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INTRODUCTION: Patients with Chronic hypoparathyroidism (CHPT) receiving conventional treatment are exposed to several long-term complications including basal ganglia calcifications, posterior subcapsular cataract, kidney stones, and renal insufficiency. The aim of this study was to assess the prevalence and the associated factors of these complications in patients with CHPT. METHODS: We conducted a cross-sectional study including 58 patients with CHPT. All participants underwent physical examination, biochemical assessment (total serum calcium, serum phosphorus, serum albumin, intact-PTH, serum magnesium, 25-hydroxy-vitamin D, serum creatinine, thyroid stimulating hormone (TSH), and 24-hour urinary calcium), slit lamp examination, brain computed tomography scan (CT-scan), and renal ultrasound. RESULTS: Participants had a mean age of 52.6 ± 16.4 years and a gender ratio (women/men) of 3.5. Fahr syndrome, cataract, urolithiasis, and renal failure were found in 55%, 62%, 12%, and 17% of cases, respectively. CHPT duration >15 years (Adjusted-OR = 43.1, 95-CI: 2.63-703.06, p = 0.008) and poor adherence to treatment (Adjusted-OR = 8.04, 95%-CI: 1.52-42.42, p = 0.014) were independently associated with the risk of Fahr syndrome. Age >55 years (adjusted-OR = 5.07, 95-CI: 1.10-23.42, p = 0.037), disease duration >15 years (adjusted-OR = 20.21, 95-CI: 1.54-265.84, p = 0.022), and magnesium level <0.8 mmol/l (adjusted-OR = 36.46, 95-CI: 3.75-354.08, p = 0.002) were independently associated with the risk of subcapsular cataract. Only hypercalciuria (Adjusted-OR = 21.27, 95-CI: 2.31-195.91, p = 0.007) was an independent risk factor for kidney stones. Renal failure was not associated with kidney stones (p = 1). However, creatinine clearance was negatively correlated with age (r = -0.784; p < 10-3) and disease duration (r = -0.352; p = 0.007). CONCLUSION: Our results revealed high prevalences of neurological, ocular, and renal complications in patients with CHPT and emphasized the importance of regular biological monitoring, therapeutic adjustments, screening, and adherence to treatment in the prevention of these complications.
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Catarata , Hipoparatireoidismo , Humanos , Hipoparatireoidismo/epidemiologia , Hipoparatireoidismo/etiologia , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Estudos Transversais , Prevalência , Idoso , Catarata/epidemiologia , Catarata/etiologia , Insuficiência Renal/epidemiologia , Insuficiência Renal/etiologia , Cálculos Renais/epidemiologia , Doenças dos Gânglios da Base/epidemiologia , Doenças dos Gânglios da Base/etiologia , Fatores de Risco , Urolitíase/epidemiologia , Calcinose/epidemiologia , Calcinose/etiologiaRESUMO
Double-chambered left ventricle (DCLV) is a rare congenital cardiac lesion. It is usually an incidental finding in children and young adults. Diagnosis during fetal life is exceedingly rare. We report a case of DCLV diagnosed in the prenatal period associated with a ventricular septal defect (VSD). Transthoracic echocardiographic and magnetic resonance imaging confirmed the prenatal findings. At seven-month follow-up, the baby was asymptomatic. Transthoracic echocardiographic check-up revealed spontaneous closure of the VSD and stable aspect of the main left ventricle and the accessory chamber.
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Comunicação Interventricular , Ventrículos do Coração , Feminino , Humanos , Gravidez , Ecocardiografia , Feto , Seguimentos , Comunicação Interventricular/diagnóstico por imagem , Comunicação Interventricular/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/anormalidades , LactenteRESUMO
INTRODUCTION: Several ultrasound scoring systems have been developed to stratify the risk of malignancy of thyroid nodules, including ACR (American College of Radiology) and EU (European) TI-RADS. This study aimed to assess the diagnostic performance of these two classifications using histology as a reference standard. METHODS: It was a single-centre, retrospective study including 156 patients who underwent thyroidectomy. Ultrasound data of 198 nodules (99 malignant nodules and 99 benign nodules) were analysed. Both classifications were applied for all nodules. RESULTS: Ultrasound criteria associated with malignancy were solid composition (OR=7.81; p < 10-3 ), hypoechoic character (OR=16.42; p < 10-3 ), irregular contours (OR=7.47; p < 10-3 ), taller-than-wide shape (OR=3.58; p = 0.02), microcalcifications (OR=3.02; p = .006) and the presence of cervical adenopathy (OR=3.89; p = .006). The prevalence of malignancy was 15.5%, 69% and 76.9% for EU TI-RADS categories 3, 4 and 5, respectively. It was 33.3%, 57% and 91.1% for ACR TI-RADS categories 3, 4 and 5, respectively. For category 5, EU TI-RADS and ACR TI-RADS had sensitivities of 60% and 41%, specificities of 82% and 96%, respectively. For categories 4 and 5 combined, the diagnostic performance of these two classification systems became comparable with a sensitivity of 89% and 86% for EU-TIRADS and ACR-TIRADS, respectively. The area under the ROC curve was 0.81 for the EU TI-RADS classification and 0.82 for the ACR TI-RADS classification. CONCLUSIONS: EU TI-RADS and ACR TI-RADS scoring systems seem to be comparable in predicting malignancy in thyroid nodules.
