RESUMO
Overt hyperthyroidism was found in a 35-year-old pregnant woman at the 13th week of gestation who was referred to us for tachycardia, tremors, and weight loss. Clinical signs, symptoms, and laboratory findings led to the diagnosis of toxic thyroid nodule. She was treated with ultrasound guided percutaneous ethanol injection (PEI) and, after 2 weeks of treatment, the woman was completely euthyroid. These findings suggest that during pregnancy PEI appears to be a rapid and safe therapy for toxic nodular goiter and an effective alternative to the administration of antithyroid drugs.
Assuntos
Etanol , Hipertireoidismo/terapia , Complicações na Gravidez/terapia , Nódulo da Glândula Tireoide/terapia , Administração Cutânea , Adulto , Etanol/administração & dosagem , Feminino , Humanos , Hipertireoidismo/sangue , Hipertireoidismo/patologia , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/patologia , Hormônios Tireóideos/sangue , Nódulo da Glândula Tireoide/sangue , Nódulo da Glândula Tireoide/ultraestrutura , Tireotropina/sangueRESUMO
Systemic lupus erythematosus (SLE) has been described by many authors as a multisystem disorder involving variable and protean clinical manifestations and with an unpredictable course. We report the case of a 68-year-old woman suffering from SLE in whom tremor appeared ten years before a clinical picture suggestive of SLE and which remained the only clinical neurological sign even during overt disease. Tremor and other SLE manifestations disappeared with corticosteroid therapy.
Assuntos
Corticosteroides/uso terapêutico , Lúpus Eritematoso Sistêmico/complicações , Tremor/etiologia , Idoso , Encéfalo/diagnóstico por imagem , Feminino , Humanos , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Fatores de Tempo , Tomografia Computadorizada por Raios X , Tremor/diagnóstico por imagem , Tremor/tratamento farmacológicoRESUMO
We report the clinical, magnetic resonance imaging (MRI) and laboratory findings in 5 patients with clinical spinal cord involvement with an acute or subacute course; in two of the patients the myelitic episode preceded, in one it was concomitant to, and in two it followed the diagnosis of systemic lupus erythematosus (SLE). The marked clinical and MRI heterogeneity detected in our patients suggests that various factors may be implied in the pathogenesis of spinal cord involvement in SLE. The possibility of a future evolution to SLE should be kept in mind in women presenting spinal cord involvement with no other explanation, and should be assessed by means of extensive and repeated clinical and laboratory evaluations.
Assuntos
Lúpus Eritematoso Sistêmico/complicações , Mielite Transversa/etiologia , Medula Espinal/patologia , Adolescente , Adulto , Feminino , Humanos , Lúpus Eritematoso Sistêmico/patologia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Mielite Transversa/patologiaRESUMO
We describe four patients with Churg-Strauss syndrome admitted to the hospital in 1988. Some clinical and histological features of particular relief are present in these cases. All patients had been treated with corticosteroids and they are now in remission. Our work suggests that Churg-Strauss syndrome is not a rare disease and that an early diagnosis and appropriate therapy may influence favourably at least long term survival.
Assuntos
Síndrome de Churg-Strauss , Adulto , Idoso , Biópsia , Síndrome de Churg-Strauss/complicações , Síndrome de Churg-Strauss/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The effect in vitro of the naturally occurring flavonoid silybin on human polymorphonuclear leukocyte (PMN) functions has been studied. Preincubation of PMNs for 10 min at 37 degrees C with silybin inhibited, in a dose-dependent way, the luminol-enhanced chemiluminescence (CL) generated by stimulated cells without affecting the non-enhanced CL or superoxide anion production evaluated by the cytochrome C reduction assay. No significant effect of silybin on PMN phagocytic or chemotactic activities were found. Silybin did not absorb light at the wavelength of luminol-enhanced CL and was not toxic to PMNs at the concentrations used. Catalase, a scavenger of H2O2, inhibited luminol-enhanced CL to a similar degree as silybin; moreover, when incubated together with PMNs, silybin and catalase did not produce an additive inhibition of CL. On the contrary, the simultaneous addition of silybin and sodium azide, an inhibitor of myeloperoxidase, further increased inhibition over that seen with azide alone. These results suggest that inhibition of H2O2 may be the mechanism by which silybin inhibits the luminol-enhanced CL generated by stimulated PMNs. Such results indicate a possible anti-inflammatory activity for silybin even if their clinical relevance remains to be elucidated.
