Is it possible to determine the origin of cyst in empty thyroid bed in patient with lingual thyroid?

Some patients with ectopic thyroid gland or athyreotic patients have one or more cysts in empty thyroid bed. The origin of these cysts is uncertain. We present the patient with lingual thyroid gland and small cyst in empty thyroid bed featuring the diagnostic algorithm used and discussing the possible etiologic scenarios.

Thyroid echogenicity: A clue to precise individual dosimetry in radioiodine therapy of hyperthyroidism.

BACKGROUND: Radioiodine therapy is a frequent option in treatment of patients with hyperthyroidism. Despite efforts to plan the thyroid absorbed dose by accounting for the gland size and radioiodine kinetics, the success of radioiodine therapy remains largely unpredictable. The current methods plan the mean thyroid radiation absorbed dose, assuming that it applies to target tissue - the thyroid follicular cells. However, the unique thyroid follicular structure and iodine kinetics may violate this assumption. Upon oral administration and capture by thyroid, the vast majority of time radioiodine spends in organified form in follicular colloidal lumen: the greater the follicle the more radiation is wasted before reaching the target cells. HYPOTHESIS: The (131)I radiation absorbed dose to thyroid follicular cells is less than the average thyroid dose, the more the greater the follicles. Thyroid echogenicity can be used to assess the amount of colloid in thyroid tissue, which in turn can be used to assess the follicle size and adjust the planned absorbed dose to patient-specific thyroid micro-architecture. EVALUATION: Animal data on intrathyroidal iodine kinetics were considered in conjunction with model predictions that relate the size of thyroid follicles with (131)I irradiation of follicular cells. It turned out that the correction factors in the range 5-40% should be applied to oral activities of radioiodine calculated by the standard method. Next, several histology studies documented that normoechogenic thyroids have relatively large follicles, while hypoechogenic thyroids are mostly cellular, with almost empty, small follicles. All these concur with clinical data that Graves' disease patients with normoechogenic thyroids that received 200Gy in thyroid had comparable outcome to Graves' disease patients with hypoechogenic thyroid that received 100-120Gy in thyroid. CONCLUSION: Thyroid echogenicity is a probable clue to a better patient-specific dosimetry in radioiodine therapy of hyperthyroidism; direct evidences and precise estimates of benefits over current practices would be provided by controlled clinical trials.

Diving-induced venous gas emboli do not increase pulmonary artery pressure.

Venous gas emboli are frequently observed in divers even if proper decompression procedures are followed. This study was initiated to determine if pulmonary artery pressure increases in asymptomatic divers, which could increase the risk of arterial embolization due to passage of venous gas emboli from the right to the left side of the heart. Recordings of venous gas emboli and estimation of pulmonary artery pressure by non-invasive transthoracic echocardiography were applied in 10 recreational scuba diving volunteers before and 20, 40, 60, and 80 min after simulated dives to 18 m (80 min bottom time) in a hyperbaric chamber. The ratio between pulmonary artery acceleration time and right ventricular ejection time was used as an estimate of pulmonary artery pressure. None of investigated divers had signs of decompression sickness. Despite the post-dive presence of the venous gas emboli, measured in the region of the pulmonary valve annulus (mean=1.71 bubbles.cm-2, 40 min after dive), the ratio between pulmonary artery acceleration time and right ventricular ejection time did not decrease, but actually increased (from 0.43+/-0.06 to 0.49+/-0.06, 40 min after dive; p<0.05), suggesting a decrease in pulmonary artery pressure after the dive. We conclude that diving-induced venous gas bubbles do not cause significant changes in the central circulation which could increase the risk of arterial embolization.

Acute effects of a single open sea air dive and post-dive posture on cardiac output and pulmonary gas exchange in recreational divers.

OBJECTIVE: To evaluate the cardiopulmonary effects of open sea scuba air diving to 39 m (30 minutes bottom time) with standard decompression. To account for possible gravity dependent effects of venous gas bubbles, the variables were measured in different post-dive body postures and compared with the baseline values before the dive in the same posture. METHODS: Eight male divers conducted two similar dives on successive days. Their posture before and after the dive was either sitting or supine, in random order. The divers were evaluated before and 30, 60, and 90 minutes after the dive. Venous bubbles were detected by precordial Doppler after the dive in four divers in the supine posture and two divers in the sitting posture. RESULTS: Arterialised oxygen tension had decreased at all times after the dive (-11.3 mm Hg, p = 0.00006), due to decreased alveolar oxygen tension, irrespective of posture. Apart from an increase in the sitting posture 30 minutes after the dive, pulmonary capacity for carbon monoxide diffusion and cardiac index decreased, mostly 60 minutes after the dive (-9%, p = 0.0003 and -20%, p = 0.0002 respectively). The decrease in cardiac index was greater in the supine posture (p = 0.0004), and the physiological dead space/tidal volume ratio increased more in the sitting position (p = 0.006). CONCLUSIONS: Field dives are associated with moderate impairments in cardiac output and gas exchange. Some of these impairments appear to depend on the posture of the diver after the dive.