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Neoplasias da Glândula Tireoide , Nódulo da Glândula Tireoide , Humanos , Nódulo da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/cirurgia , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/cirurgia , UltrassonografiaRESUMO
OBJECTIVES: The aim of the study was to analyze the performance of the anti-mullerian hormone (AMH) level for the diagnosis of polycystic ovary syndrome in women with morbid obesity. STUDY DESIGN: A single-centre cross-sectional study was conducted in 50 women of reproductive age with a body mass index (BMI) ≥ 40 kg/m2. Each patient underwent a clinical examination, biological and hormonal assays, and an ovarian ultrasound between the third and the fifth day of the menstrual cycle. Polycystic ovary syndrome was diagnosed according to the Rotterdam's criteria. RESULTS: The mean age of participants was 34.2 ± 7.5 years. Polycystic ovary syndrome was diagnosed in 20 women (40%). Age and anthropometric parameters did not differ between women with and without polycystic ovary syndrome. The mean AMH level was significantly higher in women with polycystic ovary syndrome (3.4 ± 3.6 vs 1.3 ± 1.2 ng/ml, p=0.010). It was positively correlated with the Ferriman and Gallwey score (r=0.496, p=0.016), total testosterone level (r=0.524, p < 10-3) and the LH/FSH ratio (r=0.290, p=0.046). In women aged between 35 and 45 years, the optimum cut-off level for the diagnosis of polycystic ovary syndrome was 0.81 ng/mL, providing a sensitivity and a specificity of 90 and 71%, respectively with an area under the ROC curve of 0.857. CONCLUSIONS: AMH level was significantly higher in morbid obese women with polycystic ovary syndrome compared with those without polycystic ovary syndrome. Specific thresholds for this population must be assessed to improve the sensitivity and specificity of AMH for the diagnosis of polycystic ovary syndrome.
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Obesidade Mórbida , Hormônios Peptídicos , Síndrome do Ovário Policístico , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Hormônio Antimülleriano , Estudos Transversais , Hormônio Luteinizante , Obesidade Mórbida/complicações , Obesidade Mórbida/diagnóstico , Síndrome do Ovário Policístico/complicações , Síndrome do Ovário Policístico/diagnóstico , MasculinoRESUMO
Hepatocellular carcinoma (HCC) arising from hepatic adenoma is an infrequent situation. Only a few cases were reported in the literature. We present a rare case of hepatocellular carcinoma arising from HA in a young woman with no medication history of oral contraceptives. Surgical resection is the only available treatment.
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Enormous bilateral renal angiomyolipoma (AML) are extremely rare, their spontaneous bleeding also called Wunderlich's syndrom (WS) is also an unusual situation. It is considered as a life threatening condition requiring fast and effective care. We present a case of hypovolemic shock due to spontaneous rupture of bilateral giant angiomyolipomas in a 35-year-old female patient with tuberous sclerosis complex (TSC). The hemodynamic instability of the patient leads to an immediate surgery and unilateral nephrectomy was done for the biggest angiomyolipomas. The review of the literature revealed only few cases of spontaneous rupture of renal angiomyolipomas of comparable size.
