ISSN:1051-2144    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

A 40-year-old woman with Graves disease and idiopathic thrombocytopenic purpura (ITP) is described. After treatment with an antithyroid agent (methimazole), both the Graves disease and thrombocytopenia resolved. Since it is reported that thyroid stimulating hormone receptor antibodies (TRAb) may recognize antigens on both thyroid follicular cells and the platelet membrane, the decrease in the titer of TRAb by the immunomodulatory actions of methimazole may be responsible for the improvement in the thrombocytopenia.

ISSN:1051-2144    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

The overall prognosis of differentiated thyroid cancer (DTC) is favorable, although patients with metastasized undifferentiated carcinoma have a less favorable prognosis. These metastasis usually are resistant to conventional radio- or chemotherapy. Thus, the search for new therapeutic options is important. Experimental and clinical studies show that retinoic acid (RA) has anti-proliferative effects and can induce thyroid follicular cell redifferentiation. Based on these data, we administered 13-cis-RA to a patient with follicular thyroid cancer, persistent detectable thyroglobulin and pulmonary metastases, who could not concentrate radioiodide after cumulative dose of 200mCi of131iodide (131I). Chemotherapy was the first therapeutic choice, but no significant response was observed. After 5 weeks of treatment with 13-cis-RA, the pulmonary metastasis were able to concentrate radioiodide after a therapeutic dose of 150mCi131I.

ISSN:1051-2144    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

The mainstays of therapy of familial dyslipoproteinemia (FDB) are diet and long-term niacin or fibrate therapy. Statins are progressively recognized as accepted alternatives for FDB. We hereby describe the case of a 32-year-old obese man with treated panhypopituitarism and FDB, whose hyperlipidemia improved significantly on atorvastatin therapy. In this patient, we also noted a marked discrepancy between the serum high-density lipoprotein cholesterol (HDL-C) and apolipoprotein (apo-) AI levels, with HDL-C being disproportionately low in comparison to the corresponding apo-AI values. Although atorvastatin therapy resulted in a significant improvement of lipid metabolism parameters within 8 weeks, the aforementioned discrepancy between HDL-C and apo-AI levels persisted. This case buttresses the effectiveness of atorvastatin therapy in FDB, and highlights the occurrence of discrepancy between HDL-C and measured apo-AI levels in rare cases of dyslipidemia. We speculate that the latter phenomenon may be caused by allelic variation(s) in any of three genes: apo-AI, apo-CIII, and apo-AIV.

ISSN:1051-2144    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Hypopituitarism is a relatively rare condition with a varying presentation, which depends upon the underlying etiology and the pattern of hormone insufficiency. A 42-year-old man with panhypopituitarism secondary to Rathkes cleft cyst, who sought treatment for pleural and pericardial effusions, is reported. Both effusions responded promptly to anterior pituitary hormone replacement therapy.

ISSN:1051-2144    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:1051-2144    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Since their discovery 20 years ago, natriuretic peptides have rapidly moved to the forefront in cardiovascular medicine, and have contributed to an appreciation that the heart is an important endocrine organ. Of the natriuretic peptides, brain (B-type) natriuretic peptide (BNP) has proven to be the most clinically useful. Physicians now measure circulating levels of BNP and the Nterminal fragment of its prohormone (N-proBNP) for diagnostic and prognostic assessment in patients with suspected congestive heart failure (CHF), and administer recombinant human BNP as a therapeutic agent for patients with decompensated CHF. This review will highlight the mechanisms of natriuretic peptide regulation, the physiologic actions of BNP, and its utilization in patients with cardiovascular diseases.

