ISSN:1051-2144    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:1051-2144    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Adrenal vein sampling (AVS) is primarily used to determine the various types of primary aldosteronism. AVS is infrequently used to work-up other functional adrenal disorders, such as pheochromocytoma or virilization syndromes. A number of diagnostic methods are available for evaluation of hyperaldosteronism, but AVS is the most accurate. After confirmation that the patient has primary aldosteronism, anatomic imaging is usually the next step in diagnosis. Most patients evaluated for hyperaldosteronism will have unilateral adrenal limb thickening, bilateral abnormalities, or normal appearing adrenal glands with computed tomography or magnetic resonance imaging. Therefore, AVS is required to differentiate unilateral from bilateral aldosterone production of patients so that appropriate treatment can be provided.This report will review the anatomy of adrenal venous drainage and the techniques used in adrenal sampling. The indications for use of AVS in the diagnosis of functional adrenal states will be described. Particular emphasis will be placed on the role of AVS in the evaluation of primary aldosteronism. The complications and potential drawbacks of the procedure will also be discussed.

ISSN:1051-2144    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

BackgroundNo studies have been performed to determine if intravenous calcium replacement in critically ill patients with mild, asymptomatic hypocalcemia improves clinical outcome.MethodsCase-control study of patients in the medical-surgical intensive care unit of the San Francisco Veterans Affairs Medical Center. Two groups of patients were studied; one group consisting of all 15 patients who received intravenous calcium infusions in May 1999, and a control group consisting of an equal number of patients matched for severity of illness, as determined by Simplified Acute Physiology Score (SAPS II). Length of hospital stay and in-hospital mortality were calculated for each group. Results: The two groups did not differ significantly in baseline characteristics or severity of illness. The two groups also did not differ in mean serum calcium concentrations or degree of hypocalcemia during their hospital course. The calcium replacement group, however, had a longer hospital stay (20.7 vs. 12.4 days,p= 0.02). Conclusions: Intravenous calcium replacement in mild, asymptomatic hypocalcemia of critical illness does not seem to benefit patients and may be associated with longer hospital stays.

ISSN:1051-2144    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Diabetes mellitus is a metabolic disease that is associated with high rates of cardiovascular mortality. Therapeutic strategies available for treatment of diabetes involve modification of cardiovascular risk factors by dietary changes, tight control of blood glucose, pharmacological lowering of plasma lipids, and reduction of elevated blood pressure. In this review, the role of hypolipidemic agents in treating diabetic patients is addressed. Included are findings from clinical studies that have evaluated the efficacy and safety of various classes of hypolipidemic agents, alone or in combination, in the treatment of diabetic dyslipidemia. Statins are a major class of hypolipidemic agents that effectively reduce total cholesterol and low-density lipoprotein cholesterol (LDL-C) and plasma triglycerides, while increasing high-density lipoprotein cholesterol (HDL-C) levels. Fibrates are another important class of lipid altering drugs that lower plasma triglycerides, increase HDL-C, and favorable modify LDL-C particle composition. Niacin and nicotinic acid analogs lower total cholesterol, LDL-C, and triglycerides, while increasing HDL-C. However, niacin therapy may or may not be associated with decreased glucose control. Conventional bile acid sequestrants, although effective in decreasing total cholesterol and LDL-C, can increase triglycerides under certain circumstances. Various combinations of these agents seem to be highly effective at allowing diabetic patients to achieve lipid-lowering goals. Furthermore, new hypolipidemic agents, such as colesevelam hydrochloride, can be used alone or in combination therapy and may offer physicians therapeutic alternatives, particularly for diabetic patients who cannot tolerate higher dosage levels of systemic agents yet require further reductions to reach plasma cholesterol target levels. Integration of a complete therapeutic strategy targeted to achieve specific reduced levels of LDL, including effective and safe lipid-lowering drugs for treatment of dyslipidemia in people with diabetes, will likely reduce the risk and burden of cardiovascular disease in these patients.

ISSN:1051-2144    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveWe evaluated the feasibility of using Polaroid retinal photographs evaluated by an experienced endocrinologist as a screening tool to identify diabetic retinopathy needing referral to an ophthalmologist.Research Design and MethodsIn 23 diabetic subjects, a total of 138 retinal Polaroid photographs were taken with a nonmydriatic camera. These Polaroid photographs were followed immediately by seven view stereoscopic photographs taken through dilated pupils. The Polaroid prints were evaluated and graded independently by the primary care endocrinologist, whereas the stereoscopic photographs were graded in the Ocular Epidemiology Reading Center in Madison, WI.ResultsAll 138 sets of photographs were satisfactory for grading. Nonproliferative diabetic retinopathy was present in 69 photographs and proliferative retinopathy was present in 54 photographs. The endocrinologist correctly identified all cases. However, there were four normal eyes that were graded as microaneurysms only by the endocrinologist, five cases of microaneurysms only that were graded as other nonproliferative retinopathy, and two cases of nonproliferative retinopathy that were graded as microaneurysms only.ConclusionsAfter proper training, a nonophthalmologist physician can identify a normal retina and appropriately refer any diabetic retinopathy evident on Polaroid films taken with a nonmydriatic camera. Retinopathy, one of the specific vascular complications of diabetes, can lead to loss of vision or blindness. Because early treatment of retinopathy can prevent the loss of vision in a large majority of diabetic patients [1], current recommendations include yearly examinations by an ophthalmologist or optometrist experienced in making the diagnosis [2]. Ophthalmology visits add an extra burden on the diabetic patient both in terms of dollars and time. Seven field stereoscopic retinal photographs, graded by an experienced grader, have been shown to provide an objective recording of the presence or absence of retinal pathology and have been proposed as a screening method to avoid the extra burden of referral visits [3]. However, this procedure is still costly, and under the best of circumstances, causes a delay in diagnosis and ophthalmology referral. More importantly, the entire process is cumbersome enough that in some settings it may be delayed or omitted altogether. Recently, a nonmydriatic camera has been proposed as a screening tool [3,4]