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Aneurisma/diagnóstico por imagem , Calcinose/diagnóstico por imagem , Nefropatias/diagnóstico por imagem , Artéria Renal/patologia , Adulto , Angiografia , Diagnóstico Diferencial , Feminino , Humanos , Cálculos Renais/diagnóstico , Artéria Renal/diagnóstico por imagem , Tomografia Computadorizada por Raios XAssuntos
Neoplasias Abdominais/complicações , Polipose Adenomatosa do Colo/complicações , Fibromatose Agressiva/complicações , Neoplasias Abdominais/tratamento farmacológico , Adolescente , Adulto , Antineoplásicos Hormonais/uso terapêutico , Feminino , Fibromatose Agressiva/tratamento farmacológico , Humanos , Masculino , Tamoxifeno/uso terapêuticoAssuntos
Neoplasias Ósseas/diagnóstico , Osteocondrite/diagnóstico , Osteossarcoma/diagnóstico , Sarcoma de Ewing/diagnóstico , Adolescente , Neoplasias Ósseas/diagnóstico por imagem , Diagnóstico Diferencial , Cabeça do Fêmur/diagnóstico por imagem , Cabeça do Fêmur/patologia , Humanos , Masculino , Osteocondrite/diagnóstico por imagem , Osteocondrite/patologia , Osteossarcoma/diagnóstico por imagem , Ossos Pélvicos/diagnóstico por imagem , Ossos Pélvicos/patologia , Radiografia , Sarcoma de Ewing/diagnóstico por imagemRESUMO
BACKGROUND: Multi-detector-row computed tomography (MDCT) has emerged as method for non-invasive imaging of the heart. AIM: To investigate the frequency of the non cardiac findings in cardiac imaging with MDCT. METHODS: A total of 191 patients underwent cardiac imaging with 64-slice MDCT over a period of 8 months. The detected abnormalities were classified in major (implying an immediate workup and treatment or at least a further investigation) and minor abnormalities. RESULTS: Extra cardiac abnormalities were detected on 69 examinations (36 %). Major abnormalities were found in 17 % of the patients, and the minor abnormalities in 25,6 %. The scan revealed 4 cases of lung carcinomas, all at a still surgical stage. CONCLUSION: There were a significant number of non cardiac findings in cardiac MDCT. To avoid missing clinically important findings, we should carefully evaluate all the organs included in the scan.
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Angiografia Coronária , Achados Incidentais , Doenças Torácicas/diagnóstico por imagem , Tomógrafos Computadorizados , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/epidemiologia , Carcinoma/diagnóstico por imagem , Carcinoma/epidemiologia , Angiografia Coronária/métodos , Angiografia Coronária/estatística & dados numéricos , Feminino , Coração/diagnóstico por imagem , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/epidemiologia , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/epidemiologia , Enfisema Pulmonar/diagnóstico por imagem , Enfisema Pulmonar/epidemiologia , Estudos Retrospectivos , Doenças Torácicas/epidemiologia , Tomógrafos Computadorizados/estatística & dados numéricosRESUMO
BACKGROUND: Carpal tunnel syndrome (CTS) is the most frequent ductal syndrome. Few epidemiological studies in Tunisia exist. AIM: To describe clinical, biological and electromyographic data of Tunisian patients with CTS METHODS: A retrospective study including 80 patients with CTS, during the period going from 2009 to 2010. RESULTS: A female predominance was observed with an average age of 52 years. Acroparesthesia was the main complaint, followed by night awakenings and muscular weakness. Physical examination showed a positive Tinel (91.2%) and Phalen (82.5%) tests, a decrease of tactile sensitivity (26.2%) and a thenar amyotrophy (10%). The Electromyography was abnormal in 85% cases. The most revealing lesions were demyelinating, sensitivo-motor predominance (66%) abnormalities. on Biology, hyperglycemia (12.5%), hyperuricemia (8.7%) and renal failure (7.5%) were the most observed. Medical treatment was drawn on analgesics and anti-inflammatory for 90% of our patients. Local steroid injections were indicated for 35% of patients, leading to a clinical improvement in 90% of cases. Surgery was made in only 13.8% patients. CONCLUSION: Tunisian patients with CTS were female patients, housewifes with obesity or overweight. No other differences were observed in comparison with the literature.
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Síndrome do Túnel Carpal/diagnóstico , Síndrome do Túnel Carpal/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Eletromiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Distribuição por Sexo , TunísiaRESUMO
Adamantinoma is a rare tumour of long bones, representing less than 1% of them. Adamantinoma commonly occurs in the tibia. It is locally aggressive and recurrences are uncommon after resection. Metastases have been reported in less than 10% of cases. The most common radiographic appearance is multiple sharply demarcated radiolucent lesions surrounded by areas of dense sclerotic bone. The authors report a patient who developed pulmonary metastasis 1 year after complete resection of primary neoplasm.
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Adamantinoma/diagnóstico , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/secundário , Adamantinoma/cirurgia , Dispneia/etiologia , Evolução Fatal , Feminino , Fíbula , Hemoptise/etiologia , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Pessoa de Meia-Idade , TíbiaRESUMO
Hyperdynamic hemangiomas (HH) are atypical hepatic hemangiomas with an incidence of approximately 16% of all hemangiomas in the liver. We report a case of HH in a 47-year-old woman. Multiphase helical CT scan, MRI appearances and differential diagnoses are discussed.