scholarly journals Effects of Total Thyroid Ablation Versus Near-Total Thyroidectomy Alone on Mild to Moderate Graves’ Orbitopathy Treated with Intravenous Glucocorticoids

2007 ◽  
Vol 92 (5) ◽  
pp. 1653-1658 ◽  
Author(s):  
Francesca Menconi ◽  
Michele Marinò ◽  
Aldo Pinchera ◽  
Roberto Rocchi ◽  
Barbara Mazzi ◽  
...  
Keyword(s):  
T Lymphocytes ◽  
Total Thyroidectomy ◽  
Outcome Measure ◽  
Randomized Study ◽  
Radioiodine Uptake ◽  
Main Outcome Measure ◽  
Thyroid Ablation ◽  
Graves Orbitopathy ◽  
Uptake Test

Abstract Context: Graves’ orbitopathy (GO) is probably caused by autoimmune reactions against autoantigen(s) shared by thyroid and orbital tissues sustained by intrathyroidal autoreactive T-lymphocytes infiltrating the orbit. Total thyroid ablation (TTA) may be beneficial for GO through removal of shared antigen(s) and autoreactive T-lymphocytes, but randomized studies are lacking. Objective: Our objective was to evaluate the effects of TTA in patients with GO treated with iv glucocorticoids (GC). Design/Setting: A prospective, single-blind, randomized study was conducted at a referral center. Patients/Interventions: Sixty patients with mild to moderate GO were randomized into: 1) near-total thyroidectomy (TX); or 2) TX plus 131I (TTA) groups, and then treated with iv GC. Patients were evaluated 3 and 9 months after iv GC. Main Outcome Measure: Overall improvement of GO at 9 months was the main outcome measure. Results: The distribution of GO outcome at 9 months was significantly more favorable in TTA than in TX patients (P = 0.0014 by χ2 test). A cumulative significant (P = 0.0054) difference between the two groups at 3 and 9 months was found using a generalized linear model. Radioiodine uptake test and thyroglobulin assay in a patient sample showed complete ablation in the majority of TTA, but not of TX patients. Conclusions: Compared with thyroidectomy alone, TTA is followed by a better outcome of GO in patients given iv GC. Whether TTA maintains this advantage in the long-term remains to be established.

THE GOITROGENIC EFFECT OF NATURALLY OCCURRING L-5-VINYL- AND L-5-PHENYL-2-THIO-OXAZOLIDONE IN RATS

1966 ◽  
Vol 53 (2) ◽  
pp. 342-352 ◽  
Author(s):  
F-E. Krusius ◽  
Pentti Peltola
Keyword(s):  
Endemic Goitre ◽  
Control Series ◽  
Radioiodine Uptake ◽  
Clear Cut ◽  
Naturally Occurring ◽  
Term Administration ◽  
Uptake Test ◽  
Rat Thyroid ◽  
Oral Doses

ABSTRACT L-5-vinyl-2-thio-oxazolidone (VTO), found in the seeds of cruciferous weeds and in milk specimens from the endemic goitre districts of Finland, was fed to rats. A dose of 0.1 μg/day had an almost significant and of 0.5 μg/day a significant weight-increasing effect on the thyroid in 1—15 weeks. The quantities of VTO found in milk specimens from endemic goitre districts of Finland are greater than the concentration of VTO in drinking fluid necessary for producing enlargement of the thyroid in rats. The minute daily oral doses of VTO that led to enlargement of the thyroid did not inhibit the radioiodine uptake of the gland. The smallest single oral dose of VTO which inhibited the 4-h radioiodine uptake in the rat thyroid was 0.1 mg (almost significant) and 0.5 mg (significant), i. e. about 1000 times greater than the smallest daily amount which produced thyroid enlargement in long-term administration. The inhibition seemed to last for less than 8 hours. The goitrogenic activity of milk to which VTO had been added was still present after storage for one day, though VTO was no longer demonstrable by the chemical method of assay generally employed. L-5-phenyl-2-thio-oxazolidone (PTO), a compound also occurring naturally in weeds of the Cruciferae family, when administered to rats in doses as low as 2 μg/day in long-term experiments, caused a distinct increase in relative thyroid weight, which appeared from 1 to 9 weeks after the start of the experiments. In the radioiodine tests, there were no clear-cut differences as compared with the control series. The results with both compounds show that the inhibition in the radioiodine uptake test after a single dose is too insensitive a method for the detection of minute amounts of goitrogens with a thiouracil-type of activity in foodstuffs.

scholarly journals Long-Term Corticosteroid Replacement and Bone Mineral Density in Adult Women with Classical Congenital Adrenal Hyperplasia

