Endocrine effects of organophosphate antidotal therapy

To determine the endocrine effects of the treatment of organophosphate poisoning, this prospective study was conducted in a university-based emergency department among patients with a history and clinical findings compatible with those of organophosphate poisoning. Thyrotrophin (TSH), free triiodothyronine (FT3), free thyroxine (FT4), follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), progesterone (PRG), adrenocorticotropic hormone (ACTH), cortisol, and testosterone (TST) levels were analyzed before and after treatment with atropine and pralidoxime. The Wilcoxon’s sign rank sum (nonparametric) test was used to compare dependent variables before and after treatment. A total of 44 patients (19 male; mean age: 28.5±12.6 y) were enrolled in the study. Patients were hospitalized for 5.4±1.3 days. Posttreatment ACTH, cortisol, PRL, FT3, FSH, and PRG levels were significantly lower than pretreatment levels (P<.05). The decrease in TSH, LH, and TST levels did not reach statistical significance, while FT4 levels increased following the treatment (P<.05). Six patients were diagnosed on admission with sick euthyroid syndrome, and 11 patients who were euthyroid on admission developed sick euthyroid syndrome following treatment. ACTH, cortisol, PRL, FT3, FT4, FSH, and PRG levels are affected by acute organophosphate poisoning. The change in hormone levels may result from the effects of neurotransmitters, from the direct effect of the toxic agent, or from stress associated with events leading to the poisoning incident.     

Cardiac resynchronization therapy in a case of myotonic dystrophy (Steinert's disease) and dilated cardiomyopathy

Steinert's disease (Dystrophia myotonica type 1) is an autosomal dominant neuromuscular disease characterized by myotonia, muscle weakness, frontal balding, cataracts, cardiac conduction abnormalities, especially long PR interval and wide QRS complex. Although subclinical mild myocardial dysfunction may be detected in this syndrome, overt myocardial dysfunction with heart failure called as "myotonic heart disease" is not frequent. Cardiac resynchronization therapy is an effective treatment modality to improve morbidity and mortality in patients with intraventricular conduction delay and congestive heart failure. We report improvement of cardiac dyssynchrony and symptoms of heart failure with biventricular pacing in a 37-year-old male patient with overt myotonic heart disease, PR segment prolongation, and complete left bundle branch block.     

Effect of cardiac resynchronization therapy on left atrial reverse remodeling and spontaneous echo contrast

Recent studies revealed reverse remodeling in left ventricle with cardiac resynchronization therapy (CRT). However, effects on left atrial remodeling, left atrial total emptying fraction and left atrial spontaneous echo contrast (SEC) have not been adequately evaluated. The aim of this study was to investigate the long-term changes in SEC, left atrial reverse remodeling, and left atrial total emptying fraction after CRT. Twenty patients with systolic heart failure and complete left bundle-branch block underwent implantation of biventricular pacemaker devices. Transthoracic and transesophageal echocardiography were performed one week before and one and six months after pacemaker implantation. After biventricular pacemaker implantation, significant clinical improvement was observed in all patients. Left atrial maximal and minimal volumes showed a significant progressive decline after CRT (reverse remodeling). Left atrial total emptying ejection fraction (LATEF) was 33 +/- 19% at baseline and increased to 37 +/- 10% and 41 +/- 11% at the 1st and 6th months respectively (p = 0.01 and p = 0.04). SEC was detected in 18 of 20 patients (90%) at the beginning of the study. After six months SEC disappeared in 5 patients and frequency of SEC reduced to 45%. Decrease in the intensity of the SEC was also statistically significant (at the 1st and 6th months; p = 0.001 and p < 0.001 respectively). Long-term CRT results in atrial reverse remodeling, increases LATEF, and reduces both frequency and intensity of atrial SEC.     

