Influence of chronic lymphocytic thyroiditis on the risk of persistent and recurrent disease in patients with papillary thyroid carcinoma and elevated antithyroglobulin antibodies after initial therapy / Influência da tireoidite linfocítica crônica sobre o risco de doença persistente e recorrente em pacientes com carcinoma papilífero de tireoide e anticorpos antitireoglobulina elevados após a terapia inicial

Abstract Introduction In patients with papillary thyroid carcinoma who have negative serum thyroglobulin after initial therapy, the risk of structural disease is higher among those with elevated antithyroglobulin antibodies compared to patients without antithyroglobulin antibodies. Other studies suggest that the presence of chronic lymphocytic thyroiditis is associated with a lower risk of persistence/recurrence of papillary thyroid carcinoma. Objective This prospective study evaluated the influence of chronic lymphocytic thyroiditis on the risk of persistence and recurrence of papillary thyroid carcinoma in patients with negative thyroglobulin but elevated antithyroglobulin antibodies after initial therapy. Methods This was a prospective study. Patients with clinical examination showing no anomalies, basal Tg < 1 ng/mL, and elevated antithyroglobulin antibodies 8-12 months after ablation were selected. The patients were divided into two groups: Group A, with chronic lymphocytic thyroiditis on histology; Group B, without histological chronic lymphocytic thyroiditis. Results The time of follow-up ranged from 60 to 140 months. Persistent disease was detected in 3 patients of Group A (6.6%) and in 6 of Group B (8.8%) (p = 1.0). During follow-up, recurrences were diagnosed in 2 patients of Group A (4.7%) and in 5 of Group B (8%) (p = 0.7). Considering both persistent and recurrent disease, structural disease was detected in 5 patients of Group A (11.1%) and in 11 of Group B (16.1%) (p = 0.58). There was no case of death related to the disease. Conclusion Our results do not support the hypothesis that chronic lymphocytic thyroiditis is associated with a lower risk of persistent or recurrent disease, at least in patients with persistently elevated antithyroglobulin antibodies after initial therapy for papillary thyroid carcinoma.

Resumo Introdução Em pacientes com carcinoma papilífero de tireoide e com tireoglobulina sérica negativa após a terapia inicial, o risco de doença estrutural é maior entre aqueles com anticorpos antitireoglobulina elevados em comparação com pacientes sem anticorpos antitireoglobulina. Outros estudos sugerem que a presença de tireoidite linfocítica crônica está associada a um menor risco de persistência/recorrência do carcinoma papilífero de teireoide. Objetivo Este estudo prospectivo avaliou a influência da tireoidite linfocítica crônica sobre o risco de persistência e recorrência do carcinoma papilífero de tireoide em pacientes com tireoglobulina negativa, mas com anticorpos antitireoglobulinas elevados após a terapia inicial. Método Esse foi um estudo prospectivo, no qual foram selecionados pacientes com exame clínico sem anomalias; tireoglobulina basal < 1 ng/mL e anticorpos antitireoglobulina elevados 8-12 meses após ablação. Os pacientes foram divididos em dois grupos: Grupo A, com tireoidite linfocítica crônica no exame histológico; Grupo B, histologicamente sem tireoidite linfocítica crônica. Resultados O tempo de seguimento variou de 60 a 140 meses. Doença persistente foi detectada em 3 pacientes do Grupo A (6,6%) e em 6 do Grupo B (8,8%) (p = 1,0). Durante o seguimento, as recidivas foram diagnosticadas em 2 pacientes do Grupo A (4,7%) e em 5 do Grupo B (8%) (p = 0,7). Considerando tanto a doença persistente quanto a recorrente, doença estrutural foi detectada em 5 pacientes do Grupo A (11,1%) e em 11 do Grupo B (16,1%) (p = 0,58). Não houve nenhum caso de óbito relacionado à doença. Conclusão Nossos resultados não apoiam a hipótese de que a tireoidite linfocítica crônica esteja associada a um menor risco de doença persistente ou recorrente, pelo menos em pacientes com anticorpos antitireoglobulina persistentemente elevados após a terapia inicial do carcinoma papilífero de tireoide.

