. Is minimally invasive, video-assisted thyroidectomy feasible in Graves' disease?

    Science.gov (United States)

    Alesina, Pier F; Singaporewalla, Reyaz M; Eckstein, Anja; Lahner, Harald; Walz, Martin K

    2011-04-01

    Although the safety and advantages of minimally invasive, video-assisted thyroidectomy (MIVAT) are well documented in nodular thyroid disease, its role in Graves' disease is controversial. We compared the outcomes of patients undergoing MIVAT with those undergoing conventional thyroidectomy for Graves' disease. Of the 497 patients with Graves' disease referred for surgery (1999-2009), 157 (31.6%) patients underwent the MIVAT procedure (video-assisted group). As a control group, 340 patients undergoing conventional thyroidectomy (conventional thyroidectomy group) were included in the current analysis. MIVAT was proposed if the thyroid volume was ≤ 30 mL. The data were obtained through a prospectively maintained surgical database. Most patients in both groups underwent total thyroidectomy (98% in the MIVAT group and 96.5% in the conventional group). Three (1.9%) conversions to open surgery occurred in the video-assisted group. Hospital stay was significantly shorter (P = .008) in the video-assisted group (2.1 ± 0.4 days) compared with the conventional thyroidectomy group (2.4 ± 1.4 days). The mean operative time was shorter (84 ± 29 min; range, 15-240) for the video-assisted group compared with the conventional thyroidectomy group (94 ± 43 min; range, 20-360), although this difference was not statistically significant (P = .05). Postoperative transient hypocalcemia occurred in 14 (8.9%), transient recurrent laryngeal nerve palsy occurred in 2 (1.3%), and postoperative hematoma occurred in 5 (3.2%) patients in the video-assisted group compared with 23 (6.8%), 11 (3.2%), and 8 (2.3%) patients in the conventional thyroidectomy group, respectively (P = ns). In selected patients with Graves' disease, MIVAT is feasible and can be performed safely with results comparable with open surgery. Copyright © 2011 Mosby, Inc. All rights reserved.

  7. Audit de la morbidite obstetricale grave «near miss» au gabon ...

    African Journals Online (AJOL)

    Audit de la morbidite obstetricale grave «near miss» au gabon. ... La prévalence des « near miss » a été de 3,15 % soit 137 cas pour 4350 accouchements. ... of shock, eclampsia and severe maternal infection) and/or those in whom a major surgical intervention was imperative to prevent death were included in the study.

  8. Pensamientos sobre como enfrentar el sufrimiento en personas mentalmente discapacitadas y que padecen una enfermedad grave

    OpenAIRE

    Arancibia Silva,Margarita

    2007-01-01

    La práctica de la Medicina pone en nuestro camino constantemente dilemas éticos y morales. Se plantea el enfrentamiento del médico al sufrimiento de pacientes con discapacidad mental y que padecen una enfermedad grave. Se refiexiona sobre la relación médico paciente, el respeto a los principios bioéticos y los confiictos éticos en el tratamiento de estos pacientes en particular

  9. 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.

  10. Anti-mitochondrial antibodies in patients with Graves' disease may not signify primary biliary cirrhosis.

    OpenAIRE

    Perros, P.; Palmer, J. M.; Yeaman, S. J.; Kendall-Taylor, P.

    1994-01-01

    Two patients with Graves' disease were incidentally found to have anti-mitochondrial antibodies by immunofluorescence in the absence of symptoms, clinical signs or biochemical evidence of liver dysfunction. Anti-mitochondrial antibody titres became undetectable in both patients on follow-up. Screening of the patients' sera by immunoblotting against the purified antigens of the M2 complex was negative. We conclude that in these cases, anti-mitochondrial antibodies detected by immunofluorescenc...

  11. Field performance of timber bridges. 4, Graves Crossing stress-laminated deck bridge

    Science.gov (United States)

    J. P. Wacker; M. A. Ritter

    The Graves Crossing bridge was constructed October 1991 in Antrim County, Michigan, as part of the demonstration timber bridge program sponsored by the USDA Forest Service. The bridge is a two-span continuous, stress-laminated deck superstructure and it is 36-ft long and 26-ft wide. The bridge is one of the first stress-laminated deck bridges to be built of sawn lumber...

  12. Demographic differences between funerary caves and megalithic graves of northern Spanish Late Neolithic/Early Chalcolithic.

    Science.gov (United States)

    Fernández-Crespo, Teresa; de-la-Rúa, Concepción

    2016-06-01

    The study focuses on the estimation of demographic parameters of Late Neolithic/Early Chalcolithic (mid 4th-early 3rd millenniums cal. BC) burial sites from the La Rioja region (Ebro valley, northern Spain) to identify demographic characteristics. The human remains come from three caves (Las Yurdinas II, Peña Larga, and La Peña de Marañón) and three megalithic graves (Alto de la Huesera, San Martín, and Peña Guerra II). The total skeletal sample consists of a minimum of 261 individuals, 149 being buried in caves and 112 in megalithic graves. Data based on age and sex estimation are analyzed using abridged life tables, mortality rates, and sex ratios. A systematic bias against children under 5 years of age is detected both in caves (5 q0  = 187.92%) and megalithic graves (5 q0  = 71.43%) but also against some juveniles and adults compared with population models, though a statistically significant greater lack of infants is worth noting in the megaliths (t-test, P = 0.012). Moreover, a significant divergence in sex ratios (χ(2) , P = 0.002) is also identified between site types, clearly prioritizing women in caves (sex ratio = 0.45) and men in megalithic graves (sex ratio = 1.33). This evidence is interpreted as the result of different selective burial patterns. The mortuary variability could lie behind intragroup differential status relationships, though the hypothesis of two populations performing distinct funerary practices in a small region cannot be rejected at the present state of the research. Am J Phys Anthropol 160:284-297, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  13. 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

  14. 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. © 2015 Royal College of Physicians.

  15. Effect of Selenium Supplementation on Recurrent Hyperthyroidism Caused by Graves' Disease: A Prospective Pilot Study.

    Science.gov (United States)

    Wang, L; Wang, B; Chen, S R; Hou, X; Wang, X F; Zhao, S H; Song, J Q; Wang, Y G

    2016-09-01

    The effect of selenium supplementation on recurrent hyperthyroidism caused by Graves' disease is unclear. Our study aimed to assess the efficacy of selenium supplementation therapy on recurrent Graves' disease. Forty-one patients with recurrent Graves' disease were enrolled in this study. All patients received the routine treatment using methimazole (MMI), while patients allocated to the selenium group received additional selenium therapy for 6 months. The influence of selenium supplementation on the concentrations of thyroid stimulating hormone (TSH), anti-TSH-receptor antibodies (TRAb), free thyroxine (FT4), and free triiodothyronine (FT3) were assessed. The remission rate was also compared between 2 groups. There was no obvious difference in the demographic data and the levels of serum FT4, FT3, TSH, and TRAb between the 2 groups at baseline. Both FT4 and FT3 decreased more at 2 months in the selenium group than the controls, while the TSH level increased more in patients receiving selenium supplementation (pselenium supplementation (2.4 IU/l vs. 5.6 IU/l, p=0.04). The percentages of patients with normal TRAb level at 6 months was also significantly higher in the selenium group (19.0 vs. 0%, p=0.016). Kaplan-Meier survival curve showed patients receiving selenium supplementation had a significantly higher rate of remission than controls (Log-rank test p=0.008). In conclusion, selenium supplementation can enhance the effect of antithyroid drugs in patients with recurrent Graves' disease. Randomized trials with large number of participants are needed to validate the finding above. © Georg Thieme Verlag KG Stuttgart · New York.

  16. Should radioiodine be the first-line treatment for paediatric Graves' disease?

    Science.gov (United States)

    West, James D; Cheetham, Timothy D; Dane, Carole; Natarajan, Anuja

    2015-07-01

    Debate exists regarding the optimal treatment strategy for paediatric Graves' disease with radioiodine (RAI), and surgery, usually reserved for failure of medical therapy. We present our own experience to introduce a review of the published literature focussing on the predictors of remission after antithyroid drug (ATD) therapy from diagnosis, and discuss whether RAI should be considered as a first-line therapy. A retrospective analysis of all diagnosed cases of paediatric Graves' disease presenting to a large District General Hospital. Thirteen patients were diagnosed with Graves' disease between February 2004 and May 2013. The median age at diagnosis was 13.7 years (range 7.2-17.1 years) with a female:male ratio of 11:2. Some nine patients completed a 2-year course of carbimazole out of which 8 relapsed after a mean duration of 0.82 years (range 0.08-1.42 years); the ninth currently remains in remission. Of the eight patients who relapsed, three have undergone RAI treatment. Two patients failed to tolerate carbimazole treatment, one of whom received RAI treatment because surgery was contraindicated and one patient with severe autism proceeded to RAI treatment due to poor compliance and persistent hyperthyroidism. Prognostic factors at presentation predicting a low likelihood of remission following ATD treatment include younger age, non-Caucasian ethnicity, and severe clinical and/or biochemical markers of hyperthyroidism. Psycho-social factors including compliance also influence management decisions. In specifically selected patients presenting with paediatric Graves' disease, the benefits and risks of radioactive iodine as a potential first-line therapy should be communicated allowing families to make informed decisions.

  17. Thymic Involution After Radioiodine Therapy for Graves Disease: Relationships With Serum Thyroid Hormones and TRAb.

    Science.gov (United States)

    Jinguji, Megumi; Nakajo, Masayuki; Nakajo, Masatoyo; Koriyama, Chihaya; Yoshiura, Takashi

    2017-07-01

    The mechanisms of thymic hyperplasia in Graves disease and its involution after radioiodine (I-131) therapy remain unknown. To examine whether computed tomography (CT) findings of the thymus in patients with Graves disease change before and 6 months after I-131 therapy and to elucidate factors that affect these changes. A retrospective, single-center study was conducted. Thymic and thyroid volumes and thymic density were measured on CT. The associations of thymic volume or density with the following factors before I-131 therapy were examined: age; serum triiodothyronine (T3), thyroxine (T4), and thyroid-stimulating hormone receptor antibody (TRAb) levels; and thyroid volume. The changes in thymic volume and density and TRAb levels before and after I-131 therapy, and the correlations of thymic volume with T3 and T4 decline rates and TRAb changing rate and age were examined. We studied 40 consecutive patients with Graves disease who underwent neck and chest CT before and 6 months after I-131 therapy. Observational study. A significant negative correlation was observed only between thymic density and age before I-131 therapy. Thymic volume and density decreased and TRAb levels increased significantly after I-131 therapy. The thymic volume decline rate significantly positively correlated with serum T3 and thyroid volume decline rates. No significant correlation was found between thymic volume decline and TRAb changing rates. Significant thymic involution occurs after I-131 therapy in patients with Graves disease. Serum T3, but not TRAb, may be related to thymic hyperplasia and involution following I-131 therapy.

  18. Graves' disease in children: long-term outcomes of medical therapy.

    Science.gov (United States)

    Rabon, Shona; Burton, Amy M; White, Perrin C

    2016-10-01

    Management options are limited for the treatment of Graves' disease, and there is controversy regarding optimal treatment. We describe the demographic and biochemical characteristics of children with Graves' disease and the outcomes of its management. This is a retrospective study reviewing medical records from 2001 to 2011 at a tertiary-care paediatric hospital. Diagnostic criteria included elevated free T4 and total T3, suppressed TSH, and either positive thyroid-stimulating immunoglobulin or thyroid receptor antibodies or clinical signs suggestive of Graves' disease, for example exophthalmos. Patients were treated with antithyroid drugs (ATD), radioactive iodine, or thyroidectomy. The main outcome measures were remission after medical therapy for at least 6 months and subsequent relapse. A total of 291 children met diagnostic criteria. A total of 62 were male (21%); 117 (40%) were Hispanic, 90 (31%) Caucasian, and 59 (20%) African American. Mean age (±standard deviation) at diagnosis was 12·3 ± 3·8 (range 3-18·5) years. At diagnosis, 268 patients were started on an antithyroid drug and 23 underwent thyroid ablation or thyroidectomy. Fifty-seven (21%) children achieved remission and 16 (28%) of these patients relapsed, almost all within 16 months. Gender and ethnicity did not affect rates of remission or relapse. Of 251 patients treated with methimazole, 53 (21%) had an adverse reaction, including rash, arthralgias, elevated transaminases, or neutropenia. Most children with Graves' disease treated with ATD do not experience remission, but most remissions do not end in relapse. Adverse reactions to methimazole are common but generally mild. © 2016 John Wiley & Sons Ltd.