Pulmonary ventilatory function in premenopausal women with and without genital descensus.

A hypothesis on the existence of link between the changes in connective tissue in patients with genital descensus and impairments of their pulmonary function was made. In the sample of 40 patients, admitted to hospital for surgical correction of their genital descensus, their pulmonary ventilatory function was examined and compared with 40 matched female examinees without genital descensus. All the examinees were in premenopausis, nonsmokers and without history or clinical signs of the diseases that could affect their pulmonary function. Patients exhibited highly significant decrements in all expiratory flows, especially in the peak expiratory flow (-26%) and other flows at large lung volumes. The forced vital capacity and forced expired volume at 1 second were also decreased (-9% and -16%, respectively). The findings were typical for reduced strength of the expiratory muscles, suggesting the possible link between the lack of collagen and the impairments of pulmonary function in women with genital descensus.

Correlation between symptomatology and site of acute myocardial infarction.

OBJECTIVE: We determined the occurrence of presenting symptoms in patients with different sites of acute myocardial infarction after controlling for age and conventional risk factors. METHODS: Hospital-based study of patients hospitalized because of first anterior (n=731), inferior (n=719) and lateral (n=96) infarction in Clinical Hospital Split between 1990 and 1994. Data form about presenting symptoms and clinical profile was completed for each patient. RESULTS: Anterior infarctions were more often presented by headache (adjusted odds ratio (OR)=1.67, 95% CI=1.06-2.62), weakness (OR=1.60, 95% CI=1.31-1.96), dyspnea (OR=1.40, 95% CI=1.14-1.72), cough (OR=2.24, 95% CI=1.59-3.16), vertigo (OR=2.04, 95% CI=1.40-2.99) and tinnitus (OR=2.09, 95%CI=1.06-4.14). Inferior infarctions were more often associated with epigastric (OR=1.71, 95%CI=1.30-2.24), neck (OR=1.47, 95% CI=1.10-1.98) and jaw pain (OR=2.16, 95% CI=1.42-3.27), sweating (OR=1.56, 95% CI=1.27-1.92), nausea (OR=2.01, 95%CI=l.64-2.46), vomiting (OR=1.55, 95% CI=1.22-1.97), belching (OR=1.57, 95% CI=1.21-2.03) and hiccups (OR=2.88, 95%CI=1.53-5.42). Patients with lateral infarctions were more likely to complain of left arm (OR=1.80, 95% CI=1.07-3.05), left shoulder (OR=1.82, 95% CI=1.19-2.79) and back pain (OR=2.40, 95% CI=1.28-4.46). Pain was less frequently reported by hypercholesterolemic (P=l.4x10(-7)), patients over 70 years (P=0.002), women (P=0.0007) and those with non-triggered infarction (P=0.0009), whereas those over 70 (P=1.7x10(-6)) and men (P=0.0003) were less likely to report other relevant symptoms. CONCLUSIONS: Our study suggests a linkage between different infarction sites and specific groups of symptoms. Furthermore, coronary patients should give their full attention to non-specific symptoms and any kind of discomfort.

Effect of simvastatin on micropulmonary red cell mass in patients with hyperlipoproteinemia.

The purpose of this study was to compare the macrocirculatory and microcirculatory effects of simvastatin in hyperlipemic patients. In vitro measurements of lipoprotein levels and macrocirculatory hemorheology were complemented by in vivo measurements of the pulmonary capillary red cell volume (RCVpc) before and after 6 weeks of treatment with 40 mg of simvastatin daily in 30 male patients with hyperlipoproteinemia type IIa. RCVpc was assessed from the vascular component of the lung diffusing capacity for carbon monoxide, using the modification of the Roughton-Forster's method. RCVpc was increased in patients (60.9+/-9 versus 40+/-9 ml in healthy controls) and it decreased to 47+/-6 ml after treatment (P=5x10(-11)). The decreases in RCVpc correlated to concomitant decreases in peripheral hematocrit (R=0.68) and serum total cholesterol (-34% on average; R=0.59). Membrane diffusing capacity was normal in patients and not affected by the therapy; suggesting that increased RCVpc was due to increased micropulmonary hematocrit. Thus, it appears that viscosity in microcirculation is greatly increased in hyperlipemic patients and that simvastatin is able to normalize it. Since microcirculatory conditions can only partly be inferred from in vitro measurements the use of lung diffusional parameters was advocated, which enable in vivo assessment of hemorheology in microcirculation.

