RESUMO
Celiac disease is an immune-mediated disorder induced by the intake of gluten proteins involving primarily the gastrointestinal tract. Myelodysplastic syndromes are clonal hematologic disorders, expanded from myeloid stem cells of uncertain pathogenesis. Anaemia is a common finding in patients with celiac disease. Frequently it is secondary to malabsorption of iron, folic acid or vitamin B12 and usually disappears completely with a strict adherence to a gluten-free diet and supplement of deficient factors. To the best of our knowledge, in medical literature only two cases of myelodysplastic syndrome associated with celiac disease have been described. Here we describe the case of a patient affected by adult celiac disease who went into remission following a gluten free diet. Later a macrocytic anaemia without vitamin B12 or folate deficiency appeared. Hematologic tests showed findings consistent with refractory anemia with ring sideroblasts. The association of celiac disease with myelodysplastic syndromes seems not to be casual. It raises the hypothesis of a primitive immunological disorder in both diseases.
Assuntos
Doença Celíaca/complicações , Síndromes Mielodisplásicas/complicações , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Endocrin paraneoplastic syndromes are characterized by an ectopic hormonal production. The ectopic adrenocorticotropic hormone (ACTH) secretion is often associated with small cell lung cancer. We report the case of 64-years-old man with persistent hypokalemia in Cushing's syndrome due to ectopic ACTH secretion. The patient was affected by small cell lung cancer and presented an hypothiroidism too. A proper chemotherapy resulted in remission of the hypokalemia, but the hypothiroidism was not influenced during our observation period.
Assuntos
Síndrome de ACTH Ectópico/complicações , Carcinoma de Células Pequenas/metabolismo , Síndrome de Cushing/etiologia , Hipopotassemia/etiologia , Hipotireoidismo/etiologia , Neoplasias Pulmonares/metabolismo , Síndrome de ACTH Ectópico/diagnóstico , Biópsia , Carcinoma de Células Pequenas/diagnóstico por imagem , Carcinoma de Células Pequenas/patologia , Síndrome de Cushing/diagnóstico , Diagnóstico Diferencial , Humanos , Pulmão/patologia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Radiografia Torácica , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVES: Hyperuricaemia is a constant finding in patients with heart failure (HF). Upregulated xanthine-oxidase activity seems to contribute to progression of the disease through the production of oxidative stress and the development of vascular and endothelial dysfunction. On this basis we speculated that in HF serum uric acid levels correlated with a reliable marker of endothelial dysfunction as urinary albumin excretion. METHODS: Fifty-three patients with HF underwent assessment of serum uric acid, N-terminal probrain natriuretic peptide (NT-proBNP), glomerular filtration rate (GFR), other metabolic parameters and determination of urinary albumin concentration (UAC) in a morning urine sample. RESULTS: In univariate analysis there is a direct correlation between serum uric acid levels and log UAC (r = 0.43, P < 0.01); uric acid correlates also positively with log NT-proBNP (r = 0.31, P < 0.05) and negatively with log-GFR (r = -0.38, P < 0.01). In stepwise regression analysis serum uric acid emerged as the only predictor of increased UAC (standardized coefficient = 0.42, P = 0.001) independent of other clinical determinants and metabolic factors. CONCLUSION: Serum uric acid represents the strongest predictor of elevated UAC in HF. Regression of albuminuria may be a simple target to verify the efficacy of xanthine-oxidase inhibition in these patients.