Assuntos
Flavonoides/farmacologia , Neutrófilos/efeitos dos fármacos , Silimarina/farmacologia , Azidas/farmacologia , Catalase/farmacologia , Quimiotaxia/efeitos dos fármacos , Grupo dos Citocromos c/metabolismo , Humanos , Técnicas In Vitro , Indicadores e Reagentes , Medições Luminescentes , Neutrófilos/metabolismo , Fagocitose/efeitos dos fármacos , Azida Sódica , Superóxidos/metabolismo , Xantina Oxidase/metabolismoRESUMO
The action of the new non-steroidal anti-inflammatory drug (NSAID) pirprofen on different functions of human polymorphonuclear leukocytes (PMNs) has been studied. The chemotaxis of PMNs was found to be affected by pirprofen in a dose-dependent fashion; at a concentration of 2 micrograms/ml (10 times lower than the therapeutic blood levels) it significantly inhibited PMN locomotion toward two different chemoattractants. Moreover pirprofen inhibited the chemiluminescent response in a dose- and stimulus-dependent way. In fact the drug inhibited the chemiluminescence induced by the soluble stimuli FMLP or PMA, but it was ineffective when zymosan particles were used. The phagocytosis and adhesion functions of the PMNs were not modified by pirprofen at the concentrations tested. These experimental results suggest that a reduction of the accumulation and activation of inflammatory cells in tissues may represent another way, together with cyclooxygenase inhibition, by which pirprofen realizes its antiinflammatory activity in vivo.
Assuntos
Neutrófilos/fisiologia , Fenilpropionatos/farmacologia , Adesão Celular/efeitos dos fármacos , Quimiotaxia/efeitos dos fármacos , Humanos , Medições Luminescentes , Neutrófilos/efeitos dos fármacos , Fagocitose/efeitos dos fármacosRESUMO
The aim of this report is to highlight the risk of anabolic androgenic steroid-induced gynecomastia in young men involved in nonagonistic sports and the role of ultrasonography in its diagnosis. The authors describe two cases of gynecomastia in nonprofessional weight lifters with histories of AAS use. In both cases, the diagnosis was based on patient history and clinical findings, but the sonographic examination confirmed the clinical suspicion and excluded the presence of other types of disease associated with mammary-gland enlargement in men.
Assuntos
Linfócitos T CD4-Positivos/patologia , Lúpus Eritematoso Sistêmico/imunologia , Lúpus Eritematoso Sistêmico/patologia , Esclerose Múltipla/imunologia , Esclerose Múltipla/patologia , Subpopulações de Linfócitos T/patologia , Citometria de Fluxo , Humanos , Subpopulações de Linfócitos T/imunologiaAssuntos
Neoplasias Pulmonares , Linfangiomioma , Transtornos Linfoproliferativos , Adulto , Quimioterapia Combinada , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/tratamento farmacológico , Linfangiomioma/diagnóstico por imagem , Linfangiomioma/tratamento farmacológico , Transtornos Linfoproliferativos/diagnóstico por imagem , Medroxiprogesterona/uso terapêutico , Radiografia , Tamoxifeno/uso terapêuticoRESUMO
In order to investigate dopaminergic activity in two types of human obesity, childhood- and adult-onset, we have studied the responses of plasma TSH and prolactin to domperidone, a dopamine receptor antagonist, in 12 patients obese since early childhood, 12 patients with adult-onset obesity, and in 12 lean controls. All subjects were females. In childhood-onset obese patients the responses of plasma prolactin and TSH to antidopaminergic stimulation were lower than those of adult-onset obese patients and lean controls. Conversely, the stimulus elicited a normal response of plasma prolactin and an exaggerated response of plasma TSH in adult-onset obese patients. These data indicate the presence of differing dopaminergic tone in the two types of human obesity.
Assuntos
Dopamina/metabolismo , Obesidade/metabolismo , Adolescente , Adulto , Fatores Etários , Domperidona/farmacologia , Estradiol/sangue , Feminino , Humanos , Pessoa de Meia-Idade , Progesterona/sangue , Prolactina/sangue , Tireotropina/sangue , Hormônio Liberador de Tireotropina/farmacologia , Tiroxina/sangueRESUMO
Oxygen derived free radical release from activated neutrophils may be in part responsible of tissue damage in the acute phase of inflammation. We have shown that the methane sulfonanilide antiinflammatory agent nimesulide inhibits the respiratory burst of phagocytosing neutrophils without affecting their phagocytic or chemotactic responsiveness. In fact, chemiluminescence and superoxide anion generation by polymorphonuclear leukocytes (PMN) stimulated with zymosan particles or with the synthetic peptide FMLP are inhibited by nimesulide and its 4-OH metabolite in a dose dependent fashion without affecting cell viability. The control of the extracellular flux of radical species by pharmacological compounds may affect the course of inflammation reducing tissue damage. Our data suggest that the inhibition of superoxide anion production by neutrophils is an additional mechanism of action of the antiinflammatory agent nimesulide.