Arterial stiffness and 25-hydroxyvitamin D levels in chronic kidney disease patients

Summary Objective: Arterial stiffness refers to arterial wall rigidity, particularly developing in central vessels. Arterial stiffness increases in early stage chronic kidney disease (CKD), and it is a strong predictor of cardiovascular and all cause mortality. Vitamin D has beneficial effects on blood pressure, vascular endothelial function and arterial stiffness. 25-hydroxyvitamin D (25(OH)D) deficiency is quite common worldwide and in the CKD population. We aimed to evaluate the prevalence of 25(OH)D deficiency and its relation with arterial stiffness in CKD. Method: Our study included 101 patients (51 male, 50 female), with stages 3B-5 CKD not on dialysis. A single-cuff arteriograph device (Mobil-O-Graph) was used to evaluate arterial stiffness parameters of pulse wave velocity (PWV) and augmentation index (Alx@75). The patients were divided into two groups: group I vitamin D non-deficient [25(OH)D > 15 ng/mL] and group II vitamin D deficient [25(OH)D ≤ 15 ng/mL]. Results: Overall, the mean 25(OH)D level was 14.1±7.9 ng/mL and 70 patients (69.4%) were vitamin D deficient. The mean Alx@75 value was significantly higher in group II (28.6±10.8% vs. 23.3±13.5%, p=0.038). PWV was higher in group II, but the difference was not significant. Group II exhibited significantly lower serum albumin (p<0.001), hemoglobin (p=0.005), calcium (p=0.041) and estimated glomerular filtration rate (eGFR) (p=0.041), but significantly higher 24-hour proteinuria (p=0.011) and more females (p=0.006). Vitamin D was negatively correlated with Alx@75 augmentation pressure, parathyroid hormone, proteinuria and body mass index, and positively correlated with albumin, hemoglobin, eGFR, calcium and transferrin. 25(OH)D was independently associated with Alx@75 (beta=-0.469, p=0.001) and albumin (beta=0.447, p=0.002). Conclusion: In CKD patients 25(OH)D deficiency was common, particularly in females. Level of 25(OH)D was independently associated with Alx@75.

Substance P in rectal mucosa of children with chronic constipation

Niveles de Substancia P fueron determinados por radioinmunoassay en la mucosa rectal de 17 niños con constipación, idiopática crónica y comparados con la de 9 ninõs sin constipación. En el grupo de niños con constipación, los niveles de Sustancia P fueron menores que aquellos de los controles: 47,6+-11 vs. 79,4+-11 pg/mg de peso húmero de tejido respectivamente (la diferencia no obtuvo significación estadística). Niveles de Sustancia P en la mucosa rectal de niños con soiling (11/17) no fueron diferentes de los niveles en niños constipados sin soiling (46,0+-13 vs. 50,5+-19). En niños con constipación, los niveles de Sustancia P no varían de acuerdo a la edad o la duración de síntomas. Los niveles de Sustancia P en la mucosa rectal de niños controles (sin constipación) fueron similares a aquellos que previamente observamos en adultos normales, y los niveles en niños constipados fueron intermediarios entre estos niveles normales y los de adultos constipados. Estas observaciones sugieren un problema de motilidad como factor importante en la patogenesis de la constipación crónica en niños.

New biochemical markers in chronic heart failure

We investigated the plasma levels of tumour necrosis factor-alpha [TNF-alpha], leptin and insulin, and their relation to body mass index [BMI] in 80 male patients who presented with chronic heart failure [mean age: 47 +/- 4 years] at Tanta University Hospital. Plasma leptin, TNF-alpha and insulin were significantly increased and BMI significantly decreased in New York Heart Association classes III and IV patients. TNF-alpha, leptin and insulin were positively correlated, and TNF-alpha and BMI and leptin and BMI were negatively correlated in stages III and IV of heart failure. We conclude that cytokine neuroendocrine activation may form part of advanced stage heart failure. It may also be responsible for worsening cachexia, and can be used as a marker to determine disease severity

Infecçäo por citomegalovírus (CMV): epidemiologia, diagnóstico e tratamento / Cytomegalovirus infection (CMV): epidemiology, diagnosis and treatment

As infecçöes por citomegalovírus (CMV) vêm cada vez mais assumindo importância em imunodeprimidos: transplantados, pacientes com câncer submetidos a quimioterapia e portadores de AIDS. Também o CMV é considerado a causa mais comum de infecçäo congênita. Esta revisäo faz uma abordagem ampla e completa de vários tópicos das citomegaloviroses: histórico, características do vírus, patogênese, epidemiologia, quadro clínico, diagnóstico laboratorial e tratamento.

Gonadotropinas y sexoesteroides en mujeres posmenopáusicas del círculo de abuelos

En publicaciones recientes se han evaluado varios factores que pueden influir en las hormonas de la reproducción durante el climaterio. En nuestro medio no existen investigaciones sobre esta problemática, razón por la cual se diseñó este estudio con el objetivo de conocer la relación entre los niveles hormonales posmenopáusicos y la actividad en los círculos de abuelos. Se seleccionó una muestra simple aleatoria de 134 mujeres posmenopáusicas, estratificada según participaran o no en el círculo de abuelos (67 en cada estrato), de un área de salud urbana. Se determinaron por radioinmunoanálisis las siguientes hormonas: FSH, LH, prolactina, testosterona, estradiol 17 beta, androstenediona y 17 hidroxiprogesterona (17 OH-P). La prolactina fue mayor en las mujeres que no participan en las actividades del círculo de abuelos, mientras que la testosterona y la 17 OH-P fueron menores con respecto al grupo que participa en el círculo de abuelos. El resto de las hormonas no mostró diferencias entre los 2 grupos. Según estos resultados, las actividades realizadas por estas mujeres en el círculo de abuelos influyen en los niveles de algunas de las hormonas de la reproducción, lo que pudiera tener efectos favorables para la salud, al disminuir el estrés y en particular sobre la osteoporosis que se desarrolla en esta época de la vida