Assuntos
Albuminúria/urina , Insuficiência Cardíaca/metabolismo , Hiperuricemia/metabolismo , Ácido Úrico/sangue , Idoso , Albuminúria/etiologia , Albuminúria/fisiopatologia , Biomarcadores/sangue , Biomarcadores/urina , Progressão da Doença , Feminino , Seguimentos , Taxa de Filtração Glomerular , Insuficiência Cardíaca/complicações , Humanos , Hiperuricemia/etiologia , Hiperuricemia/fisiopatologia , Masculino , Peptídeo Natriurético Encefálico/sangue , Nefelometria e Turbidimetria , Fragmentos de Peptídeos/sangue , Prognóstico , Precursores de Proteínas , Índice de Gravidade de DoençaRESUMO
Lung cancer is an elevated mortality disease in spite of conventional therapy. Today it is possible to identify some molecules, as the epidermal growth factor receptor, involved in the earliest molecular alterations ofcancerogenesis. Here we show the inhibitors of the epidermal growth factor receptor as a therapeutic mean.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Neoplasias Pulmonares/tratamento farmacológico , Carcinoma Pulmonar de Células não Pequenas/patologia , Humanos , Neoplasias Pulmonares/patologia , Estadiamento de NeoplasiasRESUMO
In this study we try to determine a cut off for detecting heart failure (HF) with the highest sensitivity and specificity in a population of hospitalized people aged > or = 65 years and to identify potential confounding variables for the interpretation of plasma concentration of the marker. We evaluated 212 consecutive patients admitted to our Department of Medicine, the only inclusion criterion being an age > or = 65 years. We identified a group with clinical and/or instrumental HF, and among remaining patients we selected a normal group without obvious cardiac disease. The strongest predictors of higher levels of NT-proBNP resulted age and free-triiodothyronine as in all models they were strongly associated with Log NT-proBNP. Using receiver-operating characteristics (ROC) curves, we found an optimal discriminatory value for detecting HF in 879 pg/ml for subjects aged between 65 and 74 years and 1658 pg/ml for subjects aged > or = 75 years. In elderly hospitalized patients the discriminatory cut offs of NT-proBNP for the diagnosis of HF are significantly higher than community derived reference values. Adjustments for the independent effects of age and other confounding variables appear necessary.
Assuntos
Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/diagnóstico , Pacientes Internados , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Idoso , Biomarcadores/sangue , Feminino , Humanos , Masculino , Sensibilidade e EspecificidadeRESUMO
Heart failure involves many organs and systems. Because of heart failure is one of the most common admission diagnosis in a Medical Ward, we sought their abdominal ultrasound features in addition to the cardiac ones.
Assuntos
Abdome/diagnóstico por imagem , Insuficiência Cardíaca/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Colelitíase/complicações , Colelitíase/diagnóstico por imagem , Dilatação Patológica/diagnóstico por imagem , Feminino , Insuficiência Cardíaca/complicações , Hepatomegalia/diagnóstico por imagem , Hepatomegalia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Ultrassonografia , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/patologiaRESUMO
Venous thromboembolism is one of the main causes of morbidity and mortality in many diseases, either in medical or in surgical wards. The aim of this study is to determine its frequency in a medical ward and to find all the patients who need a prophylaxys. We examined all the inpatients admitted in our Department during a period of three years, selecting all subjects affected by venous thromboembolism. Patients affected by metastatic cancer, namely pancreatic one, or congestive heart failure showed higher risk to develope venous thromboembolism. A prompt heparinic prophylaxys could reduce thromboembolic events. Male gender could be a further risk factor.
Assuntos
Anticoagulantes/uso terapêutico , Heparina/uso terapêutico , Pacientes Internados , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/prevenção & controle , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/administração & dosagem , Distribuição de Qui-Quadrado , Interpretação Estatística de Dados , Feminino , Insuficiência Cardíaca/complicações , Heparina/administração & dosagem , Humanos , Imobilização , Incidência , Masculino , Metástase Neoplásica , Neoplasias/complicações , Fatores de Risco , Fatores Sexuais , Tromboembolia Venosa/diagnósticoRESUMO
This study reports a case of an 82-year-old white woman with a history of congestive heart failure refractory to diuretic therapy who was found to have systemic amyloidosis, confirmed by a rectal biopsy. Cardiac involvement by amyloid should be considered in the differential diagnosis of any patient with heart failure with preserved ventricular systolic function, who does not have evidence of ischaemic heart disease or hypertension. However, the rarity of this disease and the various involvement of different organs and tissues are often responsible for missed or delayed diagnosis. Systemic amyloidosis is a life-threatening disease but an early diagnosis may modify its course; therefore it is important to maintain a high clinical suspicion and to increase the awareness of this overlooked condition among clinicians.