The association of low-grade systemic inflammation with hypertensive retinopathy

High-sensitivity C-reactive protein (hs-CRP) is a marker of systemic low-grade inflammation. The pathophysiologic mechanism of hypertensive retiopathy (HR) is not fully established. Elevated blood pressure (BP) alone does not fully account for the extent of retinopathy, other pathogenic mechanisms may be involved, such as low-grade inflammation. Therefore, this study was designed to answer the following questions. (i) Do hs-CRP levels change in HR? (ii) Is there any relation between degree of HR and hs-CRP levels? This study included 84 hypertensive patients with HR. The hypertensive patients were divided into two groups according to the Keith-Wagener classification. Group 1 comprised 42 patients with grade I HR, and Group 2 comprised 42 patients with grade II HR. We selected 42 healthy subjects matched for age, sex, and body mass index (BMI) for control group. The level of hs-CRP in group 2 was significantly higher than in group 1 group (p = 0.018) and control group (p = 0.001), it was also higher in group 1 than in control group (p = 0.002). Also, hs-CRP showed positive correlations with degree of HR (r = 0.29, p = 0.017). Our study suggests that there is a relationship between HR and hs-CRP levels, which may be associated with systemic low- grade inflammation.     

The combination of ınterleukin-10 -1082 and tumor necrosis factor α -308 or ınterleukin-6 -174 genes polymorphisms suggests an association with susceptibility to Hashimoto's thyroiditis

BackgroundThe etiopathogenesis of Hashimoto's thyroiditis (HT) has not been clearly elucidated although the role of chronical inflammation and endothelial dysfunction has been established. The imbalance between pro- and anti-inflammatory cytokines may play a role in the etiology. The aim of the present study was to investigate whether cytokine gene polymorphisms are associated with HT, and to evaluate the relationship between genotypes and clinical/laboratory manifestation of HT.MethodsTumor necrosis factor α (TNFα) G-308A (rs 1800629), interleukin-6 (IL-6) G-174C (rs 1800795) and IL-10 G-1082A (rs 1800896) single nucleotide polymorphisms (SNPs) in DNA from peripheral blood leukocytes of 190 patients with HT and 231 healthy controls were investigated by real-time PCR combined with melting curve analysis using fluorescence-labeled hybridization probes.ResultsThere was no notable risk for HT afflicted by TNFα ? 308, IL-6 ? 174 and IL-10 ? 1082 polymorphisms alone. However, carriers of variant alleles of both IL-10 ? 1082 and TNFα ? 308 polymorphisms had four-fold times higher risk for HT in comparison with non-carriers. Additionally, concomitant presence of both mutant IL-10 ? 1082 A and IL-6 ? 174 C alleles raised three-fold the HT risk.ConclusionOur results suggest that the combined effects of TNFα ? 308, IL-6 ? 174 and IL-10 ? 1082 variant alleles may be more decisive to induce functional differences and modify the risk for HT.     

Spinal cord compression caused by vertebral hemangioma being symptomatic during pregnancy

BACKGROUND: Hemangioma is one of the most common benign tumors of the spine, and it remains silent in the vast majority of subjects afflicted. Pregnancy is a known risk factor for symptomatic conversion of the previously silent vertebral hemangiomas. However, the occurrence is rare with only 26 cases reported in the English medical literature. CASE DESCRIPTION: A 22-year-old woman in her 36th week of gestation presented with acute onset of upper back pain and progressive paraplegia. Imaging studies revealed a T4 vertebral hemangioma, which involved the vertebral body, pedincules, transverse, and spinous process with a focal extradural extension of soft tissue component. She underwent emergent cesarean delivery and endovascular embolization, respectively. Her symptoms and neurologic deficits improved quickly. Her complaints restarted 2 years after embolization. Surgical treatment which consists of intraoperative vertebraplasty and segmental fixation was performed. The patient's postoperative recovery was excellent. CONCLUSION: According to literature review and our patient's outcome, pregnancy may induce neurologic symptoms and signs in silent spinal hemangiomas. The way of management is decided by whether the neurologic deficits depend on the deformity caused by hemangioma or some other factors including vascular insufficiency.     