  19. Both interleukin-23A polymorphism and serum interlukin-23 expression are associated with Graves' disease risk.

    Science.gov (United States)

    Jia, Huiying; Tao, Feng; Liu, Changqin; Guo, Ting; Zhu, Wei; Wang, Shu; Cui, Bin; Ning, Guang

    2015-03-01

    Two independent Chinese cohorts were used to study the genetic association between the interleukin-23A (IL-23A) gene polymorphism (rs11171806) and susceptibility to Graves' disease (GD). The initial Shanghai cohort consisted of 712 unrelated patients with GD and 705 healthy control subjects, and the replication cohort from Xiamen Island included 433 patients with GD and 410 healthy control subjects. The serum concentration of IL-23 in GD patients was measured significantly higher than in health controls. Moreover in the subgroup analysis, higher concentrations of IL-23 were identified in patients of older age (⩾40 years) and female gender. We also performed an association study with the IL-23 gene polymorphism rs11171806 in both cohorts, in Shanghai cohorts, the frequencies of rs11171806 alleles were strongly different between Graves' disease patients (G 95.7% and A 4.3%) and healthy controls (G 97.7% and A 2.3%) (P=2.6×10(-3), OR=1.93 (95% CI: 1.25-2.97)), and in Xiamen cohorts, the proportion of individuals carrying the A allele of rs11171806 was the same significantly higher in Graves' disease patients than in controls [Graves' disease vs. control, 4.8% vs. 4.3%, OR=2.15 (95% CI: 1.23-3.79), P(allele)=6.3×10(-3)]. The distribution of rs11171806 genotype was also investigated in subgroups according to the age and gender. All of these findings suggested that IL-23 may play an important role in the development of GD, and the IL-23A gene is a genetic risk marker for GD in Han Chinese population. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. 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.

  1. L'haptoglobine chez les enfants atteints de paludisme grave a ...

    African Journals Online (AJOL)

    Objectifs : Cette étude avait pour objectifs d'évaluer l'haptoglobine chez les enfants âgés de 0 à 15 ans atteints de paludisme grave à Plasmodium falciparum, et de rechercher les relations entre cette protéine de l'inflammation avec l'âge, la densité parasitaire et le taux d'hémoglobine. Méthodologie et résultats : Il s'agissait ...

  2. Les formes graves de la grippe A(H1N1) 2009 chez la femme ...

    African Journals Online (AJOL)

    Conclusion: Les résultats rejoignent les données de la littérature, à savoir, un risque accru pour la femme enceinte de développer une forme grave, une présentation clinique similaire au reste de la population, l'intérêt de la vaccination et d'un traitement antiviral précoce et le rôle de l'ECMO dans le traitement des ...

  3. Infarctus splénique au cours d'une forme grave de la granulomatose ...

    African Journals Online (AJOL)

    Infarctus splénique au cours d'une forme grave de la granulomatose avec polyangéite: à propos d'un cas. Olfa Berriche, Wafa Alaya. Abstract. La granulomatose avec polyangéite (GPA) est une vascularite nécrosante systémique, caractérisée par une inflammation granulomateuse, une nécrose tissulaire et une vascularite ...

  4. Haptoglobin study in myasthenia gravis Estudo sobre a haptoglobina na miastenia grave

    Directory of Open Access Journals (Sweden)

    Leonardo H. Mendonça Oliveira

    2008-06-01

    Full Text Available OBJECTIVE: A cross-sectional study of haptoglobin (Hp in myasthenia gravis (MG was designed, with the objective to identify its values and correlate them with different disease status. METHOD: 46 patients were enrolled in the study, all having disease severity established according to the quantitative myasthenia gravis strength scores (QMGSS. Based on the functional scale determined by Myasthenia Gravis Foundation of America (MGFA recommendations, patients were classified as having: complete stable remission (CSR; n=10; minimal manifestations-0 (MM0; n=6, minimal manifestations-1 (MM1; n=4; pharmacological remission (PR; n=6. Two other groups participated: thymomatous patients (T; n=10 and patients without imunosuppression or thymectomy, until the assessment for Hp (WIT; n=10. Hp dosage was done by immunonephelometry, blindly to clinical data. Student's t-test, Anova test and linear regression were employed for statistical analyses. RESULTS: Statistically significant differences occurred between CSR+MM0xWIT groups (86.62x157.57, pOBJECTIVO: Desenhou-se estudo transversal sobre a haptoglobina (Hp na miastenia grave (MG com o objetivo de identificar seus valores e correlacioná-los a diferentes condições na doença. MÉTODO: 46 pacientes foram incluídos, todos tendo a gravidade da doença estabelecida segundo escores internacionais (QMGSS. Os pacientes tiveram seu estado funcional determinado de acordo com a Myasthenia Gravis Foundation of América (MGFA e classificados em: remissão completa estável (CSR; n=10; mínima manifestação-0 (MM0; n=6, mínima manifestação-1 (MM1; n=4; remissão farmacológica (PR; n=6. Dois outros grupos participaram: pacientes timomatosos (T; n=10 e pacientes sem imunossupressão ou timectomia, até o momento da inclusão no estudo (WIT; n=10. A dosagem de Hp foi realizada por imunonefelometria, de modo cego quanto à clínica. As análises estatísticas incluíram o teste de Student, Anova e regressão linear

  5. 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...

  6. Histologic Findings and Cytological Alterations in Thyroid Nodules After Radioactive Iodine Treatment for Graves' Disease: A Diagnostic Dilemma.

    Science.gov (United States)

    El Hussein, Siba; Omarzai, Yumna

    2017-06-01

    Unlike the well-documented relation between radiation to the neck and development of papillary thyroid carcinoma, a causal association between radioactive iodine treatment for Graves' disease and development of thyroid malignancy is less defined. However, patients with a background of thyroid dysfunction presenting with clinically palpable thyroid nodules are followed more closely than the average population, and fine needle aspiration is recommended in such circumstances. Cytological examination of aspirates, and histologic examination of tissue provided from patients with a known history of Graves' disease, managed by radioactive iodine therapy can create a diagnostic dilemma, as the distinction between radiation effect and a malignant primary thyroid neoplasm can be very challenging. Thus, pathologists should be aware of the existence of these changes in the setting of radiation therapy for Graves' disease. Providing pathologists with appropriate clinical history of Graves' disease treated with radioactive iodine is of paramount importance in order to prevent an overdiagnosis of malignancy.

  7. Identificação das bactérias envolvidas na sepse grave de fêmeas caninas com piometra submetidas a ovário-histerectomia terapêutica

    Directory of Open Access Journals (Sweden)

    Tabatha do Amaral Kalenski

    2012-04-01

    Full Text Available A piometra é uma afecção reprodutiva comum que acomete fêmeas caninas, podendo se agravar e progredir para o quadro de sepse grave e choque séptico. A precocidade da instituição da antibioticoterapia é determinante para um melhor prognóstico. O objetivo deste estudo foi avaliar os principais microrganismos envolvidos nos casos de sepse grave em cadelas acometidas por piometra e submetidas à ovário-histerectomia terapêutica, por meio de realização de hemocultura e cultura da secreção uterina e antibiograma. Foram avaliadas 33 fêmeas caninas e o principal agente envolvido com a sepse grave secundária à piometra foi a Escherichia coli, identificada em 57,57% dos casos. Também foram identificados Staphylococcus sp., com incidência de 9,09%, Citrobacter koseri, Enterobacter cloacae, Enterobacter faecalis, Eduardsiella sp., Klebsiella pneumoniae e Streptococcus sp., com 3,03% de frequência cada. Após a realização do antibiograma pelo método de difusão, os antimicrobianos que apresentaram maior eficácia contra as cepas de Escherichia coli foram a gentamicina, a enrofloxacina, a cefalexina e a associação de amoxicilina com ácido clavulânico, nesta ordem. A cultura da secreção uterina foi mais sensível que a hemocultura para identificação do agente microbiano (p<0,0001. A identificação bacteriana é útil para direcionar a antibioticoterapia empírica mais específica, de acordo com o perfil de sensibilidade, minimizando assim o desenvolvimento de resistência, o custo do tratamento e o risco de reações adversas aos antimicrobianos utilizados.

  8. Transient Graves' hyperthyroidism during pregnancy in a patient with Hashimoto's hypothyroidism.

    Science.gov (United States)

    Lu, Rui; Burman, Kenneth D; Jonklaas, Jacqueline

    2005-07-01

    The course and severity of autoimmune thyroid disease are altered during pregnancy and in the postpartum period. The thyroidal response to a fluctuating immune status, combined with changes in thyroid economy during pregnancy, may result in a need to adjust the treatment regimen for thyroid disease during pregnancy. Patients with Hashimoto's hypothyroidism on thyroid hormone replacement are frequently observed to have an increased requirement for levothyroxine early in pregnancy, although this is not a universal finding. Hashimoto's hypothyroidism does not typically remit during pregnancy, although further progression of thyroiditis may be seen in the postpartum period. Graves' disease usually improves during pregnancy and flares after delivery, again necessitating monitoring of thyroid status and possible adjustments in thionamide therapy. However, spontaneous transformation from Hashimoto's hypothyroidism to Graves' disease during pregnancy is rare. We report a case of transient Graves' hyperthyroidism during the late second trimester in a patient on levothyroxine replacement for Hashimoto's hypothyroidism. This resulted in a need to discontinue the patient's thyroid hormone entirely to avoid exacerbation of her hyperthyroidism. This interesting case is presented, along with a discussion of how the expression of autoimmune thyroid disease may be altered during pregnancy.

  9. 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. Copyright © 2016 The Chartered Society of Forensic Sciences. Published by Elsevier Ireland Ltd. All rights reserved.

  10. 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.

  11. 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.

  12. Avaliação e tratamento da hiperglicemia em pacientes graves

    Directory of Open Access Journals (Sweden)

    Marina Verçoza Viana

    2014-03-01

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

  13. Military graves from the Late Roman necropolis at slog in Ravna (Timacum Minus

    Directory of Open Access Journals (Sweden)

    Petković Sofija

    2014-01-01

    Full Text Available The necropolises of the Roman fortification and settlement Timacum Minus, in the village of Ravna, near Knjaževac, were partially explored by systematical and rescue archaeological excavations. The most extensively explored was the part of the Late Roman necropolis on the eastern slope of the Slog hill, about 400m west of the fortification, where 80 graves from this period have been investigated. The analysis of the human osteological material, and the archaeological finds from the aforementioned necropolis, confirmed 17 military graves, containing adult male individuals with traces of injuries, stress markers and pathological changes, characteristic of a military population, as well as military equipment and weapons. At the time of the formation of the Late Roman necropolis at the site of Slog, during the second half of the 4th and the first half of the 5th century, the garrison of the Timacum Minus fortification consisted of an equestrian unit of pseudocomitatenses Timacenses, a part of the auxiliary formation that secured the forts and roads in the Timok region. Among the graves from the three phases of the Late Roman necropolis, similarities as well as certain differences are apparent, indicating changes in the structure of the civilian and military population of Timacum Minus. [Projekat Ministarstva nauke Republike Srbije, br. 177007: Romanisation, urbanisation and transformation of urban centres of civil, military and residential character in Roman provinces in the territory of Serbia

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

    Directory of Open Access Journals (Sweden)

    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.

  15. Safety and efficacy of technetium-99 methylene diphosphate combined with glucocorticoid for Graves ophthalmopathy

    Directory of Open Access Journals (Sweden)

    Ri-Qiu Chen

    2016-04-01

    Full Text Available AIM:To evaluate the clinical efficacy and safety of technetium-99 methylene diphosphate(99Tc - MDPwith glucocorticoid therapy for Graves ophthalmopathy. METHODS:A total of 96 patients with Graves ophthalmopathy were randomly divided into two groups, The control group assigned to receive methylprednisolone injection pulse therapy and oral prednisone tablets in the intermittent period. The experimental group was given the treatment of 99Tc - MDP injection based on therapy of the control group. Then the clinical efficacy and safety of the two therapies were compared. RESULTS:The clinical symptoms of the two groups were improved. The efficiency rate of the experimental group was higher than that of the control group, especially on the degree of exophthalmos, and the difference was statistically significant(PP>0.05. The experimental group did not have serious adverse reactions associated with 99Tc-MDP.CONCLUSION:There are obvious improvements in patients with Graves ophthalmopathy treated by 99Tc - MDP combined with glucocorticoid, especially in the degree of exophthalmus and with less adverse reactions, which deserves promotion.