Assuntos
Amiloidose/diagnóstico , Insuficiência Cardíaca/etiologia , Idoso de 80 Anos ou mais , Amiloidose/complicações , Amiloidose/patologia , Diagnóstico Diferencial , Diástole , Feminino , HumanosRESUMO
OBJECTIVES: A low T3 syndrome was described in patients with heart failure (HF), and it appears to be associated with adverse outcome, representing an independent predictor of mortality. However, it is not known if low T3 levels contribute to the pathophysiology of HF. On the other hand, it has been seen that an elevation of brain natriuretic peptides (BNP and NT-proBNP) may represent a warning signal for future cardiovascular disease and may be an early marker of diastolic dysfunction. Therefore we tested the hypothesis that low levels of free-triiodothyronine (FT3) are sufficient to determine an increased concentration of the amino-terminal fragment of pro-brain natriuretic peptide (NT-proBNP), as the result of an initial and asymptomatic cardiac impairment. METHODS: A total of 52 consecutive non-cardiac patients underwent thyroid function profile evaluation and NT-proBNP determination. On the basis of FT3 values they were divided in two subgroups: a low T3 group (19 patients) and a normal T3 group (33 patients). RESULTS: The median NT-proBNP concentration of patients with low T3 syndrome was significantly higher than in those with normal FT3 (370 vs. 120 pg/ml, P = 0.002). There is a strong and inverse correlation between FT3 and Log NT-proBNP (R = -0.47, P < 0.001); this relation persists in a multivariable regression analysis, after adjustment for other potentially confounding variables (P = 0.008). CONCLUSION: In absence of overt cardiovascular disease, patients with low T3 syndrome present an increased concentration of NT-proBNP. These data suggest that low FT3 levels may be a contributing factor for the development of cardiac dysfunction.
Assuntos
Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Tri-Iodotironina/deficiência , Idoso , Progressão da Doença , Feminino , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Estudos ProspectivosRESUMO
In one of our previous articles we noted that many patients affected by atrial fibrillation had more thyroid nodules > or = 10mm (38%) than general population (10%). These data are confirmed by a same number of patients without atrial fibrillation admitted to our Department of Internal Medicine. The high incidence of low-T3 syndrome is confirmed too.
Assuntos
Fibrilação Atrial/complicações , Fibrilação Atrial/epidemiologia , Nódulo da Glândula Tireoide/complicações , Nódulo da Glândula Tireoide/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico por imagem , Estudos de Casos e Controles , Feminino , Departamentos Hospitalares/estatística & dados numéricos , Humanos , Incidência , Medicina Interna , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Nódulo da Glândula Tireoide/diagnóstico por imagem , UltrassonografiaRESUMO
Heart failure represents a very common disease with high mortality, despite therapeutic and preventive measures. In order to evaluate the characteristics of heart failure patients, a case-control study was carried out, comparing sixty heart failure patients versus sixty patients who presented an evident atherosclerotic disease, but not heart failure. Among the differences we found, a higher heart rate, reduced levels of free-triiodothyronine and increased levels of serum uric acid in heart failure patients might directly contribute to its pathophysiology and represent potential therapeutic targets.