Leiomyomatosis peritonealis disseminata in a postmenopausal woman.

Leiomyomatosis peritonealis disseminata (LPD), a multifocal proliferation of smooth muscle like cells, has so far been described in 48 cases. Most of them were pregnant women or women taking the oral contraceptives, which supported the hypothesis that LPD is associated with hyperestrogenism. We report a 65-year-old women, without history of taking exogenous estrogens, which suggests that factors other than hormonal influences may contribute to pathogenesis of LPD.

Epidemiological study of nontraumatic phakic rhegmatogenous retinal detachment.

We studied the epidemiological characteristics of nontraumatic phakic rhegmatogenous retinal detachment (RRD) in a defined population of Split-Dalmatia County, Croatia. A total of 278 eyes of 272 patients developed RRD during an 11-year period, 1988-1998, with a population of 465,947. The annual incidence was 5.4 per 100,000 population. The mean age of patients was 58.3 years, and the sex distribution corresponded with that in the general population. There was insignificant preponderance of right eye involvement. Bilaterality was observed in 2.2%. The presence of myopia was diagnosed in 46.9% eyes.

A cure from the small cell neuroendocrine carcinoma of the uterine cervix following conventional surgery.

The small cell neuroendocrine carcinoma of the uterine cervix is a rare, but very aggressive neoplasm. Previous reports suggested that it had dismall prognosis if treated with conventional surgery and radiotherapy, even in early stage disease. We present the case of neuroendocrine cervical carcinoma that was cured from the disease following conventional surgery only.

Gender differences in triggering of acute myocardial infarction.

The frequencies of potential triggers of acute myocardial infarction differ between men and women. There is a possibility that anti-ischemic drugs protect against trigger-related infarctions.

Blood gases and sex hormones in women with and without genital descensus.

BACKGROUND: Abnormalities in connective tissue and spirometric disorders have previously been found in women with genital descensus. OBJECTIVE: To evaluate the association of descensus and respiratory function. METHODS: The blood gases and sex hormones were measured in 130 women scheduled for surgical correction of descensus and 60 matched women without descensus. All subjects were nonsmokers and without past or present cardiorespiratory disease. RESULTS: Women with descensus had a lower pH (7.39+/-0.04 vs. 7.41+/-0.04, p = 0.01), lower arterial tensions of oxygen (12.7+/-12. vs. 14.1+/-0.9 kPa, p = 0.003) and carbon dioxide (5.1+/-0.4 vs. 5.3+/-0.3 kPa) but a higher hemoglobin concentration (141+/-11 vs. 132+/-9 g/l) and a higher serum progesterone in the follicular phase of the cycle (3.1+/-4 vs. 1.5+/-1 ng/ml, p = 0.03). In 39 (30%) women with descensus, the arterial carbon dioxide tension was below 4.9 kPa. All subjects ventilated more in the luteal compared to the follicular phase of the cycle. In women with descensus, the hemoglobin concentration increased with decreasing arterial oxygen tension (p = 10(-4)) and with decreasing pH (p<10(-3)). CONCLUSION: Women with descensus frequently hyperventilate and, compared with women without descensus, have a lower arterial oxygen tension, increased hemoglobin concentration and slightly lower pH.

Pyelolithotomy improves while extracorporeal lithotripsy impairs kidney function.