  16. 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)

  17. Volume changes in remnant thyroid tissue after thyroidectomy in Graves disease.

    Science.gov (United States)

    Chen, Pei-Yin; Chao, Cheng-Min; Wu, Ta-Jen; Huang, Shih-Ming

    2014-09-01

    Surgery is one of the treatment choices for Graves disease. The residual thyroid tissue may shrink or become larger. The object of this study was trying to find out what factors affect the residual thyroid gland volume change after thyroidectomy in Graves disease. We followed thyroid volume changes by ultrasonography in 101 patients with Graves disease who underwent one side lobectomy and another side subtotal thyroidectomy from 1996 to 2006. These patients were divided into three groups according to the residual thyroid size increasing, no change in size, and shrinking. We checked the factors as follows: age, body weight, thyroid-stimulating hormone (TSH) level, TSH-receptor antibody level, anti-thyroid peroxidase (TPO) antibody level, total thyroid volume before and after thyroidectomy, and degree of lymphocyte infiltration. We found that young age and lower residual volume ratio were the most powerful two factors affecting remnant thyroid gland volume changing. We also found that there is no significant correlation between TSH levels and thyroid volume change, nor TSH-receptor antibody titer or thyroid volume change. Age and residual volume ratio were the most powerful two factors in this study. Copyright © 2012. Published by Elsevier B.V.

  18. Patients' perceptions and views of surgery and radioiodine ablation in the definitive management of Graves' disease.

    Science.gov (United States)

    Hookham, Jessica; Truran, Peter; Allahabadia, Amit; Balasubramanian, Sabapathy P

    2017-05-01

    Patients' perceptions and preferences influence the choice of radioiodine ablation (RIA) or surgery in the definitive management of Graves' disease. This study aimed to evaluate their concerns, experiences and satisfaction following definitive treatment. A postal survey of patients who had treatment with surgery or RIA between January 2011 and June 2013 for Graves' disease was conducted. Of 214 patients, 136 (64%) responded. The majority of patients felt actively involved in decision making (83.8%) and were satisfied (84.9%) with their treatment. Compared with RIA, patients who underwent surgery were more satisfied with their treatment (p=0.008). Discussion with the doctor was the most useful aid to decision making. Feeling involved in decision-making process was associated with improved satisfaction (pdisease were common reasons for not choosing RIA. Ongoing concerns were hypothyroidism, scarring and eye problems after surgery and hypothyroidism and eye problems after RIA. This study provides insight into patients' experiences of surgery and RIA for Graves' disease and reinforces the importance of patient involvement in the decision-making process. 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/.

  19. Risk factors for neonatal thyroid dysfunction in pregnancies complicated by Graves' disease.

    Science.gov (United States)

    Uenaka, Mizuki; Tanimura, Kenji; Tairaku, Shinya; Morioka, Ichiro; Ebina, Yasuhiko; Yamada, Hideto

    2014-06-01

    To determine the factors related to adverse pregnancy outcomes and neonatal thyroid dysfunction in pregnancies complicated by Graves' disease. Thirty-five pregnancies complicated by Graves' disease were divided into two groups: adverse pregnancy outcome (n=15) and no adverse pregnancy outcome (n=20). Adverse pregnancy outcomes included spontaneous abortion, stillbirth, premature delivery, fetal growth restriction, and pregnancy-induced hypertension. The 31 pregnancies resulting in live births were also divided into two groups: neonatal thyroid dysfunction (n=9) and normal neonatal thyroid function (n=22). Serum levels of thyroid-stimulating hormone (TSH), free thyroxine (FT4), TSH-receptor antibody (TRAb), the duration of hyperthyroidism in pregnancy, doses of antithyroid medication, and the duration of maternal antithyroid medication throughout pregnancy were compared. There were no significant differences in these factors between pregnancies with an adverse pregnancy outcome and those with no adverse pregnancy outcome. However, serum levels of FT4, TRAb, the duration of hyperthyroidism in pregnancy, the maximum daily dose of antithyroid medication, and the total dose of antithyroid medication were significantly different between pregnancies with neonatal thyroid dysfunction and those with normal neonatal thyroid function. Multivariate logistic regression analysis showed that the FT4 level in mothers was a significant factor related to the development of neonatal thyroid dysfunction (odds ratio 28.84, 95% confidence interval 1.65-503.62, pGraves' disease activity in women of childbearing age should be well controlled prior to conception. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  20. Enfoque terapéutico de los traumatismos graves de los miembros

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    Roberto Joaquín del Gordo D´Amato

    2013-12-01

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

  1. Chronology of the 1st–2nd Century Graves from the Tarasovo Burial Ground

    Directory of Open Access Journals (Sweden)

    Goldina Rimma D.

    2016-03-01

    Full Text Available The article focuses on the chronology of graves dating back to the early (1st – 2nd centuries AD – Nyrgynda stage of the 1st – 5th century Tarasovo burial ground, a classical monument attributed to the Cheganda culture of the Pyany Bor cultural-historical community. Cultural stratigraphy is applied as a research method. Artifacts from the early stage were correlated for 37 male and 102 female complexes, separately. The analysis of grave goods from male burials showed the following three chronological groups, that can be distinguished at the Nyrgynda stage: 1st century (group 1, 2nd century (group 2 and 1st – 2nd centuries AD (group 3. The goods from female graves are more representative and various, so three more groups with shorter chronological lives can be singled out: the fi rst half of the 2nd century (group 2а, the second half of the 2nd century (group 2б and the 1st – fi rst half of the 2nd century (group 4. Certainly, the suggested chronology leaves room for any eventual corrections subject to new findings.

  2. Hyperthyroidism in Patients with Graves' Ophthalmopathy, and Thyroidal, Skeletal and Eye Muscle Specific Type 2 Deiodinase Enzyme Activities.

    Science.gov (United States)

    Molnár, Ildikó; Szentmiklósi, József A; Somogyiné-Vári, Éva

    2017-09-01

    Graves' ophthalmopathy is characterized by hyperthyroidism, which is associated with higher serum T 3 levels than T 4 due to deiodinase enzymes.The effect of Graves' patient's sera (n=52) with elevated thyroid hormone and TSH receptor or thyroid peroxidase antibody (anti-TPO) levels was investigated on thyroidal, skeletal and eye muscle type 2 deiodinase enzyme (DII) activities. DII activities were measured with 125 I-T 4 substrate, while thyroid hormone and antibody levels with immunoassays.In Graves' ophthalmopathy, sera with elevated FT 4 or FT 3 levels reduced DII activites remarkably in all tissue fractions. Thyroidal DII activities were lower than those using eye muscle fraction (0.6±0.22 vs 1.14±0.43 pmol/mg/min, Pactivities in patients with Graves' ophthalmopathy after methimazole therapy compared to those who had no ophthalmopathy (2.88±2 vs 20.42±11.82 pmol/mg/min, Pactivities, while sera with anti-TPO antibodies were connected to lower DII activities in Graves' ophthalmopathy.In summary, the actions of hyperthyroid sera derived from patients with Graves' disease were tested on tissue-specific DII activities. Elevated FT 4 level-induced DII inactivation is present in Graves' ophthalmopathy, which seems to be also present at the beginning of methimazole therapy. Stimulating TSH receptor antibiodies increased DII activities via their nongenomic effects using sera of hyperthyroid Graves' ophthalmopathy, but anti-TPO antibodies could influence DII activities via altering FT 4 levels. © Georg Thieme Verlag KG Stuttgart · New York.

  3. Genetic association between Interleukin-17A gene polymorphisms and the pathogenesis of Graves' disease in the Han Chinese population.

    Science.gov (United States)

    Qi, Yicheng; Zheng, Huan; Liu, Nan; Guo, Ting; Zhu, Wei; Wang, Shu; Cui, Bin; Ning, Guang

    2015-01-19

    Graves' disease, one of the commonest autoimmune disorders, has a complex genetic basis. Interleukin-17A (IL-17A) is an important cytokine involved in innate and adaptive immune responses. This case-control study sought to investigate genetic association between the IL-17A gene and the process of Graves' disease (GD). Our pilot study was performed on a cohort from Shanghai, which included 713 patients with GD and 756 healthy controls. A replicate cohort was from Xiamen, recruiting 444 patients with GD and 427 healthy subjects. Six single nucleotide polymorphisms (SNPs) (rs4711998, rs3819024, rs2275913, rs8193037, rs3819025 and rs3748067) within the IL-17A gene were genotyped by the SNPstream Genotyping Systems and Taqman PCR method. In Shanghai cohorts, the frequencies of rs8193037 alleles were strongly different between patients with Graves' disease (G, 87·6% and A, 12·4%) and healthy controls (G, 91·4% and A, 8·6%) (P = 0·00067). The A carriers were associated with increased Graves' disease risks when compared with the G carriers (OR = 1·51, 95%CI = 1·19-1·92). In replicate cohorts, the proportion of individuals carrying the A allele of rs8193037 was significantly higher in patients with Graves' disease than in controls [Graves' disease vs control, 14·3% vs 9·1%, OR = 1·66 (95% CI: 1·23-2·24), Pallele  = 0·0082]. In addition, rs8193037 and rs3748067 were found to be different in both genotype and allele distributions in Graves' disease-associated ophthalmopathy patients and controls in Shanghai cohorts. Haplotype association analysis also identified five main haplotypes of those six SNPs. These results suggested that the polymorphism of IL-17A rs8193037 was strongly associated with Graves' disease susceptibility in the Chinese Han population.z. © 2015 John Wiley & Sons Ltd.

  4. Excessive Cytosolic DNA Fragments as a Potential Trigger of Graves' Disease: An Encrypted Message Sent by Animal Models.

    Science.gov (United States)

    Luo, Yuqian; Yoshihara, Aya; Oda, Kenzaburo; Ishido, Yuko; Suzuki, Koichi

    2016-01-01

    Graves' hyperthyroidism is caused by autoantibodies directed against the thyroid-stimulating hormone receptor (TSHR) that mimic the action of TSH. The establishment of Graves' hyperthyroidism in experimental animals has proven to be an important approach to dissect the mechanisms of self-tolerance breakdown that lead to the production of thyroid-stimulating TSHR autoantibodies (TSAbs). "Shimojo's model" was the first successful Graves' animal model, wherein immunization with fibroblasts cells expressing TSHR and a major histocompatibility complex (MHC) class II molecule, but not either alone, induced TSAb production in AKR/N (H-2k) mice. This model highlights the importance of coincident MHC class II expression on TSHR-expressing cells in the development of Graves' hyperthyroidism. These data are also in agreement with the observation that Graves' thyrocytes often aberrantly express MHC class II antigens via mechanisms that remain unclear. Our group demonstrated that cytosolic self-genomic DNA fragments derived from sterile injured cells can induce aberrant MHC class II expression and production of multiple inflammatory cytokines and chemokines in thyrocytes in vitro, suggesting that severe cell injury may initiate immune responses in a way that is relevant to thyroid autoimmunity mediated by cytosolic DNA signaling. Furthermore, more recent successful Graves' animal models were primarily established by immunizing mice with TSHR-expressing plasmids or adenovirus. In these models, double-stranded DNA vaccine contents presumably exert similar immune-activating effect in cells at inoculation sites and thus might pave the way toward successful Graves' animal models. This review focuses on evidence suggesting that cell injury-derived self-DNA fragments could act as Graves' disease triggers.

  5. Celulitis por citomegalovirus

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    A. Ruiz Lascano

    2002-12-01

    Full Text Available Las lesiones cutáneas por citomegalovirus (CMV son infrecuentes y a menudo una manifestación tardía de una enfermedad sistémica, que generalmente anuncia un curso fatal. Comunicamos un caso de celulitis por CMV: una mujer de 70 años con trasplante renal efectuado 1 mes antes de la consulta, terapia inmunosupresora con ciclosporina A y metilprednisona. La paciente ingresó por fiebre, dolor e impotencia funcional en pierna derecha. Comprobamos la existencia de una placa de 8 por 4 cm eritematoedematosa. La tratamos con antibióticos sin mejoría, por lo que realizamos un estudio histopatológico de piel que mostró cambios citopáticos compatibles con infección por CMV. Los cultivos bacteriológicos y micológicos fueron negativos. La inmunohistoquímica específica para CMV y el estudio de reacción en cadena de la polimerasa (PCR de la biopsia de piel fueron positivas, al igual que la antigenemia. El tratamiento con ganciclovir produjo la mejoría del cuadro clínico. En la literatura revisada no hemos encontrado la celulitis como manifestación de enfermedad cutánea por CMV.

