Comparison of completion thyroidectomy and primary surgery for differentiated thyroid carcinoma.

AIM: The objective of this study is to analyze the complication rates after the completion thyroidectomy and compare them with primary total thyroidectomy. METHODS: The outcomes of patients with differentiated thyroid carcinoma who were operated over a period of eight years were evaluated. One hundred and forty-one patients underwent completion thyroidectomy and 92 patients had primary surgery. RESULTS: The two groups were comparable in respect of clinical variables. Residual tumor was found in 66 of 141 patients (46.8%) in completion thyroidectomy group. The rate of the two most important complications, permanent recurrent laryngeal nerve palsy and permanent hypoparathyroidism were 3.5 and 4.2%, in completion thyroidectomy group, and 3.3 and 4.3%, in primary total thyroidectomy group. The complication rates were not significantly different between groups. CONCLUSION: In conclusion, completion thyroidectomy can be done safely in a specialized center with acceptable morbidity.     

Factors associated with the blood levels of lead in residents of Mexico City

A study aimed at detecting risk factors for high blood lead levels in Mexico City inhabitants, undertaken at the local National Institute of Public Health, is described. Measurements of blood lead levels for a sample of 300 civil servants were related to several potential risk factors. The statistical analysis was based on analysis of variance and logistic regression. The results of the analysis seem to suggest differences in blood levels by sex, zone of residence, hours of transportation and eating habits, such as the consumption of canned meals and the use of "earthenware dishes" in the preparation of meals. The nature of the study is exploratory, but it seems to suggest directions of research in the complex problem of lead levels in people of polluted cities.     

Genetic and enzymatic characterization of sphingomyelinase D isoforms from the North American fiddleback spiders Loxosceles boneti and Loxosceles reclusa.

In this study we report the isolation and characterization of several sphingomyelinase D isoforms from the venoms of the North American spiders Loxosceles boneti and Loxosceles reclusa, from Mexico and the United States, respectively. We have measured their enzymatic activity, their capacity to induce necrotic lesions in rabbits, cloned the cDNAs coding for the mature forms of two of the isoforms from L. boneti and two of L. reclusa based on N-terminal sequence information of the purified proteins, and performed a comprehensive comparison of the sequence data generated by us with that reported for other sphingomyelinase genes to date.     

Performance evaluation of MR-proadrenomedullin and other scoring systems in severe sepsis with pneumonia

Background

In sepsis, risk assessment is as crucial as early and accurate diagnosis. In this study, we aimed to evaluate the prognostic value of mid-regional proadrenomedullin (MR-proADM) with other scoring systems in severe sepsis and septic shock patients due to community acquired pneumonia (CAP).

Methods

Patients were divided into 2 groups as severe sepsis and septic shock due to CAP (group 1, n=31) and only CAP group (group 2, n=26). Serum MR-proADM, procalcitonin (PCT), C-reactive protein (CRP), and d-dimer level were analyzed. Acute Physiological and Chronic Health Evaluation (APACHE) II score, Sequential Organ Failure Assessment (SOFA) score, and Pneumonia Severity Index (PSI) were performed for all patients.

Results

There was no difference between groups in terms of serum MR-proADM levels (P=0.780). Serum MR-proADM was not found a significant value for the prediction of death within the 4 and 8 weeks in all patients. SOFA score was the most significant to predict mortality in 4 and 8 weeks (P<0.001). The combination of SOFA score and serum MR-proADM was a strong factor to predict death in 4 weeks (specifity 86.8% and sensitivity 66.7%). The combination of MR-proADM, SOFA score, and APACHE II score was found 75.0% sensitive and 71.4% specific to predict mortality within 4 weeks in group 1.

Conclusions

The MR-proADM does not correlate with mortality or disease severity to predict mortality. The combination of SOFA, APACHE II scores, and MR-proADM was efficient to predict prognosis and mortality rate in severe sepsis or septic shock patients.     

Usefulness of measuring the gastric emptying time in a case of brittle diabetes

Gastric emptying time measurement by radionuclide study, although quite informative, is rarely remembered in clinical practice. We presented a patient with brittle diabetes who had multiple emergency admissions due to hypoglycemia under routinely prescribed insulin therapy. She had severe gastroparesis, which was determined by scintigraphic gastric emptying study (gastric half-emptying time = 260 min for a mixed meal). She had not presented to the emergency service for two years because of only a slight change the timing of her insulin administration time (after meal instead of before meal) in the light of gastric-emptying study.     

Ocular findings in Sturge-Weber syndrome

PURPOSE: We reviewed the rare ocular findings of Sturge-Weber syndrome (SWS) and the results of implantation of the Ahmed valve in cases associated with glaucoma. METHODS: Seven patients (range 18 to 52 years) diagnosed as SWS were reviewed as clinical findings over two years. An anterior chamber maintainer was placed in patients with glaucoma to maintain stable intraocular pressure and minimize the risk of intraocular hemorrhage due to sudden pressure changes during surgery, when an Ahmed valve is implanted. RESULTS: Episcleral venous vessels were prominent in all cases. Diffuse choroidal hemangiomas were seen in three cases. Nevus of Ota was observed in only one case. Three cases had juvenile glaucoma. One also had buphthalmos. No intraocular hemorrhage or choroidal effusion was observed intraoperatively in valve-implant patients. The surgical treatment of the patients with glaucoma gave favorable outcomes. CONCLUSIONS: Rare ocular findings such as choroidal hemangioma and nevus of Ota are sometimes seen in SWS. Drainage valve implantation, with an anterior chamber maintainer, is a good choice for treatment when surgery is done in cases with glaucoma. This method may reduce the risk of intraoperative suprachoroidal effusion and expulsive hemorrhage by stabilizing intraocular pressure within normal limits during the surgery.     

Color Doppler ultrasonography in ocular Behçet's disease

PURPOSE: The aim of this prospective study was to assess the ocular hemodynamic changes in patients with Behcet's disease who had involvement of the posterior segment by color Doppler ultrasonography. METHODS: The present study was carried out in 32 eyes of 24 patients with ocular Behcet's disease and 42 eyes of 21 persons as a healthy age-matched control group. In order to detect the hemodynamic changes in ocular Behcet's disease, peak systolic and end-diastolic velocities (PSV, EDV; cm/sec), resistive and pulsatile indices (RI, PI), and PSV/EDV ratio of central retinal artery (CRA), short posterior ciliary artery (PCA) and ophthalmic artery (OA) were determined. RESULTS: The mean PSV and EDV (8.1+/-2.6 and 2.7+/-0.1 cm/sec, respectively) in the CRA were significantly lower in patients with Behcet's disease than in healthy controls (11.5+/-2.2 and 3.5+/-1.0 cm/sec, respectively, p<0.001). For the PCA, these values (12.7+/-4.2 and 4.3+/-1.1 cm/sec, respectively) were significantly lower in the patient group than in the control the group (18.2+/-4.2 and 6.1+/-2.5 cm/sec, respectively, p<0.001). In the patient group, a statistically significant decrease compared to the control group was detected in the mean PSV of the OA (31.8+/-8.2 and 35.8+/-0.6 cm/sec, respectively, p<0.02). However, no significant difference in the other parameters of these vessels was observed between groups. CONCLUSIONS: These results demonstrate the presence of some circulatory changes in the flow velocities of the CRA, PCA and OA in patients with Behcet's disease when compared with control subjects.