Comparaçåo entre radioimunoensaio e imunoturbidimetria para determinaçåo da microalbumina / A comparasion of radioimmunoassay and immunoturbidimetry for determination of microalbuminuria

Microalbuminuria é a excreçåo urinária de pequenas quantidades de albumina, insuficiente para serem detectadas por métodos usais de dosagem de proteínas e possui valor preditivo para o desenvolvimento de proteinúria e insuficiência renal crônica. Radioimunoensaio com duplo anticorpo (RIA) é usualmente considerado como um método-padråo para esta dosagem. Com o objetivo de comparar as dosagens de albumina urinária por radioimunoensaio e por imunoturbidimetria (IT), foram analisadas 91 amostras de urina de pacientes diabéticos ou nåo. Verificamos nåo haver diferença estatisticamente significativa entre os valores obtidos por ambos os métodos e um coeficiente de correlaçåo r=0,99874, mostrando que a IT pode ser utilizada como um método alternativo ao RIA

Cellular adaptation of the rat medullary thick ascending limb to chronic renal failure

Chronic renal failure (CRF) is accompanied by adaptive changes in renal and extrarrenal epithelial ionic transport. Fluid reabsorption in the thick ascending limb of Henle is increased and the capacity to lower the urine osmolality in water diuresis is preserved. To study the cellular mechanism of this adaptation, we measured intracellular cAMP in microdissected medullary thick ascending limb (mTAL) segments in rats with CRF. mTAL exhibited in CRF nephrons an increase of basal cAMP from 6.0 +/- 1.5 in controls to 47.0 + 10.3 fmol. mm-1 tubule in CRF (P < 0.05). Maximally stimulated cAMP levels (10(-3) M IBMX plus 10(-5) M Forskolin) were different from basal levels in controls (6.0 + 1.5 vs 63.1 +/- 18.8, P < 0.05) but not from basal levels in CRF (47.0 +/- 10.3 vs 63.0 +/- 16.0, P = N.S.). Preincubation with the adenylate cyclase inhibitor 2'5' -dideoxyadenosine (DDA) 10(-4) M produced no changes in cAMP in controls (93.7 +/- 10.3 percent of DDA untreated samples) whereas it decreased to 76.2 +/- 8.8 percent (24 percent inhibition) in CRF (P < 0.05). No differences between controls and CRF groups were found in basal and stimulated cAMP in red blood cells and distal colon. The data would suggest that the cAMP pathway is an intracellular signal for mTAL adaptation in epithelial transport and that the adenylate-cyclase system is specifically activated in CRF.

Lactoferrin levels and unsaturated iron-binding capacity in colostrum of Brazilian women of two socioecomic levels

The objetive of this study was to compare lactoferrin (LF) levels and unsaturated iron-binding capacity (UIBC) of colostrum from Brazilian women aged 20-38 years of low (N = 28) and high (N = 15) socioeconomic level. Both groups received a similar amount of supplental iron (25-65 mg/day) during pregnancy. We also determined the relationship between LF levels and UIBC, and between these components and maternal iron status. Both groups (low and high socieconomic level) showed adequate and similar mean hematocrit (35.0 ñ 13% and 35.9 ñ 1.3%, respectively) and serum ferritin (64 ñ 12 µg/1 and 57 ñ 12 µg/1, respectively) levels. Furthermore, LF levels (5.7 ñ 0.9 mg/ml and 5.5 ñ 0.6 mg/ml) and UIBC (3.8 ñ 0.3 µg/ml and 3/1 ñ 0.3 µg/ml) were not significantly different in the two groups of women, nor were they related to maternal hematocrit or serum ferritin. UIBC was significantly (P = 0.009), although weakly positively correlated (r= 0.45) with LF levels, suggesting that other colostrum ligands may contribute substantially to the capacity of colostrum to bind exogenous iron

Revisión retrospectiva de la prevalencia del virus de la hepatitis B (VHB) en varios grupos de población / Retrospective review of prevalence of hepatitis B virus in several groups of individuals