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

    Science.gov (United States)

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

    2015-01-01

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

  7. Orbital flourine-18-fluorodeoxyglucose positron emission tomography in patients with Graves' disease for evaluation of active inflammation.

    Science.gov (United States)

    Uslu-Beşli, Lebriz; Kabasakal, Levent; Sağer, Sait; Cicik, Erdoğan; Asa, Sertaç; Sönmezoğlu, Kerim

    2017-11-01

    Prediction and early diagnosis of orbitopathy is needed in patients with Graves' disease, especially when radioiodine therapy is planned. Positron emission tomography/computerized tomography (PET/CT) using flourine-18-fluorodeoxyglucose (FDG) is an effective imaging modality in detection of inflammation, however, its ability to detect orbital inflammation has not been well studied. The aim of our study is to determine the ability of FDG PET/CT to detect orbital inflammation related with Graves' disease, identify active orbitopathy, predict the radioiodine-triggered orbitopathy, and find out the effects of radioiodine on orbital inflammation. Total 31 Graves' disease patients and 17 controls were included. All Graves' disease patients underwent cranial FDG PET/CT imaging prior therapy. Radioiodine therapy and post-treatment PET/CT study was applied to 21 patients. PET/CT images of all examinees were evaluated, measuring extraocular muscle maximum standard uptake value (SUVmax) and muscle thickness. FDG uptake was increased in the majority of extraocular muscles in Graves' disease patients in comparison to controls and this increase was found to be irrelevant from muscle thickness. Extraocular muscle SUVmax values did not increase in Graves' orbitopathy patients who received radioiodine under corticosteroid prophylaxis. SUVmax level of all orbital rectus muscles were increased after radioiodine therapy in nonsmokers, whereas no increase was detected in smokers. FDG PET/CT may be helpful in detection of extraocular muscle inflammation and it may show ongoing orbitopathy in early stages of inflammation before anatomical changes occur.

  8. Variation in the use of definitive treatment options in the management of Graves' disease: a UK clinician survey.

    Science.gov (United States)

    Hookham, Jessica; Collins, Emma E; Allahabadia, Amit; Balasubramanian, Sabapathy P

    2017-04-01

    Graves' disease can be treated with antithyroid drugs (ATDs), radioiodine or surgery. Use of definitive treatments (radioiodine or surgery) varies widely across centres. Specific clinical circumstances, local facilities, patient and clinician preferences and perceptions will affect the choice of treatment. Detailed understanding of UK clinicians' views and their rationale for different treatments is lacking. To study the preferences and perceptions of UK clinicians on the role of surgery and radioiodine in the management of Graves' disease. 'British Thyroid Association' (BTA), 'Society for Endocrinology' (SFE) and 'British Association of Endocrine and Thyroid Surgeons' (BAETS) members were invited to complete an online survey examining their management decisions in Graves' disease and factors that influenced their decisions. 158 responses from UK consultants were included. The ratio of physicians to surgeons was 11:5 and males to females was 12:4. Most clinicians would commence ATDs in uncomplicated first presentation of Graves' disease. A wide range of risk estimates on the effectiveness and risks of treatment was given by clinicians. Radioiodine was used most frequently in relapsed Graves' disease. However, severe eye disease and pregnancy strongly influenced choice in favour of surgery. Surgeons underestimated the success of radioiodine (pGraves' disease. The variation appeared to be dependent on patient and disease-specific factors as well as physician experience, gender and specialty. 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/.

  9. 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

  10. Embolia pulmonar por polimetilmetacrilato

    OpenAIRE

    Héctor Gómez Santa María; Mauro García Aurelio; Yanina Castillo Costa; Víctor Mauro; Carlos Barrero

    2009-01-01

    Los primeros registros de embolia pulmonar por polimetilmetacrilato se publicaron recientemente (2003) y desde entonces se describieron no más de 15 casos. Se presenta el caso de un paciente joven a quien dos meses antes de la consulta se le había efectuado una vertebroplastia percutánea con polimetilmetacrilato. Por síntomas pleuríticos se le realizó una radiografía de tórax, que evidenció múltiples imágenes radioopacas en ambos campos pulmonares. La embolia pulmonar por polimetilmetacrilato...

  11. Análise comparativa da maturação óssea determinada pelo método de Grave-Brown entre imagens convencionais e digitalizadas Comparative analysis of bone maturation determined by Grave-Brown method in conventional and digitalized images

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    Marcia Spinelli Casanova

    2006-10-01

    Full Text Available OBJETIVO: o presente estudo teve como objetivo comparar os estágios de maturação óssea estimados pelo método de Grave-Brown em radiografias de mão e punho convencionais e digitalizadas. METODOLOGIA: a amostra foi composta por 129 radiografias de mão e punho de indivíduos brasileiros do gênero feminino, com idades cronológicas entre 84 e 199 meses. As radiografias foram digitalizadas e posteriormente analisadas por cinco observadores. RESULTADOS E CONCLUSÃO: os resultados mostraram que não houve diferença estatisticamente significante entre os estágios de maturação óssea estimados, tanto nas imagens radiográficas convencionais como nas digitalizadas. Verificou-se ainda a reprodutibilidade dos observadores, sendo o valor de Kappa de 0,86 para as imagens convencionais e de 0,87 para as imagens digitalizadas. Recomenda-se a utilização de imagens digitalizadas como uma alternativa à imagem convencional para estimar a maturação óssea em radiografias de mão e punho.AIM: the purpose of the present study was to compare the skeletal maturation stages estimated using the method of Grave-Brown in conventional and digitalized hand and wrist x-rays. METHODS: the sample was composed by 129 hand and wrist radiographs of Brazilian girls, with chronological ages between 84 and 199 months. The radiographs were digitalized and analyzed by five observers. RESULTS AND CONCLUSION: the results showed no statistically significant difference between the skeletal maturation stages estimated in the conventional or the digitalized images by Grave-Brown’s method. The reproducibility of the observers was also verified, the value of Kappa was 0.86 for the conventional images and 0.87 for the digitalized images. Therefore digitalized images are a reliable alternative for skeletal maturation estimation.

  12. Embolia pulmonar por polimetilmetacrilato

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    Héctor Gómez Santa María

    2009-01-01

    Full Text Available Los primeros registros de embolia pulmonar por polimetilmetacrilato se publicaron recientemente (2003 y desde entonces se describieron no más de 15 casos. Se presenta el caso de un paciente joven a quien dos meses antes de la consulta se le había efectuado una vertebroplastia percutánea con polimetilmetacrilato. Por síntomas pleuríticos se le realizó una radiografía de tórax, que evidenció múltiples imágenes radioopacas en ambos campos pulmonares. La embolia pulmonar por polimetilmetacrilato es una complicación muy poco frecuente de ese procedimiento y un diagnóstico diferencial para tener en cuenta en pacientes con el antecedente y que consulten por dolor precordial o disnea.REV ARGENT CARDIOL 2009;77:129-130.

  13. Comportamiento del fallo renal agudo en niños con sepsis grave Behavior of acute renal failure in children presenting with severe sepsis

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    María del Carmen Saura Hernández

    2010-03-01

    Full Text Available INTRODUCCIÓN. El objetivo de esta investigación fue determinar los factores de riesgo asociados al fallo renal agudo (FRA en un grupo de niños con sepsis grave atendidos entre enero del 2004 y diciembre del 2008. MÉTODOS. Se realizó un estudio observacional y analítico con una muestra de 171 pacientes. Se constituyeron dos grupos: el de estudio, integrado por 38 pacientes con estado de choque séptico o disfunción múltiple de órganos (DMO y FRA, y un grupo control, conformado por 133 niños en igual estadio de sepsis pero con función renal normal. Se revisaron las historias clínicas y se tuvieron en cuenta variables epidemiológicas, factores de riesgo de FRA y evolución de los casos. RESULTADOS. La incidencia de FRA fue del 22,2 %, y aunque disminuyó considerablemente en los 3 últimos años del estudio, la mortalidad fue del 42,1 %, mayoritariamente en el DMO (89,5 %. Se encontró dependencia entre la insuficiencia renal y la respuesta diurética no adecuada a la fluidoterapia (51,2 %, la inestabilidad hemodinámica por más de 24 h (46,5 %, la disfunción miocárdica (43,3 % y el uso de medicamentos nefrotóxicos (42,8 %. CONCLUSIONES. La respuesta diurética no adecuada a la fluidoterapia, la inestabilidad hemodinámica por más de 24 h, la disfunción miocárdica y el uso de medicamentos nefrotóxicos incrementan el riesgo de FRA en la sepsis grave, la cual duplica la mortalidad en relación con los pacientes que conservan la función renal. No obstante, la prevención de las formas graves de sepsis y un tratamiento adecuado de ésta disminuyen la incidencia de FRA.INTRODUCTION: The aim of present research was to determine the risk factor associated with the acute renal failure (ARF in a group of children with severe sepsis seen between January, 2004 and December, 2008. METHODS: An analytical and observational study was conducted in a sample including 171 patients. There were two groups: the study-group with 138 patients with

  14. Estudo de custo-análise do tratamento da artrite reumatoide grave em um município do Sul do Brasil

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    Fabíola Bagatini Buendgens

    2013-01-01

    Full Text Available O tratamento da artrite reumatoide envolve a utilização de medicamentos, terapias não farmacológicas, consultas médicas, exames complementares, entre outros procedimentos. O artigo apresenta, conforme as fontes pagadoras, os custos diretos médicos relacionados ao tratamento da artrite reumatoide. Trata-se de um estudo de custo-análise envolvendo 103 pacientes com artrite reumatoide grave atendidos por meio do Componente Especializado da Assistência Farmacêutica em Florianópolis, Santa Catarina, Brasil. O custo direto médico total foi R$ 2.045.596,55/ano, correspondendo a R$ 19.860,16 por paciente/ano. Do custo total, 90,8% foram para despesas com medicamentos, 2,5% às hospitalizações, 2,2% aos exames complementares, 2,1% às consultas médicas e 2,4% à soma dos demais componentes. O setor público foi responsável por 73,6% do custo direto médico total e por 79,3% do custo com a aquisição de medicamentos. A análise dos custos permitiu traçar um perfil de como uma população portadora de doença crônico-degenerativa altamente demandante de recursos transita pela composição público-privada que caracteriza o sistema de saúde brasileiro.

  15. 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/

  16. Fluidoterapia de reanimación en pacientes con trauma grave: ¿Necesita cambiarse? Resuscitation fluid therapy in patients with severe trauma: Is a change necessary?

    Directory of Open Access Journals (Sweden)

    Mario Miguel Morales Wong

    2006-12-01

    Full Text Available El acceso venoso en los pacientes politraumatizados ha sido tradicionalmente una medida de suma importancia que permite la administración de líquidos, analgésicos, anestésicos y drogas reanimadoras. Convencionalmente en un paciente exanguinado, la administración vigorosa de cristaloides o coloides estuvo encaminada a restablecer de forma «empecinada» los valores de tensión arterial cercanos a la normalidad, en un intento por lograr la oxigenación tisular adecuada desde el preoperatorio. Sin embargo, se ha demostrado que tal estrategia de reanimación en este tipo de paciente aumenta la morbilidad y mortalidad de este debido a las graves anormalidades metabólicas que provoca, entre ellas la hipotermia, la acidosis, la coagulopatía y el resangrado de las lesiones vasculares previamente autocontroladas por los mecanismos fisiológicos de la coagulación. Hacemos una revisión de la literatura que refleja los relativamente nuevos puntos de vistas en la fluidoterapia de reanimación del paciente politraumatizado exanguinado

  17. Aptitud clínica ante el paciente pediátrico con asma grave en residentes de pediatría y urgencias

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    J. Loría-Castellanos

    Full Text Available Objetivo. Construir, validar y aplicar un instrumento para evaluar la aptitud clínica de los residentes de pediatría y urgencia ante los pacientes pediátricos con asma grave. Sujetos y métodos. Estudio observacional autorizado por el comité de investigación. El instrumento se construyó a través de cinco casos clínicos reales, validado por consenso de expertos en pediatría, urgencias e investigación educativa, obteniéndose una versión final de 150 ítems con una consistencia de 0,89. Se evaluaron 10 residentes de pediatría y 21 de urgencias. Se realizó un análisis estadístico no paramétrico. Resultados. La mayoría de los residentes (79,73% se ubicaron en los niveles bajos-muy bajos de aptitud clínica, ninguno alcanzó niveles superiores. Las pruebas estadísticas no encontraron diferencias entre los grados académicos o la especialidad. Conclusiones. El instrumento construido tiene una adecuada consistencia. El proceso educativo al que se han sometido estos residentes parece no favorecer el desarrollo de reflexión, lo que podría limitar su práctica profesional real.

