Long-term follow-up of contralateral lobe in patients hemithyroidectomized for solitary follicular adenoma.

OBJECTIVES: Since there are no available conclusive studies on the long-term evolution of remnant thyroid tissue after hemithyroidectomy in patients who undergo surgery for solitary follicular adenomas, we searched for such cases in our records to elucidate this issue. DESIGN: Search criteria were as follows: (i) presence of a single palpable thyroid nodule with the remainder of the gland normal on palpation; (ii) clinically euthyroid status at the time of surgery; (iii) histological diagnosis of nodule as follicular adenoma; (iv) a hemithyroidectomy operation, sparing the contralateral lobe; (v) normal macroscopic aspect of the contralateral lobe at the time of surgery; and (vi) at least 4 years of postoperative follow-up. PATIENTS: Only 47 female cases were found to meet above criteria, with a mean age of 45.9 years (range: 23-79) at the time of surgery and a mean follow-up of 7.2 years (range: 4-32). Besides evaluating the presence or absence of antithyroid antibodies and the extranodular histology of tissue removed during surgery, a preoperative TRH test also allowed patients to be classified into two groups: normal extranodular thyroid (NET) (n = 32) and abnormal extranodular thyroid (AET) (n = 15). RESULTS: Eleven of the 15 patients with AET had thyroid autoimmunity, with or without overt histological thyroiditis, and the remaining four had subclinical hypothyroidism with negative antithyroid antibody titres. In the entire study population, only 28 patients received treatment with L-T4 immediately after surgery, none of whom had any alterations in the contralateral lobe. However, six of the nineteen patients not treated with T4 (31.6%) developed overt abnormalities in the contralateral lobe, including the only three with AET who had not received L-T4 treatment. The remaining three were two patients with NET, who showed postoperative TSH hyper-responsiveness to TRH (peak TSH > 25 mU/l), and one who developed a new follicular adenoma 32 years later. To date, none of the patients with NET, who had a normal TRH test after surgery, have developed any kind of alterations in the contralateral lobe, even those who received no L-T4 prophylactic treatment. CONCLUSIONS: The findings of this study suggest that: (i) there is a higher risk of follicular adenomas developing in a gland affected by thyroid autoimmunity than in a previously normal gland; (ii) L-T4 therapy may prevent the formation of new nodules or the development of goitre in the contralateral lobe; and (iii) in the absence of prophylactic treatment after surgery, the contralateral lobe of subjects with thyroid autoimmunity and/or previous subclinical hypothyroidism develops morphological abnormalities.

Virilizing ovarian tumor of cell tumor type not otherwise specified: a case report.

Whereas ovarian tumors with overt endocrine manifestations account for less than 5% of all ovarian neoplasms, the incidence of virilizing type tumors in postmenopausal women is even lower since the average age of occurrence is 43 years. Steroid cell tumors not otherwise specified (NOS) are even more rare. We report the case of a 56-year-old woman (age of onset of menopause 43 years) who consulted our service due to a hyperandrogenic syndrome: deepening of the voice, temporal balding, hirsutism and cliteromegaly. Laboratory findings indicated hyperandrogenism in male range. The dexamethasone suppression test did not modify basal values, indicating that adrenal origin was unlikely. Transvaginal ultrasound disclosed multiple microcysts in the left ovary. Abdominal tomography was normal. Suspecting an ovarian tumor, bilateral oophorectomy was performed and a pediculate, 3 cm in diameter, was encountered in the left ovary. Histopathological studies determined it to be a virilizing ovarian tumor NOS. Postoperative recovery was fast; normal hormonal values were reached together with visible clinical improvement. This case is reported because this type of tumor is very infrequent in postmenopausal women, and because in this case it was the functional hormonal test that allowed tumor localization.

Failure of the müllerian regression factor in two patients with complete androgen insensitivity syndrome.

The present paper describes the histological and endocrinologic features of 2 subjects with 46,XY karyotype affected by complete androgen insensitivity syndrome (AIS) with müllerian structures. Both patients had fallopian tubes, but only one had also uterus and presented a seminoma. Serum levels of luteinizing hormone, testosterone and estradiol were high or in the upper part of normal limits, whereas levels of follicle-stimulating hormone were normal. The association between AIS and the presence of müllerian structures observed in these 2 patients might be explained by an impaired synthesis of müllerian regression factor or by a failure in its mechanism of action.

Evaluacion de la eficacia y tolerancia de la rifamicina SV en herpes simple y herpes zoster. / Evaluation of the efficacy and tolerance of rifamycin SV in herpes simplex and herpes zoster

Se comunican los resultados alcanzados al tratar 66 pacientes afectados de herpes simple (tipo I y II) y zoster.La poblacion de estudio incluyo pacientes de ambos sexos: la medicacion consistio en la administracion de rifamicina SV, intramuscular 250 mg cada 12 h durante 7 dias en promedio. Se subdividio el universo en dos grupos, 30 casos de herpes simple y 36 con herpes zoster. Hubo desaparicion de signos y sintomas en la mayoria de los pacientes de ambos grupos y la incidencia de remisiones fue muy baja. La tolerancia fue excelente en todos los casos. El tiempo de tratamiento fue menor que con los procedimientos terapeuticos habituales. No se reportaron efectos adversos

Depuracion plasmatica de radiocoloides en la hepatopatias alcoholicas. / Plasma clearance of radiocolloids in alcoholic hepatopathies

Con el objeto de estudiar la influencia del dano inducido por el alcohol sobre la captacion hepatica de radiocoloides, fueron estudiados tres grupos de pacientes con deterioro creciente de la arquitectura hepatica: un grupo de sujetos normales, un grupo de hepatopatias alcoholicas que no llegaban a configurar el cuadro histologico de cirrosis y un grupo de cirrosis. En todos ellos, ademas de efectuar una biopsia hepatica y pruebas funcionales, se estudio en forma dinamica la captacion hepatica de un radiocoloide luego de su inyeccion en una vena periferica. La actividad a nivel del higado fue medida externamente con una camara gamma, analizandose la evolucion temporal de dicha actividad hasta que la depuracion plasmatica fue completa.En todos los casos estudiados se comprobo que dicha evolucion se apartaba de un curso monoexponencial. La determinacion de la pendiente (logaritmo de dicha concentracion a lo largo del tiempo) en dos puntos diferentes (50% y 90% del valor final) mostro que, al aumentar el grado de compromiso en la estructura hepatica, crecia la diferencia entre ambas pendientes. Se considera que este hallazgo puede ser tomado como evidencia de la irregular distribucion sanguinea intrahepatica y que el cociente entre ambas pendientes puede ser utilizado como un indice del grado de compromiso de la misma

Pycnodysostosis: some aspects concerning kinetics of calcium metabolism and bone pathology.

A 23-year-old white woman suffering pycnodysostosis whose parents and five siblings were unaffected was investigated. Chromosomal morphology was normal. Histologic examination of a biopsy specimen obtained from the distal phalanx of the left thumb, corresponding to an area on an x-ray film of osteolysis, showed a fibrous dysplasia-like picture. Kinetic studies of calcium metabolism revealed that exchangeable pool size, turnover, and bone accretion rate were all decreased. Intestinal calcium absorption was investigated simultaneously by a double isotope technique and by deconvolution of the plasmatic specific activity curve of 47Ca given per os. Results obtained by both methods coincided in that values were found to be similarly increased. Endogenous fecal calcium was also determined and revealed a similar increase. Some physiopathological implications of these findings are discussed.