2006 ◽  
Vol 91 (3) ◽  
pp. 865-869 ◽  
Author(s):  
Jeremy A. King ◽  
Amy B. Wisniewski ◽  
Brandon J. Bankowski ◽  
Kathryn A. Carson ◽  
Howard A. Zacur ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Lumbar Spine ◽  
Outcome Measure ◽  
Whole Body ◽  
Adult Women ◽  
Adrenal Hyperplasia ◽  
Mineral Density ◽  
Main Outcome Measure ◽  
Simple Virilizing

Abstract Context: Concern has been raised regarding the potential impact of chronic glucocorticoid therapy on the bone mineral density (BMD) of patients with congenital adrenal hyperplasia (CAH). Objective: The purpose of this investigation was to assess the impact of chronic glucocorticoid replacement in adult women with classical CAH. Patients and Design: We used dual energy x-ray absorptiometry to evaluate lumbar spine and whole body BMD in 11 women with salt-losing (SL) CAH and 15 with the simple virilizing form. Physical characteristics and serum hormone concentrations were also measured. Results were compared with those of unaffected sisters of CAH patients (n = 9). Main Outcome Measure: BMD was the main outcome measure. Results: Osteopenia was noted in 45% of SL CAH patients, 13% of patients with the simple virilizing form, and 11% of controls. Lumbar spine and whole body BMDs of CAH subjects were lower than those of controls (P < 0.05). Compared with CAH subjects with normal BMD, those with osteopenia had reduced serum levels of dehydroepiandrosterone sulfate and dehydroepiandrosterone. Adrenal androgen levels were particularly suppressed among postmenopausal women receiving glucocorticoid replacement. Conclusions: Adult women with classical CAH treated with long-term glucocorticoids are at risk for decreased BMD, especially those with the SL form. Oversuppression of adrenal androgens is associated with increased risk for bone loss in this population.

scholarly journals Prognostic usefulness of ACTH in the postoperative period of Cushing’s disease

2019 ◽  
Vol 8 (9) ◽  
pp. 1262-1272 ◽  
Author(s):  
Pablo Abellán-Galiana ◽  
Carmen Fajardo-Montañana ◽  
Pedro Riesgo-Suárez ◽  
Marcelino Pérez-Bermejo ◽  
Celia Ríos-Pérez ◽  
...  
Keyword(s):  
Prospective Study ◽  
Adrenal Insufficiency ◽  
Postoperative Period ◽  
Outcome Measure ◽  
Roc Curves ◽  
Late Recurrence ◽  
Plasma Acth ◽  
Main Outcome Measure ◽  
A Prospective Study

Objectives To analyze the usefulness of plasma ACTH in predicting CD remission after surgery and to evaluate the prognostic usefulness of ACTH measurement after the cortisol and ACTH nadir (48 h prior to discharge). Design A prospective study was made of 65 patients with CD operated upon between 2005 and 2016. Methods Postsurgery plasma ACTH and cortisol were measured every 6 h, in the absence of corticosteroid coverage. Hydrocortisone was started in the presence of adrenal insufficiency or cortisol <55.2 nmol/L. Plasma ACTH was again determined before discharge. Main outcome measure Usefulness of plasma ACTH in predicting CD remission. Results Remission at 3 months of CD was achieved in 56 of 65 cases, with late recurrence in 18 of 58 cases. Following resection, the ACTH nadir was significantly lower referred to late remission (2.8 vs 6.5 pmol/L; P = 0.031) and higher for recurrence (2.1 vs 4.8 pmol/L; P < 0.001), and identical results were obtained for the ACTH values before discharge. In the analysis of the ROC curves, nadir and before discharge ACTH values <1.9 pmol/L and <2.6 pmol/L were respectively indicative of early remission (AUC 0.827; P < 0.001); <6.2 pmol/L of remission at 3 months (AUC 0.847; P = 0.001) and >3.2 pmol/L of recurrence (AUC 0.810; P < 0.001) in both ACTH values. A time to ACTH nadir <46 h was indicative of early remission (AUC 0.751; P = 0.001), while a time >39 h was indicative of recurrence (AUC 0.773; P = 0.001). Conclusions We propose an ACTH value <3.3 pmol/L as a good long-term prognostic marker in the postoperative period of CD. Reaching the ACTH nadir in less time is associated to a lesser recurrence rate.