  18. Impacto do internamento em unidade de cuidados intensivos na amplitude de movimento de pacientes graves: estudo piloto

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    Balbino Rivail Ventura Nepomuceno Júnior

    2014-03-01

    Full Text Available Objetivo: Aferir a amplitude de movimento articular de pacientes graves durante o internamento numa unidade de cuidados intensivos. Métodos: Estudo prospectivo e longitudinal, realizado em uma unidade de cuidados intensivos de um hospital público da cidade de Salvador (BA, no período de setembro a novembro de 2010. A principal variável avaliada foi a amplitude de movimento articular passiva, por meio da goniometria dos cotovelos, joelhos e tornozelos, no momento da admissão e na alta. Todos os pacientes internados no período foram incluídos, sendo excluídos aqueles com tempo de internamento <72 horas e com reduções da amplitude de movimento articular na admissão. Resultados: A amostra foi composta por 22 indivíduos, com idade média de 53,5±17,6 anos, tempo de internamento na unidade de cuidados intensivos de 13,0±6,0 e de ventilação mecânica de 12,0±6,3 dias. O APACHE II foi 28,5±7,3, sendo que a maioria dos pacientes era independente funcional previamente ao internamento, com índice de Barthel prévio de 88,8±19. As perdas de amplitude de movimento articular foram 11,1±2,1°; 11,0±2,2°; 8,4±1,7°; 9,2±1,6°; 5,8±0,9° e 5,1±1,0°; para cotovelos, joelhos e tornozelos, respectivamente do lado direito e esquerdo (p<0,001. Conclusão: Houve uma tendência de decréscimo nas amplitudes de movimento de grandes articulações, como tornozelo, joelho e cotovelo, durante o internamento em unidade de cuidados intensivos.

  19. Asociación entre tuberculosis infantil grave e inmunización previa con BCG en un hospital de referencia nacional, Perú 1990-2000 Association between severe tuberculosis in children and previous BCG immunization in a national referral Hospital, Peru 1990-2000

    Directory of Open Access Journals (Sweden)

    Félix Llanos-Tejada

    2012-03-01

    Full Text Available El objetivo del estudio fue determinar la asociación entre la inmunización con BCG y tuberculosis grave (TB. Se realizó un estudio retrospectivo, se incluyó fichas de pacientes atendidos en el servicio de neumología del Instituto Nacional de Salud del Niño de Perú, entre los años 1990-2000. Se revisaron un total de 2106 casos de TB entre los que había 259 casos graves (TB miliar o meningoencefalitis por TB. Del total, 497 casos no tenían antecedente de inmunización con BCG; 202 tenían TB grave y 295 TB no grave (OR= 0,05; IC 95%= 0,03-0,07. En conclusión, los niños con diagnóstico de TB y que han sido inmunizados con BCG, tienen 94% menos riesgo de desarrollar TB grave, en comparación a los niños con diagnóstico no inmunizados con BCG.The objective of the study was to determine the association between BCG immunization and severe tuberculosis (TB. We performed a retrospective study, including medical records from patients of the pneumology department at the National Children’s Institute in Peru, between the years 1990-2000. A total of 2106 TB cases were reviewed, from them 259 patients were severe (miliary TB or meningoencephalitic TB. From all, 497 cases did not have history of BCG vaccination, 202 had severe TB and 295 non-severe TB (OR = 0.05, 95% CI = 0.03 to 0.07. In conclusion, children diagnosed with TB and who have been immunized with BCG, has 94% lower risk of developing severe TB, compared to children with TB non-immunized with BCG.

  20. O mundo da criança portadora de asma grave na escola El mundo del niño portador de asma grave en la escuela Daily life of children with acute asthma in school settings

    Directory of Open Access Journals (Sweden)

    Regina Issuzu Hirooka de Borba

    2009-01-01

    Full Text Available OBJETIVO: Compreender o significado que a criança asmática grave e sua família atribuem à doença e suas implicações na escola. MÉTODOS: Estudo de caso qualitativo, desenvolvido no ambulatório de pediatria de um hospital do Município de São Paulo. Foram estudadas três crianças e seus familiares, utilizando observação participante, entrevista e brinquedo terapêutico dramático. RESULTADOS: As demandas do tratamento e as freqüentes crises de asma influenciaram no cotidiano da criança na escola como: falta às aulas; deixar de aprender; restrinção nas brincadeiras e relacionamento conflituoso com colegas. CONSIDERAÇÕES FINAIS: Tendo em vista as dificuldades encontradas pelas crianças em freqüentar a escola e conviver com os colegas, recomenda-se um trabalho conjunto entre os profissionais de saúde e da educação, assegurando a manutenção da educação formal e do convívio social salutar.OBJETIVO: Comprender el significado que el niño asmático grave y su familia atribuyen a la enfermedad y sus implicancias en la escuela. MÉTODOS: Se trata de un estudio de caso cualitativo, desarrollado en el consultorio externo de pediatría de un hospital del Municipio de Sao Paulo. Fueron estudiados tres niños y sus familiares, utilizando la observación participante, entrevista y juego terapéutico dramático. RESULTADOS: Las demandas del tratamiento y las frecuentes crisis de asma influenciaron en el cotidiano del niño en la escuela como: falta a las clases; dejar de aprender; restricción en los juegos y relación conflictiva con sus colegas. CONSIDERACIONES FINALES: Teniendo en vista las dificultades encontradas por los niños para frecuentar a la escuela y convivir con sus colegas, se recomineda un trabajo conjunto entre los profesionales de salud y de educación, asegurando la manutención de la educación formal y de la convivencia social saludable.OBJECTIVES: To understand the meaning of asthma and its implications in daily

  1. Neumonía necrosante por Staphylococcus aureus extrahospitalario resistente a la meticilina:reporte de dos casos en Colombia

    OpenAIRE

    Ana María Perilla; Camilo González; Sandra Liliana Valderrama; Natasha Vanegas; Bibiana Chavarro; Luis Carlos Triana; José Roberto Támara; Carlos Arturo Álvarez

    2009-01-01

    En los últimos años se ha informado la aparición de Staphylococcus aureus resistente a la meticilina como causa de infecciones extrahospitalarias graves. En Colombia, en el 2006, se publicó el primer reporte de S. aureus como causa de infección de piel y tejidos blandos; en esta ocasión, presentamos el primer reporte de neumonía necrosante con etiología por S. aureus, en dos pacientes adultos que se caracterizaron por presentar progresión clínica rápida, estancia prolongada en cuidados intens...

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

    Directory of Open Access Journals (Sweden)

    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.

  3. Graves' Disease

    Science.gov (United States)

    ... your body needs. The thyroid is a small, butterfly-shaped gland in the front of your neck. ... but can reduce symptoms until other treatments take effect. These medicines act quickly to relieve many of ...

  4. Graves' Disease

    Science.gov (United States)

    ... t Miss a Beat National Women and Girls HIV/AIDS Awareness Day National Women's Health Week Supporting Nursing Moms ... t Miss a Beat National Women and Girls HIV/AIDS Awareness Day National Women's Health Week Supporting Nursing Moms ...

  5. Réactions immunoallergiques graves aux antibacillaires: à propos de 10 cas

    Science.gov (United States)

    Alami, Sabah El Machichi; Hammi, Sanae; Bourkadi, Jamal Eddine

    2014-01-01

    L'hypersensibilité aux antituberculeux est l'un des effets secondaires imprévisibles qui apparait chez 4 à 5 % de la population exposée et s’élève à 25% chez les sujets VIH positifs. Dans notre étude parmi 39 patients ayant présenté des réactions immunoallergiques, 10 avaient des formes graves. Le délai moyen d'apparition des signes était de 23 jours. Les réactions immunoallergiques observées étaient 5 cas de toxidermie généralisée fébrile, un cas de Dress syndrome, un cas de neutropénie, un cas de pancitopénie et 2 cas de thrombopénie. Tous nos patients avaient bien évolué cliniquement et bactériologiquement après l'adoption d'un régime thérapeutique excluant le ou les médicaments incriminés. En pratique, si l'effet indésirable imputé à un antituberculeux est grave, il est impératif de l'arrêter, de traiter l'incident et d'associer une autre molécule chez certains cas. Notre étude a montré une fréquence significative des complications graves probablement sous-estimée, surtout dans les pays fortement touchés par l'infection HIV.

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

    Directory of Open Access Journals (Sweden)

    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

  7. [Dispositional optimism and acceptance of illness among a group of individuals with Graves-Basedow's disease].

    Science.gov (United States)

    Basińska, Małgorzata Anna; Zalewska-Rydzkowska, Danuta; Wolańska, Paulina; Junik, Roman

    2008-01-01

    Dispositional optimism is a general tendency to positively perceive the world and one's own future. We can consider what kind of connection with ability to cope with difficulties. One situation which is very stressful for an individual is an illness, particularly a chronic one. The aim of the paper was to define the connection between dispositional optimism and acceptance of illness among the group with Graves-Basedow disease. This is autoimmunizational illness and diseases of this kind are particularly sensitive to the influence of psychological factors, as there are many connections between the immune system and the human psyche. The study group consisted of 59 individuals with Graves-Basedow disease, 50 women and 9 men and 55 of healthy ones, 49 women and 6 men according to age, sex and a level of education. The patients filled out three psychological questionnaires: The Life Orientation Test-Revised (LOT-R), The Acceptance of Illness Scale (AIS) and The Personal Questionnaire. of the study in question indicate a lack of differences between individuals with Graves-Basedow disease and healthy ones concerning the level of dispositional optimism. There no differences in the level of dispositional optimism as regards of criterion of health: by the levels of hormones TSH, fT3 and fT4, complications and a time of duration of disease. Instead, if they suffer additionally from others diseases, they have a lower level of dispositional optimism. There exist a connection between intensification of level of dispositional optimism and acceptance of illness among testing group. The dispositional optimism as a supply of individual helps her or his in adaptation to difficulty situation, which is a chronic disease. It is a reason way it is worth to help of patients to grow it stronger.

  8. Enfermedad de Graves y cáncer de tiroides: Reporte de caso

    Directory of Open Access Journals (Sweden)

    Helard Manrique-Hurtado

    2011-01-01

    Full Text Available 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 nódulo sólido en la tiroides y ganglios linfáticos aumentados de tamaño. La gammagrafía de tiroides mostró una glándula aumentada de tamaño, hipercaptadora, con presencia de un nódulo frío en el lóbulo derecho. El estudio histopatológico luego de la tiroidectomía total mostró cáncer papilar moderadamente diferenciado, con invasión local y metástasis ganglionares. La coexistencia de enfermedad de Graves y cáncer de tiroides ha sido reportada hasta en 9% de los pacientes. El tumor es más agresivo presentando metástasis a ganglios o a distancia. En general, se debería incluir a la ecografía tiroidea en la evaluación inicial de los pacientes con enfermedad de Graves, especialmente, en los que presentan nódulos tiroideos palpables. (Rev Med Hered 2011;22:34-37.

