[Acute posterior multifocal placoid pigment epiteliopathy and neurological involvement in an elderly patient: case report and review]. / Epiteliopatia acuta multifocale posteriore a placche di pigmento e coinvolgimento neurologico in un paziente anziano: caso clinico e revisione della letteratura.

We report a rare case of acute posterior multifocal placoid pigment epitheliopathy (APMPPE) in an elderly patient and a review of the recent scientific literature. A 65-year-old Caucasian man, forty-five days after return from tropical travel he developed right-sided facial palsy with right hemiplegia, dysarthria and a positive Babinski sign. He started prednisone 90 mg/day. Clinical, laboratory and imaging examinations were reported. Five months later there was a complete neurological and ophthalmological recovery. Although APMPPE was described primarily in young adults, we report the first case of APMPPE associated with neurological involvement in an older patient with a complete restitutio ad integrum.

[Pathological deglutition pattern after tumor surgery of the oro- and hypopharynx. Analysis by differentiated deglutition]. / Pathologische Schluckmuster nach Tumorchirurgie in Oro- und Hypopharynx. Analyse mittels differenzierter Schluckpassage.

Dysphagia is a common complaint following surgical intervention in the oral cavity and hypopharynx, often leading to prolonged postoperative recovery. Videofluoroscopy allows detailed visualization of deglutition, demonstrating the morphology as well as the functional aspects. Therefore, videofluoroscopy provides the basis for further therapeutic management. We discuss the pathology of deglutition in 19 patients recovering from tumor surgery of the oro- and hypopharynx. In most cases the results demonstrated severe impairment of both the oral and pharyngeal phase of deglutition. Our data emphasize the importance of the oral phase of deglutition for preparation and initiation of the following phases.

[Pathologic swallowing pattern after tumor surgery of oro- and hypopharynx. Analysis with differentiated deglutition imaging]. / Pathologische Schluckmuster nach Tumorchirurgie in Oro- und Hypopharynx. Analyse mittels differenzierter Schluckpassage.

Dysphagia is a common complaint following surgical intervention in the oral cavity and hypopharynx, often leading to prolonged postoperative recovery. Videofluoroscopy allows detailed visualization of deglutition, demonstrating the morphology as well as the functional aspects. Therefore, videofluoroscopy provides the basis for further therapeutic management. We discuss the pathology of deglutition in 19 patients recovering from tumor surgery of the oro- and hypopharynx. In most cases the results demonstrated severe impairment of both the oral and pharyngeal phase of deglutition. Our data emphasize the importance of the oral phase of deglutition for preparation and initiation of the following phases.

Spectrum of subclinical and overt hypothyroidism: effect on thyrotropin, prolactin, and thyroid reserve, and metabolic impact on peripheral target tissues.

PURPOSE: Subclinical hypothyroidism is found in about 7.5% of females and in about 3% of males. It appears to be a risk factor for atherosclerosis and for coronary heart disease and can affect various other target organs. The morbidity and clinical significance of subclinical hypothyroidism are controversial. Therefore, we evaluated the metabolic impact of progressive thyroid failure in patients with various degrees of hypothyroidism compared with control subjects. PATIENTS AND METHODS: We investigated 86 female patients with the whole spectrum of subclinical hypothyroidism (n = 69) and of overt hypothyroidism (n = 17) and 52 euthyroid women as controls. All subjects underwent full medical and endocrine evaluations (including measurements of thyrotropin [TSH], TSH beta- and alpha-subunits, and prolactin before and after oral administration of thyrotropin-releasing hormone [TRH]) as well as lipid profiles and different tests of peripheral thyroid hormone action. All hypothyroid patients were divided into five categories according to disease severity: grades I to III (subclinical hypothyroidism, with normal thyroxine [T4] levels) and grades IV and V (overt hypothyroidism, with diminished T4). RESULTS: In grade I subclinical hypothyroidism (basal TSH below 6 mU/L), we found significant changes in the clinical index (p less than 0.05), apoprotein A-I level (p less than 0.05), and stimulated prolactin level after oral TRH (p less than 0.001). The findings were similar in grade II (TSH 6 to 12 mU/L). Further changes could be demonstrated in grade III (TSH above 12 mU/L) with a definite elevation of ankle reflex time (p less than 0.001), serum myoglobin level (p less than 0.01), and, to a lesser extent, creatine kinase (p greater than 0.1). The mean low-density lipoprotein cholesterol (LDL-C) level showed an increase of 18%, which was not significant because of marked individual variations (p = 0.15). The frequency of elevated LDL-C levels was definitely higher in patients with grade III disease compared with the controls (42.9% versus 11.4%, p less than 0.05) and with patients with grades I and II disease. Total cholesterol, triglycerides, apoprotein B, and the systolic time intervals (pre-ejection period, corrected for heart rate [PEPc]) were clearly elevated only in overt hypothyroidism (grades IV and V) (p less than 0.01). CONCLUSION: Subclinical hypothyroidism has significant effects on some peripheral target organs at an early stage (grades I and II), but affects LDL-C, skeletal muscle, and myocardial contractility only at a later stage (grades III, IV, and V). Our data of elevated LDL-C in grade III subclinical hypothyroidism provide a likely pathophysiologic explanation for the reported association of coronary heart disease with this syndrome. The impact of increased prolactin secretion, observed in subclinical hypothyroidism, on gonadal function and infertility has yet to be clarified. Therapy with thyroxine should be recommended in at least some patients with subclinical hypothyroidism. Patients with high TSH levels (above 12 mU/L) will require treatment because of the metabolic effects on several target organs. Before treatment is advocated in all patients with subclinical hypothyroidism, the benefits and long-term side effects of thyroid hormone therapy should be clarified by prospective studies in larger groups of patients.

[Carbimazole therapy in Basedow's disease: therapy results in individual dosage adjustment]. / Carbimazol-Therapie beim Morbus Basedow: Therapieerfolg bei individueller Dosisanpassung.

We analyzed the results of 85 treatments with carbimazol in 71 patients with Graves' disease. The initial dose ranged from 45 to 60 mg/day, which was gradually reduced to the lowest possible maintenance dose; the mean treatment period was 17 months. All patients achieved euthyroid function after 12 weeks at the latest. Normalization of the pituitary TSH-reserve occurred late (after 6-12 months in most cases). 60% of the patients treated for the first time (n = 58) and 59% of the whole group remained in remission. The maintenance dose of carbimazol had no effect on the rate of remission. It is interesting to note that in 66% of the patients a very low dose (less than or equal to 5 mg/day) was fully effective and resulted in a remission rate of 54%. Therefore, the dose should always be reduced individually. Relapses occurred within the first year after the end of treatment in 77% of the cases, but were also observed after 2-3 years. Hence follow-up should be continued after cessation of therapy.