Invasive Fibrous Thyroiditis (Riedel's Struma): A Manifestation of Multifocal Fibrosclerosis? A Case Report with Review of the Literature

A patient is described with Riedel's thyroiditis and invasivefibrous growth in parathyroid, lacrimal glands, and retroperitoneally.It is proposed that Riedel's thyroiditis is not a disease inits own right but a manifestation of a generalized disease offibrous tissues.     

Effects of posture and saline infusion on atrial natriuretic peptide and haemodynamics in patients with Bartter''s syndrome and healthy controls

In order to explore the role of atrial natriuretic peptide (ANP) in Bartter's syndrome, five patients and five healthy controls matched for age and sex were studied. The study was designed to stimulate and suppress ANP secretion by manipulation of right atrial pressure with different body positions and mild volume expansion with saline. Other vasoactive hormones were also measured, and heart rate and blood pressure were recorded at 5-min intervals. Plasma ANP levels increased after head-down tilt and returned to baseline in the upright position. Infusion of saline failed to increase plasma ANP both in the control group and in four of the patients. No significant differences were found in plasma atrial natriuretic peptide concentrations between both groups. In view of previously reported elevated plasma ANP levels, Bartter's syndrome may be heterogeneous in this respect. Plasma renin activity was higher in the patients, but plasma aldosterone, adrenaline and noradrenaline were similar in both groups. Mean arterial blood pressure was similar in both groups, but rose significantly in the upright position in the control group only, while changes in heart rate were similar in both groups. We conclude that atrial natriuretic peptide does not seem to play a causal role in our patients with Bartter's syndrome.     

ALTERATIONS IN THYROID HORMONE METABOLISM DURING CHEMOTHERAPY IN PATIENTS WITH TESTICULAR CARCINOMA

In a prospective study, the effects of chemotherapy on thyroid function in patients with non-seminoma testicular carcinoma were evaluated. Thirty-one patients were studied; in sixteen immunoassayable HCG was present, but altered thyroid function could not be established. In fifteen patients an exaggerated TSH response to TRH was observed. In these patients, although T3 and T4N values were normal, basal TSH levels were higher compared to patients with a normal TSH response, probably due to preceding lymphangiography.During chemotherapy, T4N, T3 and rT3 levels rose significantly, but basal TSH levels and the TSH response to TRH decreased. In contrast, the prolactin responses to TRH increased. The observed changes in thyroid function during chemotherapy appear to result from delayed thyroid hormone clearance, probably caused by an effect of chemotherapy on deiodinating enzyme activity. This would result, in an increase in T4N and rT3 levels and a fall in TSH levels and in the TSH response to TRH. Furthermore, after therapy the raised T4N and lowered TSH levels remained, whilst the FT3 level did not change either during or after therapy, suggesting an unaltered hypothalamic/pituitary axis.     

Attitudes of Korean adults towards human dignity: A Q methodology approach

Aim: The aim of this study was to identify the perceived attitudes of Korean adults towards human dignity in order to determine the relationship of human dignity to its social and cultural background. Methods: The Q methodology research technique was used to explore perceived attitude typology on the basis of the respondents' ranking order for different statements. A convenience sampling method was used to select 40 Korean adults who were interested in human dignity to create statements. From the questionnaires, in‐depth interviews, and a literature review, a total of 158 statements was obtained. The final 34 Q samples were selected from a review by two nursing professors and a Q methodology expert. Moreover, 38 respondents participated as P samples by sorting 34 Q statements on a nine‐point normal distribution scale. The data were analyzed by using the QUANL software package. Results: The following four types of attitudes about human dignity were identified in Korea: a happiness‐oriented–self‐pursuit type, relationship‐oriented–self‐recognition type, reflection‐oriented–self‐unification type, and discrimination‐oriented–self‐maintenance type. Conclusions: The results indicate that approaches to developing human dignity education need to take this typology into account and the characteristics of the participants who fall into each category. These results provide general guidelines to understand Korean values for professional practice in various healthcare settings.