PURPOSE: Extracorporeal shock wave lithotripsy (ESWL) causes acute depression of kidney function, which chronically returns to baseline levels. This sequala could indicate chronic regression of acute lesions or a balance between lesions and relief of obstruction. We compared changes in kidney function 1 week and 3 months after ESWL and pyelolithotomy. MATERIALS AND METHODS: A group of 17 women and 13 men 28 to 71 years old with 0.6 to 3 cm. stones received 1,800 to 3,200 shock waves by an electromagnetic lithotriptor. Another group of 21 women and 9 men 35 to 76 years old with 2.5 to 3.8 cm. stones underwent Gil-Vernet intra-sinus pyelolithotomy. Split renal plasma flow, glomerular filtration rate and mean parenchymal transit times of nonreabsorbable filtrate solutes were measured by dual gamma camera renography, and plasma clearances of 99mtechnetium diethylenetriaminepentaacetic acid and 131orthoiodohippurate acid. RESULTS: ESWL caused acute deterioration and chronic restoration of baseline parameters of the treated kidney, and small but sometimes irreversible damage to plasma flow to the untreated kidney, especially in obese patients. In contrast, pyelolithotomy acutely and chronically improved function of the treated kidney, and normalized parenchymal transit times of radiotracers. CONCLUSIONS: ESWL does not achieve substantial improvements in kidney function, which can be achieved by other methods of stone removal.

Dermatological indicators of coronary risk: a case-control study.

OBJECTIVE: We examined the association of dermatological signs such as baldness, thoracic hairiness, hair greying and diagonal earlobe crease with the risk of myocardial infarction in men under the age of 60 years. METHODS: A hospital-based, case-control study included 842 men admitted for the first non-fatal myocardial infarction, the controls were 712 men admitted with noncardiac diagnoses, without clinical signs of coronary disease. The relative risks were estimated as odds ratios. Logistic regression was used to control for the confounding variables. RESULTS: Baldness, thoracic hairiness and earlobe crease were approximately 40% more prevalent in cases (P<10(-6) in each case). In both cases and controls, baldness and thoracic hairiness were frequently coexistent, as well as hair greying and earlobe crease (P<10(-4) in each case). After allowing for age and other established coronary risk factors, the relative risk of myocardial infarction for fronto-parietal baldness compared with no hair loss was 1.77 (95% CI 1.27-2.45) and it was 1.83 (95 CI 1.4-2.3) for men with thick, extended thoracic hairiness. The presence of a diagonal earlobe crease yielded a relative risk of 1.37 (95% CI 1.25-1.5), while hair greying was associated with myocardial infarction only in men under the age of 50 years. CONCLUSION: It appears that baldness, thoracic hairiness and diagonal earlobe crease indicate an additional risk of myocardial infarction in men under the age of 60 years, independently of age and other established coronary risk factors.

Spirometric disorders in women with genital descensus.

BACKGROUND: We hypothesized that abnormalities in connective tissue, found in women with genital descensus, could impact their pulmonary function. METHOD: Therefore we compared lung flows and volumes between women with (n = 100) and without (n = 100) descensus. RESULTS: Patients exhibited highly significant decrements in all expiratory flows, especially in the peak expiratory flow (-35%) and other flows at large lung volumes. The forced vital capacity and forced expired volume at 1 second, but not their ratio, were also decreased (-16% and -17%, respectively). These differences were exaggerated in postmenopausal subjects and in patients with third degree of descensus, but did not depend on the presence of stress incontinence. Lung flows and volumes did not change between follicular and luteal phase of the cycle, either in patients or in controls. The forced vital capacity decreased with increasing years past the menopauses in patients (65 +/- 10 ml per year), but not in controls. CONCLUSION: In women with genital descensus deteriorations in lung ventilatory function were observed in association with the presence and duration of postmenopauses.

Triggers of acute myocardial infarction regarding its site.

We have studied the incidence of possible triggers of the myocardial infarction regarding its site in 750 patients with anterior and 731 patients with inferior infarction. Infarctions occurred most frequently without recalling any triggering activity, especially in patients with anterior infarction (67 vs. 44%). Physical effort as the possible precipitator was also more frequent in anterior infarctions (22 vs. 16%). However, the onset of inferior infarction was more frequent during meteorological stress (9 vs. 2%), emotional stress (10 vs. 3%), after overeating (13 vs. 3%) and nicotine abuse (6 vs. 1.5%). These triggers were independent and highly significant (P < 0.02 in each case) discriminators of the site of myocardial infarction. Bimodal circadian rhythm, with primary peak between 6 and 9 h a.m. and the secondary peak between 3 and 6 p.m. was observed in patients which did not recall any triggering activity, and this was more pronounced in patients with inferior infarction. These results support the hypothesis that the influence of the vegetative tone is most pronounced in the onset of myocardial infarction of inferior wall.

[Dynamic aggregation of thrombocytes in acute myocardial infarct]. / Dinamika agregacije trombocita u akutnom infarktu miokarda.