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

    Directory of Open Access Journals (Sweden)

    Mohammad Pajhouhi

    1993-06-01

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

  10. GENDER INFLUENCES THE CLINICAL PRESENTATION AND LONG-TERM OUTCOME OF GRAVES DISEASE.

    Science.gov (United States)

    Magri, Flavia; Zerbini, Francesca; Gaiti, Margherita; Capelli, Valentina; Ragni, Alberto; Rotondi, Mario; Chiovato, Luca

    2016-11-01

    The outcome of antithyroid drug (ATD) treatment for Graves disease (GD) is difficult to predict. In this study, we investigated whether male gender, besides other factors usually associated with a poor outcome of ATD treatment, may affect disease presentation and predict the response to medical treatment in subjects with GD. We studied 294 patients with a first diagnosis of GD. In all patients, ATD treatment was started. Clinical features, thyroid volume, and eye involvement were recorded at baseline. Serum levels of free thyroxine (FT4), free triiodothyronine (FT3), thyroid-stimulating hormone (TSH), and TSH-receptor antibodies (TRAb) were measured at baseline and during the follow-up. Treatment outcome (FT4, FT3, and TSH serum levels and further treatments for GD after ATD withdrawal) was evaluated. When compared to women, men showed a significantly larger thyroid volume and a higher family positivity for autoimmune diseases. During ATD, the mean serum levels of TSH, FT4, FT3, and TRAb did not differ between groups. Within 1 year after ATD discontinuation, relapse of hyperthyroidism was significantly more frequent in men than in women. Within the 5-year follow-up period, the prevalence of men suffering a late relapse was higher compared with that of women. The outcome at the end of the 5-year follow-up period was significantly associated with gender and TRAb levels at disease onset. Male patients with GD have a poorer prognosis when submitted to medical treatment with ATDs. A larger goiter at presentation and a stronger genetic autoimmune background might explain this gender difference in patients with GD. ATD = antithyroid drug FT3 = free triiodothyronine FT4 = free thyroxine GD = Graves disease GO = Graves orbitopathy RAI = radioiodine TRAb = thyroid-stimulating hormone-receptor antibody TSH = thyroid-stimulating hormone.

  11. Prótesis total y unicompartimental en el manejo de artrosis grave de rodilla

    OpenAIRE

    Jaime duboy, U.

    2014-01-01

    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 re...

  12. 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.

  13. 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.

  14. R?actions immunoallergiques graves aux antibacillaires: ? propos de 10 cas

    OpenAIRE

    Alami, Sabah El Machichi; Hammi, Sanae; Jamal Eddine BOURKADI

    2014-01-01

    L'hypersensibilit? aux antituberculeux est l'un des effets secondaires impr?visibles qui apparait chez 4 ? 5 % de la population expos?e et s??l?ve ? 25% chez les sujets VIH positifs. Dans notre ?tude parmi 39 patients ayant pr?sent? des r?actions immunoallergiques, 10 avaient des formes graves. Le d?lai moyen d'apparition des signes ?tait de 23 jours. Les r?actions immunoallergiques observ?es ?taient 5 cas de toxidermie g?n?ralis?e f?brile, un cas de Dress syndrome, un cas de neutrop?nie, un ...

  15. Enfermedad de Graves y cáncer de tiroides: Reporte de caso

    OpenAIRE

    Helard Manrique-Hurtado; Miguel Pinto-Valdivia; Max Acosta-Chacaltana

    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...

  16. Factores genéticos en casos graves de gripe (H1N1) 2009

    OpenAIRE

    Francesc Calafell i Majó; Fernando González Candelas

    2011-01-01

    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 heredabili...

  17. 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...

  18. Comparative analysis of pubertal growth spurt predictors: Martins and Sakima method and Grave and Brown method

    OpenAIRE

    Iguma,Karina Emy; Tavano,Orivaldo; Carvalho,Izabel Maria Marchi de

    2005-01-01

    The aim of this study was to evaluate whether Martins and Sakima and Grave and Brown methods are useful for the study of pubertal growth spurt in children with cleft lip and palate. A total of 132 hand-wrist radiographs of patients from HRAC/USP aged 7 to 17 years old were analyzed, including girls and boys. Six radiographs of each age and gender were employed. These methods were applied to evaluating the stages of the hand-wrist ossification and epiphyseal formation, by graphic representatio...

  19. 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

    and a battery of biochemical, affective, and cognitive tests were used. RESULTS: Previously reported findings of reduced choline and myo-inositol in acute Graves' disease were confirmed and reversibility was demonstrated. Parieto-occipital white matter glutamine was and remained significantly reduced (P ....01). Acute phase parieto-occipital white matter total choline correlated significantly (r = -0.57; P glutamine (r = -0.52; P ....01) and parietooccipital white matter glutamate (r = -0.54; P glutamine in white matter, the decreasing glutamate in occipital gray matter...

  20. Paludisme grave chez l'enfant a l'hopital d'enfants yendoube de ...

    African Journals Online (AJOL)

    Objectif: Analyser les caractéristiques épidémiologiques, cliniques, thérapeutiques et évolutives des enfants hospitalisés pour paludisme grave à Dapaong. Matériels et méthode: Il s'agit d'une étude rétrospective menée du 01 juillet au 31 décembre 2007 à l'hôpital d'enfants Yendoubé de Dapaong. Etait inclus dans l'étude ...

  1. A sobrecarga em cuidadores familiares de crianças portadoras de paralisia cerebral grave

    OpenAIRE

    Francischetti, Sandra Sofia Rato

    2006-01-01

    Cuidador familiar é a pessoa que proporciona a maior parte da assistência e apoio diário ao paciente incapacitado. As crianças com paralisia cerebral grave, dependem exclusivamente de outra pessoa para realizar suas atividades de vida diária, podendo apresentar complicações associadas ao quadro, e necessitam de suporte terapêutico moderno e contínuo. Esta condição faz com que a presença da figura do cuidador, torne-se personagem fundamental para a manutenção do bem-estar da criança. Esta ativ...

  2. Miastenia grave: avaliação clinica e terapêutica de 55 casos

    OpenAIRE

    Werneck, Lineu Cesar; Teive, Hélio A. Ghizoni

    1987-01-01

    Foram estudados 55 casos de miastenia grave, avaliando os sinais e sintomas clínicos que ocorreram no início e na evolução dos pacientes, bem como os procedimentos diagnósticos e avaliação das medidas terapêuticas utilizadas. No manejo dos pacientes foram utilizados anticolinesterásicos, corticoesteróides, azathioprina, plasmaferese e timectomia, sem que fosse possível encontrar relação estatística significante entre os diferentes procedimentos com respeito à resolução da doença. Dos 55 casos...

  3. 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...

  4. Asma inducido por ejercicio

    OpenAIRE

    Ramos Zabala, Mª Gracia

    1997-01-01

    Este trabajo consiste en una revisión de artículos y libros que tratan sobre el asma inducido por ejercicio. Principalmente me he basado en cinco artículos realizados en los últimos arios y en diferentes libros que me han servido de apoyo. Algunas consideraciones del asma inducido por el ejercicio son las siguientes: La probabilidad de presentar broncoespasmo, así como la intensidad del mismo, después de realizar ejercicio, se incrementa con la severidad del asma, aunque hay individuos en los...

  5. Razonamiento rebatible por casos

    OpenAIRE

    Bodanza, Gustavo A.

    1996-01-01

    Este trabajo constituye un estudio de las dificultades de la incorporación de información disyuntiva en un sistema conteniendo reglas rebatibles. Se presenta una ampliación del sistema MTDR a fin de aumentar la capacidad de éste, permitiendo el razonamiento por casos mediante argumentos. En un artículo anterior ([BS95]) se brindaba una aproximación al problema introduciendo una relación de inferencia rebatible que incluía la prueba por casos. Tal solución presenta limitaciones en determ...

  6. Plebiscito por la paz

    OpenAIRE

    Holmes Trujillo, Carlos; Cepeda, Iván

    2016-01-01

    Sin lugar a dudas, este tema podría permitir el cambio del rumbo de la historia en nuestro país, en tanto el próximo domingo 2 de octubre los colombianos podrán votar en un Plebiscito Nacional por el Sí o por el No a estos acuerdos de paz. En esta emisión, se darán los elementos para tomar la decisión no sólo de nuestro voto, sino nuestro compromiso como ciudadanos responsables.

  7. Is severe visceral leishmaniasis a systemic inflammatory response syndrome? A case control study A leishmaniose visceral grave é uma síndrome da resposta inflamatória sistêmica? Um estudo caso-controle

    Directory of Open Access Journals (Sweden)

    Carlos Henrique Nery Costa

    2010-08-01

    Full Text Available INTRODUCTION: The objective of the study is to identify the main risk factors for death by New World visceral leishmaniasis and establish a coherent pathogenic substrate of severe disease based on clinical findings. METHODS: Seventy-six deceased inpatients and 320 successfully treated inpatients with VL were studied in a case control study. RESULTS: Bacterial infection and bleeding were mutually exclusive events leading to death. Five risk factors were unique for death by bacterial infection (malnutrition, pulmonary rales, severe anemia, severe absolute neutropenia and higher neutrophil count, while another six were unique for death by bleeding (jaundice, severe relative neutropenia, severe thrombocytopenia, liver injury, kidney failure, higher bone marrow parasite load. Bacterial infection, bleeding, severe anemia, diarrhea, dyspnea, edema, jaundice and bone marrow parasite load were the main syndromes of visceral leishmaniasis among successfully treated patients. CONCLUSIONS: The data support the idea that bacterial infections are due to immune paralysis. Broad organ and system involvement is plausibly due to the high production of proinflammatory cytokines, whose actions fit well with visceral leishmaniasis. The syndromes and causative mediators are typical of a slowly developing systemic inflammatory response syndrome.INTRODUÇÃO: O objetivo do estudo foi i dentificar os principais fatores de risco para morte na leishmaniose visceral do Novo Mundo e estabelecer um substrato patogênico baseado nos achados clínicos coerente para doença grave. MÉTODOS: Em um estudo caso-controle, foram estudados 76 pacientes internados que faleceram e 320 pacientes internados tratados com sucesso. RESULTADOS: Infecção bacteriana e sangramento foram eventos que levaram à morte, mutuamente exclusivos. Cinco fatores de risco foram únicos para morte por infecção bacteriana (desnutrição, estertores pulmonares, anemia grave, neutropenia absoluta grave e

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

    DEFF Research Database (Denmark)

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

    2007-01-01

    In this review, the authors summarise the clinical results obtained after therapy with rituximab in autoimmune diseases, including Graves' disease and Graves' ophthalmopathy. On the basis of qualitative and quantitative analyses of B- and T-cell subsets, and autoantibody levels obtained in other...... diseases before and after rituximab therapy, the authors interpret the results of the only two clinical investigations of the efficacy of rituximab in the treatment of Graves' disease and Graves' opthalmopathy reported so far. No significant effect on autoantibody levels was observed. Nonetheless, 4 out...

  9. A review of treatment options for Graves' disease: why total thyroidectomy is a viable option in selected patients.

    Science.gov (United States)

    Mohan, Vinuta; Lind, Robert

    2016-01-01

    Graves' disease is the most common cause of hyperthyroidism. If left untreated, patients may have multiple systemic complications such as cardiac, reproductive, and skeletal disease. Thionamides, such as methimazole and propylthiouracil, and I(131) iodine ablation are the most commonly prescribed treatment for Graves' disease. Total thyroidectomy is often overlooked for treatment and is usually only offered if the other options have failed. In our case, we discuss a patient who was admitted to our medical center with symptomatic hyperthyroidism secondary to long-standing Graves' disease. She had a history of non-compliance with medications and medical clinic follow-up. The risks and benefits of total thyroidectomy were explained and she consented to surgery. A few months after the procedure, she was biochemically and clinically euthyroid on levothyroxine. She had no further emergency room visits or admissions for uncontrolled thyroid disease. Here we review the advantages and disadvantages of the more typically prescribed treatments, thionamides and I(131)iodine ablation. We also review the importance of shared decision making and the benefits of total thyroidectomy for the management of Graves' disease. Given the improvement in surgical techniques over the past decade and a significant reduction of complications, we suggest total thyroidectomy be recommended more often for patients with Graves' disease.

  10. Regression of Ophthalmopathic Exophthalmos in Graves' Disease After Total Thyroidectomy: a Prospective Study of a Surgical Series.

    Science.gov (United States)

    Bhargav, P R K; Sabaretnam, M; Kumar, S Chandra; Zwalitha, S; Devi, N Vimala

    2017-12-01

    Autoimmune ophthalmopathy is one of the salient clinical features associated with Graves' disease. Exophthalmos is one of the commonest manifestations of Graves' associated ophthalmopathy. It is reported to regress after thyroidectomy favourably compared to radioiodine or antithyroid drug therapy. In this context, we present our experience based on a surgical series of Graves' disease. This is a prospective study of 15 patients of Graves' disease associated with ophthalmopathic exophthalmos. Preoperative and monthly postoperative evaluation of exophthalmos was done with Hertel's exophthalmometer, apart from documenting lid, extra-ocular muscle and orbital involvement. The minimum follow-up of the cohort was 12 months. The female to male ratio was 12:3 and the mean age of the subjects was 33.4 years (18-55). Exophthalmos was bilateral in 13 and unilateral in 2 patients. All the 15 patients underwent total thyroidectomy without any major morbidity. Exophthalmos regressed in 12 patients at a mean follow-up of 15.6 ± 6.4 months (14-38) and was static in 3. None of the cases had worsened ophthalmopathy at the final follow-up. Mean regression of exophthalmos was 2.1 mm (1-5). The regression was statistically significant at P value = 0.035. Surgery has a positive impact on the regression of ophthalmopathic exophthalmos associated with Graves' disease.