Comparison of Peritoneal Catheter Survival with Fistula Survival in Hemodialysis

1995 ◽  
Vol 15 (2) ◽  
pp. 147-151 ◽  
Author(s):  
Yong-Soo Kim ◽  
Chul-Woo Yang ◽  
Dong-Chan Jin ◽  
Suk-Joo Ahn ◽  
Yoon-Sik Chang ◽  
...  
Keyword(s):  
Survival Rate ◽  
Outcome Measure ◽  
Prosthetic Graft ◽  
Cumulative Survival Rate ◽  
Peritoneal Catheter ◽  
Main Outcome Measure ◽  
Cumulative Survival ◽  
Catheter Survival ◽  
Term Maintenance

Objective To compare continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis (HD) with regard to long-term maintenance of access. Design Retrospective study of a four to six-year time period at one center. Patients One hundred and twenty-two CAPD patients between December 1988 and December 1992, and 172 HD patients between May 1986 and December 1992. Main Outcome Measure Cumulative survival rate of peritoneal catheters and arteriovenous fistulas (AVF) was the main outcome measure. Variables affecting the survival rate including sex, age, presence or absence of diabetes, and type of AVF (autogenous or prosthetic graft) were assessed. The causes of peritoneal catheter failures were analyzed. Results The cumulative survival rate of all peritoneal catheters was significantly longer than the AVF survival rate (84% vs 74% at one year; 73% vs 61% at two years; and 63% vs 48% at three years) (p = 0.029). There were no differences in peritoneal catheter survival according to sex, age, or diabetes. Compared with A VF survival, peritoneal catheter survival was significantly longer in male (p = 0.0492), elderly (p = 0.0082), and diabetic (p = 0.0022) patients. Prosthetic graft and old age were risk factors for AVF survival. Of all peritoneal catheter failures, infectious complications were responsible for 75% (33/44) and mechanical complications for 25% (11/44). Peritonitis was the leading infectious complication (21/33) and outflow obstruction was the leading mechanical complication (9/11). Conclusion In terms of long-term maintenance of access, CAPD is superior to HD, especially in the elderly or diabetics. Prevention and proper management of peritonitis may prolong the peritoneal catheter survival.

Short-Term Psychological Intervention: A Study of Long-Term-injured Competitive Athletes

2000 ◽  
Vol 9 (3) ◽  
pp. 207-218 ◽  
Author(s):  
Urban Johnson
Keyword(s):  
Guided Imagery ◽  
Outcome Measure ◽  
Psychological Intervention ◽  
Outcome Variable ◽  
Control Group ◽  
Short Term ◽  
Main Outcome Measure ◽  
Competitive Athletes ◽  
Experimental Group

Objective:To explore the effectiveness of psychological interventions for a sample of competitive athletes with long-term injuries.Design:Modified 2-group, pretreatment and posttreatment (repeated measure).Patients:58 patients, 14 in the experimental group and 44 in the control group.Interventions:Three intervention strategies: stress management and cognitive control, goal-setting skills, and relaxation/guided imagery.Main Outcome Measure:Mood level was used as the outcome variable.Results:The experimental group had a higher overall mood level at the midpoint and end of rehabilitation and were also feeling more ready for competition than the control group was, both as rated by themselves and by the treating physiotherapist The only strategy to show statistical differences was relaxation/guided imagery.Conclusions:The results of this study support the idea that a short-term intervention has the potential to elevate mood levels in competitive athletes with long-term injuries.

scholarly journals Long-term use of benzodiazepines in older patients in Germany: a retrospective analysis

2017 ◽  
Vol 7 (6-7) ◽  
pp. 191-200 ◽  
Author(s):  
Louis Jacob ◽  
Michael A. Rapp ◽  
Karel Kostev
Keyword(s):  
Older Adults ◽  
Sleep Disorders ◽  
Older Patients ◽  
Outcome Measure ◽  
Adjustment Disorders ◽  
Main Outcome Measure ◽  
Benzodiazepine Use ◽  
First Time

Background: The purpose of this study was to analyze the prevalence of long-term benzodiazepine use in older adults treated in general and neuropsychiatric practices in Germany. Methods: This study included 32,182 patients over the age of 65 years who received benzodiazepine prescriptions for the first time between January 2010 and December 2014 in general and neuropsychiatric practices in Germany. Follow up lasted until July 2016. The main outcome measure was the proportion of patients treated with benzodiazepines for >6 months. Results: The proportion of patients with benzodiazepine therapy for >6 months increased with age (65–70 years: 12.3%; 71–80 years: 15.5%; 81–90 years: 23.7%; >90 years: 31.6%) but did not differ significantly between men (15.5%) and women (17.1%). The proportion of patients who received benzodiazepines for >6 months was higher among those with sleep disorders (21.1%), depression (20.8%) and dementia (32.1%) than among those with anxiety (15.5%). By contrast, this proportion was lower among people diagnosed with adjustment disorders (7.7%) and back pain (3.8%). Conclusion: Overall, long-term use of benzodiazepines is common in older people, particularly in patients over the age of 80 and in those diagnosed with dementia, sleep disorders, or depression.

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