Assuntos
Aterosclerose/sangue , Insuficiência Cardíaca/sangue , Isquemia Miocárdica/sangue , Idoso , Idoso de 80 Anos ou mais , Aterosclerose/diagnóstico , Aterosclerose/fisiopatologia , Aterosclerose/terapia , Biomarcadores/sangue , Estudos de Casos e Controles , Eletrocardiografia , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Frequência Cardíaca , Humanos , Masculino , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/fisiopatologia , Isquemia Miocárdica/terapia , Fatores de Risco , Tri-Iodotironina/sangue , Ácido Úrico/sangueRESUMO
The aim of this study was to elucidate whether in patients with heart failure (HF) serum uric acid (UA) levels correlated with left ventricular ejection fraction (LVEF) and systolic pulmonary artery pressure (SPAP). Fifty consecutive patients with heart failure underwent serum (UA) determination and echocardiographic examination, with measurement of LVEF and SPAP. Twenty healthy age-matched subjects served as controls. Mean serum UA in patients with HF were significantly higher that in controls (7.5 +/- 0.3 vs 4.5 +/- 0.3 mg/dl, P < 0.0001). In patients group serum UA correlated negatively with LVEF (R = -0.45, P < 0.01) and positively with SPAP (R = 0.51, P < 0.001); these relations persist in a multivariable regression analysis, after adjustment for other variables potentially confounding (P = 0.031 and P = 0.003, respectively). In patients with HF, serum UA correlates with LVEF and SPAP independently from other clinical determinants, supporting the possibility that the detection of progressive hyperuricemia in these patients may be an indicator of deteriorating cardiac function.
Assuntos
Pressão Sanguínea , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/fisiopatologia , Artéria Pulmonar/fisiologia , Volume Sistólico , Ácido Úrico/sangue , Função Ventricular Esquerda , Idoso , Ecocardiografia , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Humanos , Masculino , Análise Multivariada , Análise de RegressãoRESUMO
OBJECTIVE: Oxidative stress is increased in type 1 diabetes families. Since oxidative damage is a mediator of vascular injury and familial predisposition to hypertension increases the risk of hypertension and diabetic nephropathy, we studied blood pressure responses to exercise and cardiovascular risk factors in type 1 diabetes families. METHODS: Thirty-five type 1 patients, 74 first-degree relatives, and 95 healthy individuals without established coronary heart disease underwent a cycle ergometer test. Examination included medical history, lifestyle questionnaire, body weight, blood pressure, and laboratory tests [fasting plasma glucose and insulin, haemoglobin A1c (HbA1c), plasma lipids, C-reactive protein, fibrinogen, folate, plasma thiols, and albumin excretion rate]. RESULTS: Diabetic patients had higher plasma glucose, HbA1c, folate, and albuminuria, while lower plasma thiols than controls; relatives differed from controls in higher plasma total cholesterol and albuminuria, lower plasma thiols. No patient presented exercised-induced angina. Diabetic patients achieved a higher maximal exercise systolic blood pressure (similar workload); systolic pressure remained high during recovery. Relatives showed higher values of systolic pressure at peak exercise (same workload). The following were associated with an abnormal blood pressure response to exercise: diastolic blood pressure and HbA1c in the control sample; disease duration and fibrinogen in the diabetic group; plasma low-density lipoprotein (LDL) cholesterol, body mass index (BMI), housework, and plasma thiols among relatives. CONCLUSION: An abnormal blood pressure response to exercise testing has been identified for the first time in asymptomatic normotensive non-diabetic relatives of type 1 diabetics, which was associated with indices of metabolic syndrome and oxidative damage. Moreover, in healthy normotensive non-diabetic control individuals (without a family history of type 1 diabetes), the systolic blood pressure response to exercise was significantly correlated with HbA1c levels.
Assuntos
Pressão Sanguínea , Doenças Cardiovasculares/metabolismo , Diabetes Mellitus Tipo 1/patologia , Exercício Físico , Adulto , Glicemia/metabolismo , Índice de Massa Corporal , Estudos de Casos e Controles , LDL-Colesterol/metabolismo , Diabetes Mellitus Tipo 1/metabolismo , Nefropatias Diabéticas/patologia , Feminino , Hemoglobinas Glicadas/biossíntese , Humanos , Hipertensão/patologia , Masculino , Pessoa de Meia-Idade , Estresse Oxidativo , Análise de Regressão , Medição de Risco , Fatores de RiscoRESUMO
This study reports a case of a patient with lambda-light chain multiple myeloma who developed a high hyperamylasaemia of the salivary type during the disease and soon afterwards died. Ectopic production of amylase by myeloma cells has been described in a few cases and demonstrated by tissue culture and immunohistochemical techniques. The common characteristics of these cases were: salivary amylase isoenzyme increase, high tumor mass, extensive extra-medullary spread, extensive bone destruction and poor prognosis. In patients with amylase-producing multiple myeloma, the onset of hyperamylasaemia heralds a rapid disease progression; therefore, in these patients, a simple test such as serum amylase may represent a reliable disease activity index and provide an additional prognostic information.