  11. Periodontitis periapical sintomática y agranulocitosis por analgésicos

    OpenAIRE

    Berástegui, Esther; Planas Domingo, M. E.

    1995-01-01

    Se presentó un caso de agranulocitosis en una paciente de 62 años, atribuible a ingesta continuada de analgésicos sin prescripción, para tratar el dolor debido a periodontitis periapical sintomática. Se realizó tratamiento de conductos radiculares. Dada la escasa incidencia de agranulocitosis por analgésicos a pesar de la frecuente utilización de los mismos, hemos creído de interés su publicación ya que este efecto indeseable puede ser grave o incluso mortal en algún caso. A pesar de conocers...

  12. Semillas de Avena fatua L. expelidas por vacunos : su supervivencia enterradas en el suelo

    OpenAIRE

    Cornaglia, Patricia Susana; López, Adela C. de

    1989-01-01

    p.55-62 Avena fatua es una maleza grave del cultivo de trigo de la zona de Bordenave, provincia de Buenos Aires (lat . 37° 51`S, long . 63° 0,1 W). En un sistema trigo-rastrojo pastoreado, común en la región, se observó que los bovinos que comen A. fatua granada expelen semillas enteras. Para probar si estas semillas, que no fueron destruidas por la masticación y la digestión, pueden sobrevivir enterradas varios meses, se alimentó a novillos con heno de A. fatua granada, se recuperaron sem...

  13. Infección por virus respiratorio sincitial: Aportaciones de una década

    OpenAIRE

    Blanco del Val, Alfredo

    2012-01-01

    Las infecciones víricas del tracto respiratorio son una causa importante de morbilidad y mortalidad, en especial durante la infancia. El virus respiratorio sincitial (VRS) es la principal causa de patología de las vías aéreas inferiores en niños menores de 2 años, siendo la causa del 70% de los episodios de bronquiolitis, especialmente en sus formas graves. Su diseminación es tan eficaz, que casi la totalidad de la población ha sido infectada por el VRS en los primeros años de la vida. Sin em...

  14. Biossorção de cádmio por linhagens de Aspergillus sp

    OpenAIRE

    Ana Paula de Souza Pallu

    2006-01-01

    Os metais pesados representam o maior resíduo industrial contaminante de solos, plantas e animais no ecossistema, causando graves efeitos tóxicos ao homem principalmente devido a sua ampla distribuição no ambiente, que tem sido intensificado pela industrialização. Um dos metais pesados mais tóxicos é o cádmio, elemento bastante utilizado em processos industriais, o que o torna um importante contaminante ambiental. Pesquisadores preocupados com problemas associados à poluição ambiental por met...

  15. Infecção natural por Corynespora cassiicola em acessos de mamoeiro

    OpenAIRE

    Venturini, Marcela Tonini; Santos, Lucas Calazans; Santos, Tacila Ribeiro; Luz, Edna Dora Martins Newman

    2014-01-01

    Corynespora cassiicola, um patógeno com ampla gama de hospedeiros, tem causado graves danos nos viveiros de mamoeiro na Bahia. Avaliou-se, em ambiente misto de cobertura e a pleno sol, a incidência natural de C. cassiicola em 49 acessos de mamoeiro em experimento conduzido em blocos casualizados com quatro repetições, 49 tratamentos e variável número de plantas/tratamento. O número de plantas com sintomas e mortas por C. cassiicola foi avaliado aos 27 e 32 dias após a semeadura. A análise de ...

  16. Corticosteroides no tratamento da miastenia grave. Estudo de 12 casos com revisão da literatura Corticosteroids in the management of myasthenia gravis

    Directory of Open Access Journals (Sweden)

    José Lamartine de Assis

    1975-03-01

    Full Text Available Foram estudados os resultados do tratamento da miastenia grave em 12 pacientes, sendo 10 com a forma generalizada severa, um com a forma generalizada moderada e um com miastenia acentuada associada a polimiosite. Sete pacientes foram previamente timectomizados e somente um apresentava timoma. Todos estavam em uso de doses elevadas de drogas anticolinesterásicas com resposta terapêutica pobre ou nula. Um paciente foi tratado com dexametaxona, outro com dexametazona seguida de prednisona e os restantes com prednisona, sempre em doses altas inicialmente (100 mg por dia ou em dias alternados e com redução gradativa ulterior até doses de manutenção. Os corticosteróides foram administrados sempre pela via oral, por períodos que variaram de duas semanas até dois anos e meio. Em conclusão, 75% de 12 pacientes com miastenia grave generalizada foram influenciados favoravelmente com este método terapêutico. Deste grupo apenas um apresentava timoma e não respondeu a qualquer tratamento. Outro paciente apresentava polimiosite associada e teve excelente resposta terapêutica. Dois miastênicos sem timoma tiveram a sintomatologia exacerbada durante o tratamento. Nenhum efeito colateral importante foi observado, mesmo nos pacientes tratados a longo prazo.The results of treatment of myasthenia gravis in 12 patients are reported. There were 10 cases with severe generalized form and two cases with moderate generalized form, one of which associated with polymyositis. Seven patients had prior thymectomy and one of them had a thymoma. All the patients were receiving anticholinesterase drugs with poor response or without any response. One patient received a short, intensive course of dexametazone, and other patient used prednisone after a more prolonged dexametazone course. The remaining patients received prednisone, always beginning with high (100 mg alternate day oral single-doses. This therapy has been maintained for a period thought to be sufficient

  17. Neumonía aguda de la comunidad y hemorragia pulmonar por leptospirosis en el área metropolitana Buenos Aires

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    Alfredo Seijo

    2011-04-01

    Full Text Available El objetivo del trabajo es comunicar los hallazgos epidemiológicos, clínicos y de diagnóstico de la neumonía y hemorragia pulmonar por leptospirosis, en el período enero 2007 a octubre 2009. Un 64% (20/31 de pacientes con diagnóstico de leptospirosis tuvieron neumonía. Quince de ellos (75% presentaron neumonía grave, de los cuales siete (35% desarrollaron hemorragia pulmonar. En diez enfermos (32% el motivo de consulta e inicio del cuadro clínico fue una gastroenteritis secretoria con fiebre y dolor abdominal. La ictericia sólo se manifestó en once pacientes (35%. La técnica de reacción en cadena de la polimerasa (PCR fue útil para el diagnóstico en muestra obtenida post mortem. De un hemocultivo se aisló una cepa clasificada dentro del serogrupo canicola. Se clasificaron las neumonías en tres tipos: neumonías de curso no grave con escasa repercusión general; neumonías graves asociadas a formas clínicas sistémicas con ictericia, insuficiencia renal, trombocitopenia y hemorragia pulmonar; también de curso grave, no asociada a ictericia, insuficiencia renal o trombocitopenia grave. El tratamiento antibiótico iniciado en los primeros días de enfermedad (promedio 3.2 días no tuvo influencia en la evolución de las neumonías graves. Se plantea además considerar tres formas clínicas de leptospirosis: anictérica, ictérica (con sus variantes evolutivas y hemorragia pulmonar.

  18. Acute psychosis in a pregnant patient with Graves' hyperthyroidism and anti-NMDA receptor encephalitis.

    Science.gov (United States)

    Lu, Jesslyn; Samson, Susan; Kass, Joseph; Ram, Nalini

    2015-04-22

    A previously healthy 36-year-old woman presented with visual hallucinations and acute psychosis manifested predominantly as hypersexuality. Laboratory testing demonstrated elevated free thyroxine levels, suppressed thyroid-stimulating hormone levels and presence of thyroid-stimulating immunoglobulin and thyroid peroxidase (TPO) antibodies consistent with Graves' disease. Despite achieving biochemical euthyroidism, she remained profoundly hypersexual. She did not respond to additional treatment with antipsychotics and corticosteroids, prompting further evaluation. Cerebrospinal fluid analysis detected pleocytosis, elevated IgG, and presence of antibodies against anti-N-methyl-D-aspartate receptor (NMDAR), glutamic acid decarboxylase 65 and TPO. These results suggested a diagnosis of anti-NMDAR encephalitis. Prior to initiation of immunomodulator therapy, she was discovered to be pregnant with date of conception around the time of her original presentation. She received plasmapheresis with resolution of psychosis and decrease in free thyroxine levels. Graves' disease remitted during the remainder of the pregnancy but relapsed 5 months post partum. She has not had further neuropsychiatric symptoms. 2015 BMJ Publishing Group Ltd.

  19. Postpartum recurrence of Graves' hyperthyroidism can be prevented by the continuation of antithyroid drugs during pregnancy.

    Science.gov (United States)

    Nakagawa, Yoshinori; Mori, Kouki; Hoshikawa, Saeko; Yamamoto, Makiko; Ito, Sadayoshi; Yoshida, Katsumi

    2002-10-01

    Previous studies recommend the discontinuation of antithyroid drug (ATD) therapy during pregnancy in women with well-controlled Graves' hyperthyroidism (GH). In this study, we investigated whether this termination of ATD therapy during pregnancy is beneficial in terms of postpartum GH recurrence. A nonrandomized, retrospective study. Sixty-five pregnant GH patients treated with maintenance doses of ATDs were assigned into two groups: ATD therapy was discontinued before delivery in Group 1, but continued during pregnancy and after delivery in Group 2. The prevalence of postpartum recurrence or exacerbation of GH within 1 year after delivery was examined. Serum T4, T3 TSH, and TSH receptor antibody levels were measured. In Group 1, 70.8% (17/24) of patients suffered a recurrence of GH within 1 year after delivery. In contrast, a postpartum exacerbation of GH was observed in only 29% (12/41) of patients in Group 2 (P < 0.01). Both exacerbations and recurrences of GH appeared primarily within 4-6 months after delivery. Apparent neonatal hypothyroidism and malformations were not observed in the offspring of either group. Continuing antithyroid drug therapy throughout pregnancy prevents postpartum recurrence of Graves' hyperthyroidism without resulting in neonatal hypothyroidism or malformations.

  20. A GIS-based Quantitative Approach for the Search of Clandestine Graves, Italy.

    Science.gov (United States)

    Somma, Roberta; Cascio, Maria; Silvestro, Massimiliano; Torre, Eliana

    2017-10-30

    Previous research on the RAG color-coded prioritization systems for the discovery of clandestine graves has not considered all the factors influencing the burial site choice within a GIS project. The goal of this technical note was to discuss a GIS-based quantitative approach for the search of clandestine graves. The method is based on cross-referenced RAG maps with cumulative suitability factors to host a burial, leading to the editing of different search scenarios for ground searches showing high-(Red), medium-(Amber), and low-(Green) priority areas. The application of this procedure allowed several outcomes to be determined: If the concealment occurs at night, then the "search scenario without the visibility" will be the most effective one; if the concealment occurs in daylight, then the "search scenario with the DSM-based visibility" will be most appropriate; the different search scenarios may be cross-referenced with offender's confessions and eyewitnesses' testimonies to verify the veracity of their statements. © 2017 American Academy of Forensic Sciences.

  1. 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.

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

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    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.

  3. 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.

  4. 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.

  5. Mala Kopašnica – Sase graves: narrative of continuity

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    Tatjana Cvjetićanin

    2016-11-01

    Full Text Available The graves with cremated burials labelled as Mala Kopašnica – Sase type, supposedly covering more than 70% of registered burials in Moesia Superior, are considered to be an autochthonous form, associated to pre-Roman population, characteristic for the Moesian-Dacian region from 1st to 3rd centuries, rarely spanning to the beginning of 4th century. The general similarity of burial form and relative homogeneity of grave goods are taken as arguments in the interpretation of the key concept of continuity of the prehistoric practices, but as well of unchanged burial practices and continuity of funerary customs lasting at least two centuries of the Roman domination, its cultural superiority, and visible transformation of local identities as a result of systemic and standardized Romanization, and finally, of identification of the autochthonous population of Moesia Superior as actors of this practice. The paper discusses the necropolis Gomilice near Guberevac, the only systematically investigated one in the area of Roman imperial mines at Kosmaj, with domineering burial type of Mala Kopašnica – Sase, as the starting point in reconsidering the current interpretation of this type of burial.

