Thymic hyperplasia in patients with Graves' disease.

BACKGROUND: Graves' disease (GD) is commonly associated with other autoimmune conditions, and there is also a rare but well documented association between GD and thymic hyperplasia (TH). It is hard to say the real frequency of this latter association because most cases remain asymptomatic and are consequently not thoroughly investigated. MATERIALS AND METHODS: We reviewed the literature on GD-related thymus enlargement and found 107 cases published to date. Thymic cancer was only documented in four patients, while the majority of cases were diagnosed as TH. The causative mechanisms behind TH associated with GD have yet to be fully elucidated. Several studies support the hypothesis of a TSH receptor antibody (TRAb) mediating thymic enlargement. RESULTS: We report on a female GD patient with an incidentally discovered anterior mediastinal mass. Our case is not consistent with the hypothesis of a TRAb-mediated mechanism because the thymus reached its largest volume at the onset of GD and shrank during remission of GD under medical treatment, despite persistently positive TRAb levels. CONCLUSION: We support the hypothesis that two different pathogenic mechanisms might be responsible for thymus enlargement: thymic cortical tissue expansion seems to be due to a hyperthyroid state, while lymphoid hyperplasia appears to correlate with immune abnormalities underlying GD.

Comparison of L-hyoscyamine, glucagon, and placebo for air-contrast upper gastrointestinal series.

Previous studies have compared the use of anticholinergic drugs and glucagon for upper gastrointestinal (UGI) radiography. Many radiologists prefer glucagon because these comparisons showed it to have a shorter duration of action with fewer side effects. L-Hyoscyamine is the levo-rotatory form of atropine with minor adverse side effects. This study compared the effects of glucagon (N = 48), L-hyoscyamine (N = 43), and placebo (N = 45) on gastric and duodenal distension, mucosal coating, and patient tolerance. L-Hyoscyamine provided gastric and duodenal images equal in quality to glucagon. Except for the more frequent reporting of dry mouth with L-hyoscyamine, side effects were not different among the groups. L-Hyoscyamine is an economical alternative to glucagon for hypotonic gastrointestinal radiography.

[Thymoma: anatomo-clinical and therapeutic aspects. Analysis of our 26 cases]. / I timomi: aspetti anatomo-clinici e terapeutici. Analisi dei nostri 26 casi.

The paper reports the authors' personal experience with regard to 26 cases of thymoma treated surgically over the past 10 years. 96% of cases were associated with myasthenia gravis. Surgery was performed in all cases and 13 cases (50%) underwent additional RT. 92% of patients were affected by invasive thymoma (11 stage II cases, and 13 stage III). From an histological point of view, 38.5% of cases were epithelial-type thymomas, 38.5% were lymphoepithelial and 23% were lymphocytic. Survival was influenced by the stage of disease and the radicality of surgery. At present, 76% of patients are still alive between 10 months and 10 years of surgery. There was a perioperative mortality of 11.5% (3 cases), whereas 2 patients died some 2 months later due to pulmonary embolism. The paper also includes a critical review of the most recent literature, and the authors compare their experience with that of other centres.

Rhabdomyolysis: need for high index of suspicion.

Rhabdomyolysis, both traumatic and nontraumatic, may be defined as a triad of skeletal muscle injury, pigmented urine, and acute renal failure. Nontraumatic rhabdomyolysis may be more of a subtle diagnosis and requires a high index of suspicion. Pertinent findings in the history as well as clinical evidence of muscle injury with a marked elevation of creatinine kinase will suggest the diagnosis. A disproportionate elevation of serum creatinine to blood urea nitrogen may also occur. Treatment consists of adequate hydration to help prevent oliguric or anuric renal failure without additional calcium or bicarbonate supplementation in most cases. Radiologic studies involving intravenous contrast media as well as urologic instrumentation should be avoided in the acute setting. With early diagnosis and prompt treatment the prognosis for recovery is excellent.

Comparison of a new colon lavage solution (Golytely-RSS) with a standard preparation for air-contrast barium enema.

Golytely is a balanced electrolyte solution for per oral whole-gut lavage. It has been an accepted alternative to standard preparations for barium enema. Golytely-RSS is a new formulation designed to taste better through reduction in sodium and sulfate content. In addition, a slight increase in osmolality is intended to decrease further the net absorption/secretion ratio. One hundred outpatients who were to undergo air-contrast barium enema examinations were randomly assigned one of two colon-cleansing preparations. A standard 1-day diet/cathartic method was compared with Golytely-RSS plus oral bisacodyl. Radiographs were evaluated for the amount of fecal material present and the degree of mucosal coating by two radiologists independently of each other and without knowledge of the preparation used. Good to excellent feces removal was provided by Golytely-RSS in 98% of patients and by the standard method in 95% (p greater than .1, not significant). Mucosal coating also was similar between groups. Unpleasant side effects were reported significantly more often in the lavage group. Unwillingness to use the preparation a second time was reported in 36% of the Golytely-RSS group and in 8% of the standard preparation group (p = .03). Golytely-RSS is an acceptable alternative method to standard colon-cleansing methods for air-contrast barium enema and may be preferable in patients with certain renal or cardiovascular diseases. Side effects may preclude the use of this colon-cleansing regimen routinely.

Computed tomography of acute renal failure secondary to rhabdomyolysis.

Two patients with rhabdomyolysis and renal failure were imaged with CT. The presence of a striate nephrogram, nephromegaly, and perinephric fluid has not previously been described on CT. Although nonspecific, these findings suggest the diagnosis of acute tubular blockade, and, once identified, administration of additional urographic contrast medium should be avoided.