Assuntos
Amilases/sangue , Mieloma Múltiplo/diagnóstico , Mieloma Múltiplo/enzimologia , Idoso , Progressão da Doença , Evolução Fatal , Humanos , Masculino , Mieloma Múltiplo/sangue , Valor Preditivo dos Testes , Recidiva , Sensibilidade e EspecificidadeRESUMO
We previously found an high incidence of gallstone or cholecystectomy for lithiasis in patients affected by heart failure (52.1% up to 58.6%). As in general population the incidence of this disease is up to 38%, we tried to explain our findings.
Assuntos
Colelitíase/complicações , Insuficiência Cardíaca/complicações , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Many diseases can lead to atrial fibrillation and one of these is thyroid disfunction. The prevalence of atrial fibrillation does not differ between subclinical and overt hyperthyroidism. Hypothyroidism also can be associated to atrial fibrillation. Low-T3 syndrome is considered a risk factor in cardiac patients. In 100 patients affected by atrial fibrillation we studied the thyroid function and performed ultrasound examination of the thyroid gland. 30 patients had a low-T3 syndrome, 66 (38 > or =10 mm) patients had thyroid nodules, while just 10 patients had an abnormal thyroid function. So, in patients affected by atrial fibrillation, we suggest to study the levels of thyroid hormones and, even if these are normal, to perform an ultrasound examination of the gland.
Assuntos
Fibrilação Atrial/etiologia , Hipertireoidismo/complicações , Hipotireoidismo/complicações , Tri-Iodotironina/sangue , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/sangue , Feminino , Humanos , Hipertireoidismo/sangue , Hipotireoidismo/sangue , Masculino , Valor Preditivo dos Testes , Fatores de Risco , Glândula Tireoide/diagnóstico por imagem , Hormônios Tireóideos/sangue , UltrassonografiaAssuntos
Colo/anormalidades , Idoso , Idoso de 80 Anos ou mais , Diafragma , Humanos , Fígado , MasculinoRESUMO
BACKGROUND: Recent data suggest that low triiodothyronine (T3) syndrome may contribute to the pathophysiology of cardiac diseases. Because the development of diastolic dysfunction occurs early in a failing heart, we evaluated whether patients with low T3 syndrome show abnormalities in diastolic function, also in absence of overt cardiovascular disease. METHODS: Thirty-four patients with low T3 syndrome and 34 controls with normal levels of free T3 (FT3) underwent a complete Doppler echocardiographic examination. Criteria of exclusion from the study were the presence of cardiovascular disease or traditional cardiovascular risk factors, a primitive thyroid disease, cachexia, and the use of drugs affecting the thyroid function. RESULTS: Patients with low T3 syndrome, if compared with controls, show evidence of left ventricular diastolic dysfunction, documented by prolongation of the isovolumic relaxation time (120 vs 75 ms, p < 0.0001) and a reduction in the early diastolic mitral flow velocity/late diastolic mitral flow velocity ratio (0.66 vs 2.05, p < 0.0001), mainly due to the increased A-wave (0.96 vs 0.40 m/s, p < 0.0001). These alterations increase proportionally with FT3 reduction. CONCLUSIONS: Patients with low T3 syndrome show evidence of impaired left ventricular relaxation. Doppler echocardiography may be a useful non-invasive technique for the assessment of diastolic performance in these patients.