ISSN:1051-2144    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Prader-Willi syndrome (PWS) is characterized by hypothalamic dysfunction resulting in obesity, hypotonia, hypogonadism, and behavioral abnormalities. Body composition and growth hormone features in PWS resemble states of growth hormone (GH) deficiency (decreased total lean body mass, IGF-1 levels, and poor linear growth), in contrast to common nutritional obesity. Marked reductions in muscle mass are associated with diminished strength, physical function, and energy expenditure. Thus, individuals with PWS experience a variety of lifelong morbidities including obesity, hypotonia, osteoporosis, type 2 diabetes, respiratory disorders, and cardio-respiratory failure related to obesity and hypotonia. The past decade has seen important developments in the understanding of Prader-Willi syndrome (PWS) and the treatment of its morbidities associated with obesity. Much of this work has focused on the role of underlying growth hormone deficiency (GHD), and the effects of GH therapy. Metabolic effects of GH therapy, including changes in physical strength and agility, appear to be more important than height gain for this particular pediatric population This disorder has highlighted the impetus for a broader view of the anabolic “nongrowth” effects of GH in children. This review will focus upon the effects of GH in children with PWS, and upon outcomes related to changes in body composition, hypotonia, strength and agility, and carbohydrate and lipid metabolism.

ISSN:1051-2144    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

A unilateral surgical approach in patients with primary hyperparathyroidism (HPTH) requires a reliable preoperative parathyroid localization procedure. The aim of this study was to compare the approved planar scintiscanning by means of99mTcO4−201Tl subtraction or99mTc-sestamibi with99mTcO4−201Tl pinhole subtraction SPECT.Fifty patients with primary HPTH and preoperative localization diagnosis were retrospectively analyzed. Thirty-three of them underwent preoperative planar scintiscanning with99mTcO4−201Tl subtraction or99mTc-sestamibi, 17 had99mTcO4−201Tl pinhole subtraction SPECT.Planar scintiscanning had an overall accuracy of 81.8%,99mTcO4−201Tl pinhole subtraction SPECT of 81.3%. In patients with solitary parathyroid adenomas the planar scintiscanning provided correct results in 86.7%, whereas99mTcO4−201Tl pinhole subtraction SPECT had an accuracy of 93.3% in these patients. Concomitant thyroid nodules diminished the accuracy of planar scanning to 78.6%. The accuracy of99mTcO4−201Tl pinhole subtraction SPECT was not diminished by multinodular goiter, all patients with solitary parathyroid adenomas and multinodular thyroid disease were accurately localized.The sensitivity of99mTcO4−201Tl pinhole subtraction SPECT is statistically not significantly different compared with planar99mTcO4−201Tl subtraction or99mTc-sestamibi scintiscanning in patients with HPTH and solitary adenomas. Therefore, it is concluded that both imaging procedures are comparable in their diagnostic value for preoperative localization for successful unilateral parathyroidectomy. Although the results are not significantly different because of the number of patients, it is concluded99mTcO4−201Tl pinhole subtraction SPECT to be superior to planar scintiscanning in patients with underlying multinodular thyroid pathology.

ISSN:1051-2144    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Beta blockers are even more powerful in reducing cardiac events in the patient with diabetes, than they are in others. This is because that in addition to lowering blood pressure, lowering heart rate, and acting as an anti-inflammatory, beta blockers, in the patient with diabetes, shift the metabolism of the myocardium away from fatty acid utilization and toward glucose utilization, which decreases the cardiac workload and reduces ischemia. Furthermore, hyperglycemia is a stimulus to myocardial remodeling, which is not only prevented but is reversed by beta blockade, and the incidence of heart failure that would otherwise be increased in the patient with diabetes, is reduced. The first and second generation beta blockers induce peripheral vasoconstriction and increase insulin resistance, causing an increase in serum glucose and triglycerides, and a decrease in HDL levels. These problems can be circumvented by using a third generation beta blocker, which are vasodilatory and reduce serum glucose and triglycerides, and increase HDL cholesterol. Therefore, the traditional and long-standing reluctance of endocrinologists to utilize beta blockade in the diabetic patient is unfounded and outdated due to the availability of later-generation beta blockers.

ISSN:1051-2144    

出版商:OVID    

年代:2003

数据来源: OVID