Postoperative digestive fistulas. Etiopathogenic considerations

The digestive fistula is one of the most serious complications that might appear following different types of resectional digestive surgery. This condition still carries a considerable morbidity and mortality rate and therefore all surgical and ICU staff pay a great deal of attention and intensify their care to avoid the fatalities. The postoperative digestive fistulas, through their physiopathological and clinical complexity induce the disturbance of the biological equilibrium with vital consequences. The trend of the last decades is the increasing of digestive fistulas incidence with a variable mortality rate after different authors. A therapeutic algorithm is needed. The mortality rate due to digestive fistulas, two decades ago was, around 60%; at the present there is a decrease of the mortality rate, which is around 10%. The explanation is the introduction of the new methods of treatment such as lactic acid lavage aspiration for alkaline fistulas or total parenteral nutrition, continuous enteral nutrition and antiexocrine chemotherapy. A fistula is a communication between two epithelial or endothelial surfaces, lined by granulation tissue. It can be a life-threatening condition.     

Reversible attenuation of neuropathic-like manifestations in rats by lesions or local blocks of the intralaminar or the medial thalamic nuclei

BACKGROUND AND AIM: Thalamic somatosensory nuclei have been classified into medial and lateral systems based on their role in nociception. An imbalance between these two systems may result in abnormal somatic sensations and spontaneous pain. This study aims to investigate the effects of transient or permanent block of the medial and intralaminar nuclear groups on the neuropathic-like behavior in a rat model for mononeuropathy. METHODS: Neuropathy was induced on one hind paw in different groups of rats following the spared nerve injury model. When the resulting hyperalgesia and allodynia (tactile and cold) reached a maximum plateau, the rats received either chemical or electrolytic lesion or lidocaine (2%) microperfusion, placed in the various thalamic nuclear groups. RESULTS: All procedures produced transient but significant decrease of neuropathic manifestations. The magnitude and duration of decrease depended on the type and the site of the block. These effects can be ranked in increasing order as follows, electrolytic相似文献   

Computed tomography evaluation of the normal appendix: comparison of low-dose and standard-dose unenhanced helical computed tomography

OBJECTIVE: To determine the visualization rate of the normal appendix on low- and standard-dose unenhanced computed tomography (CT) and to evaluate the variables that may influence the identification of the appendix. METHODS: The study population was derived from the previous study, approved by the internal review board, investigating the effectiveness of low-dose CT (LDCT) in diagnosis of urolithiasis. Sixty-eight patients presenting with acute flank pain underwent 2 unenhanced dual-slice CT examinations. Standard-dose CT (SDCT) scans were obtained using 2 x 5-mm collimation, 120 kVp, and 170 effective mAs and followed by LDCT using 30 or 50 effective mAs. Two independent board-certified radiologists retrospectively recorded the visualization, outer diameter, and the wall thickness of normal appendices. The diameters, circumference, and cross-sectional area of the abdomen were measured. RESULTS: The prevalence of appendectomy was 8.8% (6 of 68 patients). The means of the 2 reviewers' sensitivity, specificity, positive and negative predictive values, and accuracy for visualization of normal appendix at SDCT versus LDCT respectively were 78% versus 73%, 100% versus 92%, 100% versus 99%, 31% versus 24%, and 80% versus 74% (P = 0.39-0.75). The interobserver agreement was good at both SDCT (kappa = 0.61) and LDCT (kappa = 0.74). Overall 40% to 58% of appendices at LDCT and 33% to 47% at SDCT was larger than 6 mm. There was no significant correlation in the appendix visualization neither with abdominal dimensions nor with visceral or pericecal fat at both dose sets. The calculated mean effective radiation dose at LDCT was 70% to 82% less than SDCT. CONCLUSIONS: Low- and standard-dose nonenhanced helical CT can visualize a normal appendix with high accuracy and good interobserver agreement. The diameter of normal appendix overlaps with that of appendicitis at CT. A diameter of 10.0 mm should be considered as the upper limit of normal in the absence of any other CT signs of appendicitis.