  6. 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. © 2016 Marshfield Clinic.

  7. 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.

  8. Karadžić's guilty verdict and forensic evidence from Bosnia's mass graves.

    Science.gov (United States)

    Klinkner, Melanie

    2016-12-01

    The International Criminal Tribunal for the Former Yugoslavia's Karadžić verdict, eagerly awaited, was unsurprising. He was found guilty of genocide, crimes against humanity and war crimes. One part of the judgment was concerned with the Srebrenica events in which much forensic evidence from mass graves featured. Whilst this was to be expected, forensic evidence from the horrific crime scenes continues to be important in determining aspects of the crime base. This paper discusses the evidence and examines how the Chamber came to the conclusion that systematic killing of thousands of Bosnian Muslim men occurred and attempts had been made to conceal the crimes and human remains in secondary graves thus confirming the actus reus of genocide. In particular, the number of people killed was at issue. Despite the absence of compelling counter-theories on behalf of the accused, this paper demonstrates that contestations over the number of those killed remain and predicts that this is unlikely to change for the ongoing Mladić case. Copyright © 2016. Published by Elsevier Ireland Ltd.

  9. Use of antihistamines after serious allergic reaction to methimazole in pediatric Graves' disease.

    Science.gov (United States)

    Toderian, Amy B; Lawson, Margaret L

    2014-05-01

    Antithyroid drugs are usually considered first-line therapy for management of pediatric Graves' disease because they avoid permanent hypothyroidism, provide a chance for remission, and are less invasive than the alternatives of thyroidectomy or radioactive iodine. Methimazole (MMI) is the only antithyroid drug recommended in pediatrics due to the risk of propylthiouracil-induced liver toxicity. Allergic reactions with MMI occur in up to 10% of patients and, when mild, can be managed with concurrent antihistamine therapy. Guidelines recommend discontinuation of MMI with serious allergic reactions. We present the case of an adolescent girl with Graves' disease and a serious allergic reaction after starting MMI whose family refused radioactive iodine and was reluctant to proceed to surgery. Antihistamine therapy was successfully used to allow continued treatment with MMI. This case demonstrates extension of management guidelines for minor cutaneous allergic reactions to MMI, through the use of antihistamines for a serious allergic reaction, allowing us to continue MMI and provide treatment consistent with the family's preferences and values. Copyright © 2014 by the American Academy of Pediatrics.

  10. 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.

  11. Cost-effectivness analysis of total thyroidectomy vs radioiodine for Graves disease

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    Prokić Anđelka

    2013-01-01

    Full Text Available Among the patients suffering from hyperthyroidism 60-80% have Graves' disease. The initial therapy of Graves's disease are antithyroid drugs. If the remission is not achieved after 12-18 months, the patients should be directed to surgical treatment or to the therapy with radioactive iodine. The aim of this study was to compare cost/effectiveness ratios for radioactive iodine and total thyroidectomy. The analysis was made using Markov model, from the perspective of Republic Fund for Health Insurance in Serbia. Duration of one cycle in the model is six months, and the time horizon is 30 years. Monte Carlo simulation was performed for 1000 virtual patients as well as the analysis of sensitivity with the variation of parameters ± 50%. For total thyroidectomy the insurance should provide 138.389,72 RSD / 57, 83 QALY i.e. 2.393,04 dinars for one quality-adjusted life year, and for radioactive iodine the insurance should provide 110.043,64 RSD / 57,82 QALY i.e. 1.903,37 dinars for one quality-adjusted life year. This economic analysis showed that radioactive iodine has better ratio of costs to clinical effectiveness as opposed to total thyroidectomy.

  12. 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.

  13. 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.

  14. Quality-of-life outcomes in Graves disease patients after total thyroidectomy.

    Science.gov (United States)

    Kus, Lukas H; Hopman, Wilma M; Witterick, Ian J; Freeman, Jeremy L

    2017-01-01

    Historically, research into surgical treatment of Graves disease has assessed subtotal rather than total thyroidectomy. Most clinicians now recommend total thyroidectomy, but little information is available regarding quality-of-life (QOL) outcomes for this procedure. Our aim was to assess QOL after total thyroidectomy. This is a retrospective, pilot study of patients with Graves disease who underwent total thyroidectomy from 1991 to 2007 at a high-volume tertiary referral center in Toronto, Canada. Questionnaires addressing disease-specific symptoms and global QOL concerns were sent to 54 patients. Analyses included parametric and nonparametric tests to assess the differences between perception of symptoms and global QOL before and after surgery. Forty patients responded (response rate: 74%) at a median of 4.8 years postoperatively. On a 10-point scale, overall wellness improved from 4.1 preoperatively to 8.7 postoperatively (p total thyroidectomy. Patients experienced marked and rapid improvement in QOL postoperatively. These findings suggest that total thyroidectomy is a safe and effective treatment.

  15. Cohort study on radioactive iodine-induced hypothyroidism: implications for Graves' ophthalmopathy and optimal timing for thyroid hormone assessment.

    Science.gov (United States)

    Stan, Marius N; Durski, Jolanta M; Brito, Juan P; Bhagra, Sumit; Thapa, Prabin; Bahn, Rebecca S

    2013-05-01

    Graves' ophthalmopathy (GO) develops or worsens in up to one-third of patients treated with radioactive iodine (RAI) for Graves' hyperthyroidism. We sought to identify the prevalence of development or worsening of GO in patients treated with RAI for Graves' hyperthyroidism and to identify the risk factors associated with that outcome. We identified a retrospective cohort of consecutive patients treated with RAI at Mayo Clinic (Rochester, MN) between 2005 and 2006. We assessed their medical records for evidence of hypothyroidism and development or worsening of GO in the year after therapy. Hypothyroidism was defined as thyrotropin >3.0 mIU/L or free thyroxine thyroid function after RAI administration is a strong predictor for adverse GO outcome. This risk is highest in patients with preexisting GO. We suggest that in order to prevent clinical hypothyroidism and the associated risk for GO, the optimal time for first measurement of fT4 is before 6 weeks after RAI therapy.

  16. Gardens of stone: searching for evidence of secularization and acceptance of death in grave inscriptions from 1900-2009.

    Science.gov (United States)

    Anderson, Keith A; Sielski, Christine L; Miles, Elizabeth A; Dunfee, Alexis V

    2011-01-01

    From the magnificent to the mundane to the sublime, grave inscriptions serve as remembrances of the dead and provide concrete evidence of the thoughts and values of the day. In this study, 1,214 grave inscriptions (N = 1,214) dated 1900 to 2009 were examined for evidence of secularization and changes in attitude toward death. Using set criteria, the researchers categorized grave inscriptions in terms of language used (sacred/secular) and acceptance of death (acceptance/other). Binary logistic regression models revealed significantly more use of sacred language and significantly less acceptance of death over the past 110 years. Findings from these analyses suggest that: (a) secularization may not be as pervasive as thought, particularly with respect to death; and (b) as death has become increasingly medicalized and marginalized, society has grown less accepting of the finitude of life. These findings are further discussed in light of the continued evolution of death memorials.

  17. Prevalencia de sífilis en mujeres gestantes atendidas por el Programa de Protección a la Gestante (PPG) y reporte de aborto en el Estado de Sergipe, Brasil

    OpenAIRE

    Fernando Saab; Carlos Tomaz

    2016-01-01

    Introducción: La sífilis ha representado un importante reto para la salud pública en Brasil, tanto por su alta prevalencia como por las graves secuelas neonatales. Objetivo: Determinar la prevalencia de infección por sífilis y la aparición de abortos involuntarios en mujeres embarazadas, por edad y distribución espacial en el estado de Sergipe en Brasil. Metodología: Estudio transversal descriptivo-retrospectivo, en el que se analizaron 39.807 registros de usuarias del Programa de Protección ...

  18. Choque cardiogênico por dissulfiram Shockcardiogénico por disulfiram Cardiogenic shock caused by disulfiram

    Directory of Open Access Journals (Sweden)

    Ana Jerónimo

    2009-03-01

    Full Text Available A intoxicação medicamentosa por dissulfiram é uma situação rara, mas, que pode se apresentar com manifestações cardiovasculares graves e potencialmente fatais, como choque cardiogênico. É apresentado o caso de uma paciente com choque refratário, após intoxicação voluntária por dissulfiram. A avaliação clínica e bioquímica, junto à avaliação ecocardiográfica e à monitorização invasiva, confirmaram tratar-se de um choque cardiogênico associado a esse fármaco. São discutidos os mecanismos de ação conhecidos do dissulfiram e descritos os principais efeitos colaterais, especialmente os cardiovasculares, alertando para a importância da suspeição diagnóstica e da abordagem terapêutica imediata mais adequada nesse contexto.La intoxicación medicamentosa por disulfiram es una situación rara, aunque puede presentarse con manifestaciones cardiovasculares graves y potencialmente fatales, como el shock cardiogénico. Este relato presenta el caso de una paciente con shock refractario, tras intoxicación voluntaria por disulfiram. La evaluación clínica y bioquímica, junto a la evaluación ecocardiográfica y el monitoreo invasivo, confirmaron tratarse de un shock cardiogénico asociado a ese fármaco. A lo largo del presente relato se discuten los mecanismos de acción del disulfiram conocidos, así como se describen los principales efectos colaterales, específicamente los cardiovasculares. En este sentido, también se alerta para la importancia de la sospecha diagnóstica y del abordaje terapéutico inmediato más adecuado a este contexto.Drug intoxication with disulfiram is a rare condition that may lead to severe and potentially fatal cardiovascular manifestations such as cardiogenic shock. We report the case of a female patient with refractory shock after deliberate self-poisoning with disulfiram. Clinical, biochemical and echocardiographic assessment, as well as invasive monitoring confirmed cardiogenic shock

  19. Diagnostic Utility of Contrast-enhanced 3D T1-weighted Imaging in Acute Cerebral Infarction Associated with Graves Disease.

    Science.gov (United States)

    Gon, Yasufumi; Sakaguchi, Manabu; Oyama, Naoki; Mochizuki, Hideki

    2017-02-01

    Graves disease is rarely complicated with cerebrovascular steno-occlusive diseases. Previous studies have suggested several hypotheses for this occurrence, including excess thyroid hormone, which stimulates the sympathetic nervous system, which in turn causes an abnormal hemodynamic response with consequent atherosclerotic changes, and antithyroid antibodies cause local vascular inflammation in patients with Graves disease. However, radiological findings of vasculitis in patients with Graves disease and cerebral infarction remain less known. We report the case of a 30-year-old Japanese woman with acute cerebral infarction due to vasculitis associated with Graves disease. She was admitted to our hospital with a 4-day history of intermittent transient dysarthria and limb shaking of the left leg when standing. Three weeks before admission, she went to a local hospital because of general malaise and was diagnosed with Graves disease. Neurological examination revealed paralytic dysarthria, left central facial nerve palsy, and left hemiparesis (manual muscle testing, 4 of 5). Blood examinations showed hyperthyroidism (thyroid-stimulating hormone ≤.010 µU/mL; free T3 ≥25.0 pg/mL; free T4 ≥8.0 ng/dL) and elevation of antithyroid antibody levels (thyroid peroxidase antibody, 87 IU/mL). The vessel wall of the right internal carotid artery was markedly enhanced on contrast-enhanced three-dimensional T1-weighted magnetic resonance imaging, suggesting vasculitis. Magnetic resonance angiography revealed right internal carotid artery occlusion after the branching ophthalmic artery. Arterial stenosis due to vasculitis was considered the cause of hemodynamic ischemic stroke. Vessel wall imaging such as high-resolution contrast-enhanced T1-weighted imaging seems useful for assessing the underlying mechanism of stroke in patients with Graves disease. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

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

    Energy Technology Data Exchange (ETDEWEB)

    Tan, Teik Hin; Lee, Boon Nang; Hassan, Siti Zarina Amir [Kuala Lumpur Hospital, Lumpur (Malaysia); Ch' ng, Ewe Seng [Univ. Sains Malaysia, Kerian (Malaysia); Hussein, Zanariah [Putrajaya Hospital, Putrajaya (Malaysia)

    2012-12-15

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