ISSN:1051-2144    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The diagnostic differentiation between Cushing’s disease and ectopic adrenocorticotropic hormone (ACTH) syndrome is frequently difficult, because dynamic biochemical testing and/or radiological imaging are commonly inconclusive. Direct inferior petrosal sinus sampling (IPSS) for ACTH is considered by many to be the most accurate test for this differential diagnosis. IPSS involves simultaneous blood sampling for ACTH from the right inferior petrosal sinus (IPS), left IPS, and a peripheral vein both before and after corticotropin-releasing hormone (CRH) stimulation. A basal central to peripheral ratio (C:P ratio) ≥ 2 or a stimulated C:P ratio ≥ 3 suggests Cushing’s disease, whereas ratios < 2 and < 3, respectively, suggest ectopic ACTH syndrome. In experienced centers, the diagnostic sensitivity and specificity of IPSS approaches 100%. The indications for IPSS are debated, with some advocating use when standard dynamic tests are inconclusive, and others advocating use only when pituitary magnetic resonance imaging (MRI) is inconclusive. Intersinus ACTH gradients ≥ 1.4 may suggest a lateralization of ACTH-secreting pituitary tumors, but the utility of IPSS in this situation is less clear. In experienced hands, IPSS is generally safe, but serious complications may rarely occur. Although some advocate direct sampling from the cavernous sinuses, this method does not seem to be superior to IPSS.

ISSN:1051-2144    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Pituitary tumors have profound effects on fertility, whereas pregnancy affects both the behavior of pituitary tumors and their management. Tumors may impair fertility by hormonal hypersecretion, when functional, or by destruction of pituitary hormone-secreting cells. Prolactin hypersecretion inhibits the hypothalamic-pituitary gonadotropic axis, leading to anovulation. adrenocorticotropic hormone (ACTH)- and growth hormone (GH)-secreting tumors cause infertility due to excess adrenal androgen production. The normal pituitary and frequently, pituitary tumors, increase in size during pregnancy and together may cause headaches and impaired vision due to mass effects. For prolactinomas, the risk with microadenomas is very low, although with macroadenomas, may be as high as 36%, warranting consideration of therapy before pregnancy. Prolactinomas frequently respond to dopamine agonists. The largest experience has been with bromocriptine, which is considered not to have untoward effects on the fetus; less experience exists for cabergoline, although no safety issues have been raised. Spontaneous tumor regression/ remission of prolactinomas may occur after delivery, particularly in those tumors first detected during pregnancy. Somatotropinomas may also ex-hibit symptomatic enlargement during pregnancy. They usually respond to octreotide, although the drug’s tumor-suppressive activity is less than that of bromocriptine and experience with this drug in pregnancy is limited. ACTH-secreting tumors cause an increase in maternal and fetal morbidity and mortality. Surgical therapy is required, because pharmacotherapy exhibits unacceptable toxicity. Treatment of thyroid-stimulating hormone (TSH)-secreting and of nonfunctioning tumors is by surgery.

ISSN:1051-2144    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:1051-2144    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Struma ovarii is an ovarian teratoma in which thyroid tissue predominates. The reported incidence ranges between 2% and 10% of all cases of teratoma. Malignant transformation, in the form of papillary or follicular carcinoma, is an even rarer event. We report a case of papillary cancer within a struma ovarii and review the pertinent literature. A 3-cm focus of malignancy was discovered after excision of a rapidly progressing pelvic mass in a 35-year-old woman with a family history of dermoid cysts. She was treated with unilateral salpingo-oophorectomy, thyroidectomy, and 100 mCi of iodine-131 to ablate residual thyroid tissue and potential microscopic metastasis. After these procedures, the whole body scan revealed no uptake in the abdominal or pelvic region. A review of the literature since 1970 revealed less than 25 cases of malignancy of the papillary type within struma ovarii and a greater rate for follicular carcinoma. The treatments ranged from exclusive local excision to extensive surgery, with additional thyroidectomy, radioiodine, and even chemotherapy in selected cases. Malignant struma ovarii can be managed satisfactorily by combining surgical procedures with treatment options commonly used for primary thyroid carcinoma. The outcome for papillary carcinoma is overall favorable, even if a less aggressive therapeutic approach is chosen. Follicular neoplasia has a higher rate of recurrence and a worse prognosis.

ISSN:1051-2144    

出版商:OVID    

年代:2001

数据来源: OVID