Nine different groups of individuals studied from 1969 to 1985 were tested for Hepatitis B Virus (HBV) markers. In 8 groups only HBsAg in serum was tested, in another group: tissular HBsAg, and in two of those groups: serum HBsAg, anti-HBs and anti-HBc. Mean HBsAg prevalence in groups similar to general population was 0.64%; 5% in cirrhotics; HBV prevalence in haemophiliacs was 18.87% by testing serum for HBsAg and anti-HBs; serum HBsAg prevalence in Viral Chronic Active Hepatitis was 43.24%; and Hepatocellular Cancer (HCC) group had a prevalence for HBV of 13.04% when only tissular HBsAg was tested, and 54.29% when serum HBsAg, anti-HBs and anti-HBc were tested in all patients. Costa Rica has a low HBV markers prevalence only similar to what is found in industrial developed countries

Circulating molecular forms of parathyroid hormone in primary and secondary hyperparathyroidism

To study the circulating forms of parathyroid hormone (PTH), sera from 5 patients with primary hyperparathyroidism (PHP) and 12 patients with secondary hyperparthyroidism due the chronic renal failure (SHP) were submitted to gel filtration chromatography. The eluent samples were analyzed using two sequence-specific radioimmunoassays (RIA), one amino-terminal (NH2), the other carboxyl-terminal (COOH). The results obtained with the NH2RIA showed a single molecular form in both groups co-eluting with the intact hormone. The COOH assay identified several molecular forms with a broader distribution in the SHP patients. These results confirm the diagnostic superiority of the NH2 assay under both conditions

Influência da glicose nas soluçöes dialíticas sobre a homeostase glicêmica de pacientes renais crônicos submetidos a hemodiálise / Influence of glucose in dialytic solutions on glycemic hemeostasis of chronic renal patients submitted to hemodyalisis

Foi avaliada a influência da glicose das soluçöes dialíticas na glicemia e insulinemia de oito pacientes com insuficiência renal crônica, submetidos a programas regulares de hemodiálise. Esses pacientes foram dialisados com soluçöes contendo 200mg/dl de glicose e soluçöes sem glicose. As amostras de sangue colhidas durante a hemodiálise näo mostraram diferenças significativas ou alteraçöes importantes dos níveis de glicemia e insulinemia nos dois tipos de soluçöes

Níveis basais de triiodotironina, tiroxina, hormônio tirotrófico, tiroxina livre e triiodotironina reversa em pacientes com insuficiência renal crônica submetidos à hemodiálise / Serum levels of triiodothyronine, thyroxine, thyrotropic hormone free thyroxine and reverse triiodothyronine in patients with chronic renal insufficiency subjected to hemodialysis

Determinamos, por radioimunoensaio, as concentraçöes séricas basais de triiodotironina (T3), tiroxina (T4), hormônio tirotrófico (TSH), tiroxina livre (T4L) e triiodotironina reversa (rT3) em 21 pacientes urêmicos submetidos à hemodiálise (as amostras de sangue foram obtidas imediatamente antes da diálise) e 11 controles normais. As concentraçöes de T3 e T4 foram, freqüentemente, diminuídas (86% e 57% dos casos, respectivamente). Os níveis de rT3 foram, usualmente, normais (81%) ou reduzidos (14%). As concentraçöes de TSH e T4L foram normais em todos os casos, mesmo quando os valores de T3 e T4 estavam abaixo de seus limites normais. Concluímos que a avaliaçäo dos níveis de TSH poderia diferenciar adequadamente as alteraçöes hormonais tiróideas da IRC do hipotiroidismo primário

Radioinmunoanalisis de la hormona paratiroidea y de su fragmento carboxil terminal en la insuficiencia renal crónica / Radioinmunoalysis of parathyroid hormone and its terminal carboxil fragment in chronic kidney failure

En un grupo de veintiseis (26) pacientes con insuficiencia renal crónica en tratamiento prolongado con hemodiálisis, se le hicieron determinaciones por radioinmunoálisis de parathormona total (1-84aa), al principio y después de 6 meses de haber iniciado la diálisis, y del fragmento carboxil-terminal (PTH-C, 53-84aa). Los valores de parathormona total (1-84aa) al inicio del tratamiento de hemodiálisis fueron de promedio 3.04 ng/ml con DE 1.68 ng/ml. Seis o más meses después de haberse iniciado la hemodiálisis, la concentración de parathormona tot al (1-84aa) osciló entre 3.5 a 10.16 ng/ml, con una media de 5.77 mg/ml con DE 2.6 ng/ml (los valores normales: 0.7 a 1.3 ng/ml, media normal 0.95 ng/ml más o menos 0.14). La determinación del fragmento carboxil-terminal, en los 26 pacientes estudiados, arrojó una media de 443.69 ng/dl, con un rango que osciló entre 217-1165 ng/dl. y DE 218.43 ng/ml. Los resultados finales demostraron que los pacientes con insuficiencia renal crónica bajo hemodiálisis presentaban concentraciones de PTH-C, dos a diez veces por encima de los valores máximos normales