The dynamics of circulating platelet aggregates (CPA) in acute myocardial infarction (MI) was correlated to its extent, localization and clinical outcome. Creatine kinase (CK) and CPA were measured in 30 patients with acute MI 24 hours after its onset, and on the third, fifth and eighth day following the accident. Twelve patients had anteroseptal MI, another 12 had inferior, and the remaining 6 had non-Q wave MI. 24 hours after the accident CPA values differed significantly between the three groups (p < 0.05). The values of CPA increased with increasing CK. In all the patients CPA and CK returned to normal or almost normal values on days 8 and 5 following MI, respectively. Eleven patients (37%) had heart failure: 8 of them (73%) had anteroseptal MI and 3 had inferior MI (27%). In 10 patients with heart failure (91%) and only in 2 out of 19 patients without heart failure (10.5%), CPA peaked on days 3 or 5 after MI (p < 0.05). In all other patients CPA declined steadily from the initial value. These results suggest that platelet aggregability is significantly associated with the severity of MI and with heart failure.

An increase in micropulmonary red cell mass in hyperlipidaemic patients.

It is known that pulmonary microcirculation rheology is partly affected by plasma levels of lipoproteins, but only a few data are available for humans. Therefore, in a sample of 30 normal volunteers and 90 patients with various types of primary hyperlipoproteinaemia, the plasma levels of total cholesterol (Chol), low density cholesterol (LDL), the high density cholesterol (HDL), triglyceride (Tg) and fibrinogen (Fib) were measured in conjunction with determinations of plasma viscosity (PV) and the pulmonary capillary red cell volume (RCVc). RCVc was estimated from measurements of the vascular component of the single-breath-diffusing lung capacity for carbon monoxide, using our own modification of the Roughton-Forster's method. By stepwise regression analysis, the variation in RCVc was almost completely accounted for (r2 = 0.87) by variations in PV, Chol, Tg and the anthropometric confounding factors. The proposed explanations for increased pulmonary capillary red cell mass (up to 151% of the predicted value) in hyperlipidaemic patients included the hypothesis of increased pulmonary microhaematocrit, which agrees with the observed in-vitro lipoprotein-dependent increase in erythrocyte aggregability.

Gated versus first-pass radioangiography in the evaluation of left-to-right shunts.

Excluding regurgitant ventricles and multiple shunting, left-to-right shunts of the central circulation can be evaluated from the difference between the right ventricular stroke counts (SCRV) and the left ventricular stroke counts (SCLV), which are obtained from gated radioangiography. The pulmonary-to-systemic flow ratio (QP/Qs) is equated to SCRV/SCLV in atrial shunts and to SCLV/SCRV in ventricular and ductal shunts. In this paper, the potentials of the stroke count method have been compared to the gamma fit first-pass technique, incorporating the recent refinements in ductal shunts and deconvolution of the pulmonary curve. In 17 patients with left-to-right shunt, the stroke count method and the gamma fit method correlated moderately with oximetry (r = .71 and .87), respectively. The gamma variate method appeared superior in the detection and estimation of small shunts, whereas when QP/Qs was two or larger, the stroke count method yielded closer agreement with oximetry data.

Increase of lung transfer factor in early sarcoidosis.

Dynamic spirometry and the lung transfer factor for CO (TLCO) were determined in 41 non-smoking patients with sarcoidosis before and after steroid treatment. Dynamic spirometry revealed usual stage-dependent restrictive and/or obstructive abnormalities; only maximal expiratory flow rate at 75% FVC (MEF75) was significantly increased after steroid treatment in stage 2 patients. The new finding is that TLCO was increased in stage 1 [on average 21% above the predicted values (p.v.)], but it was decreased in stage 2 (11% below p.v.) and stage 3 (27% below p.v.). The increase in TLCO in stage 1 was predominantly caused by an increase in TLCO membrane component (Dm) (33% above p.v.), while the pulmonary capillary blood volume (Vc') increased less (19% above p.v.). Steroid treatment significantly reduced TLCO, Dm and Vc' in stage 1 (for 14, 17 and 18% of the respective baseline values), whereas it caused TLCO and Dm increases in stage 2 (for 8 and 10% of the respective baseline values). In conclusion, a TLCO in pulmonary sarcoidosis may not only be decreased in its advanced stages, but also exhibit increased values, which appeared related to the subclinical inflammatory reaction in the stage 1 patients.