Assuntos
Anti-Inflamatórios não Esteroides/farmacologia , Neutrófilos/efeitos dos fármacos , Sulfonamidas/farmacologia , Anti-Inflamatórios não Esteroides/metabolismo , Antioxidantes/farmacologia , Grupo dos Citocromos c/metabolismo , Depressão Química , Radicais Livres , Humanos , Inflamação , Medições Luminescentes , N-Formilmetionina Leucil-Fenilalanina/antagonistas & inibidores , Neutrófilos/metabolismo , Oxirredução , Oxigênio/metabolismo , Fagocitose/efeitos dos fármacos , Sulfonamidas/metabolismo , Superóxidos/biossíntese , Zimosan/antagonistas & inibidoresRESUMO
D53 (Immucytal) is a compositive vaccine made of immunogenic ribosomes extracted from 4 bacterial species (Klebsiella pneumoniae, Haemophilus influenzae, Streptococcus pyogenes and Streptococcus pneumoniae) associated with a membrane proteoglycan from a non-encapsulated strain of Klebsiella pneumoniae (MPG-Kp). In this work we have studied the effect of the compound on human polymorphonuclear leukocyte (PMN) function "in vitro". We have demonstrated that D53 was able to significantly increase Fc- receptor dependent phagocytosis without modify the C3-receptor dependent activity. Furthermore D53 enhanced the oxidative metabolism (evaluated by chemiluminescence) both using cells in resting conditions or after stimulation with phagocytable or soluble stimuli. On the contrary D53 caused a dose-dependent inhibition of PMN migration toward different chemoattractants. Using the two constitutive fractions of the compound (ribosomes and proteoglycans) we have observed that the MPG-Kp component was mainly responsible for the modulating activity of the drug on human PMNs.
Assuntos
Adjuvantes Imunológicos , Vacinas Bacterianas/farmacologia , Vacinas Anti-Haemophilus , Neutrófilos/efeitos dos fármacos , Neutrófilos/imunologia , Vacinas Pneumocócicas , Vacinas Estreptocócicas , Quimiotaxia de Leucócito/efeitos dos fármacos , Relação Dose-Resposta a Droga , Humanos , Técnicas In Vitro , Medições Luminescentes , Fagocitose/efeitos dos fármacosRESUMO
Following the diagnosis of fetal goitre at 22 and 24 weeks' gestation in two hyperthyroid pregnant women who underwent treatment with 400-500 mg of propylthiouracil in the first weeks of pregnancy, a total of seven fetal blood samplings were performed to evaluate thyroid function before and after the initiation of two different treatment regimens. L-Thyroxine (600 micrograms) was injected five times intra-amniotically in one woman and continuous maternal administration of the thyroid analogue 3, 5, 3'-triiodothyroacetic acid (Triac) was attempted in the other. Normalization of fetal thyroid function and reduction of fetal goitre were achieved in both fetuses and transplacental passage of Triac was indirectly demonstrated by high levels of free triiodothyronine in fetal blood. In cases of fetal hypothyroidism, direct or indirect prenatal therapy can be adopted successfully and safely.
Assuntos
Hipertireoidismo/tratamento farmacológico , Hipotireoidismo/embriologia , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Tiroxina/uso terapêutico , Tri-Iodotironina/análogos & derivados , Adulto , Líquido Amniótico/química , Feminino , Sangue Fetal/química , Idade Gestacional , Humanos , Hipertireoidismo/complicações , Hipotireoidismo/induzido quimicamente , Hipotireoidismo/tratamento farmacológico , Troca Materno-Fetal , Gravidez , Efeitos Tardios da Exposição Pré-Natal , Propiltiouracila/efeitos adversos , Propiltiouracila/uso terapêutico , Tireotropina/sangue , Tireotropina/efeitos dos fármacos , Tiroxina/efeitos adversos , Tiroxina/sangue , Tri-Iodotironina/efeitos adversos , Tri-Iodotironina/sangue , Tri-Iodotironina/uso terapêuticoRESUMO
We investigated the effect of RU41740, a glycoprotein extracted from Klebsiella pneumoniae and possessing immunomodulating properties, on human neutrophil functions in vitro and ex vivo. Our in vitro results showed that RU41740 increased complement- and Fc receptor-dependent phagocytosis. Moreover, the drug enhanced the oxidative metabolism (assessed by chemiluminescence) both in resting and stimulated cells; in the latter case the RU41740-induced enhancement was observed when neutrophils were stimulated with opsonized particles of N-formyl-methionyl-leucyl-phenylalanine (FMLP) but not when phorbol myristate acetate was used. Using otherwise effective experimental conditions, RU41740 did not affect spontaneous or FMLP-induced neutrophil migration. For the ex vivo experience we tested neutrophils of ten elderly subjects with a previously demonstrated phagocytic defect. These subjects were treated orally with RU41740 at a daily dose of 2 mg for 1 week during the first month, and of 1 mg for 1 week in the second month. In this population, RU41740 was able to restore the impaired phagocytic activity and to induce a significant increase of spontaneous chemiluminescence (CL); stimulated CL was also positively influenced. These effects on neutrophils provide new explanatory bases for the immunostimulatory activity of RU41740.
Assuntos
Adjuvantes Imunológicos/imunologia , Proteínas de Bactérias/farmacologia , Neutrófilos/efeitos dos fármacos , Citotoxicidade Celular Dependente de Anticorpos , Proteínas de Bactérias/imunologia , Quimiotaxia de Leucócito , Humanos , Técnicas In Vitro , Medições Luminescentes , Neutrófilos/imunologia , FagocitoseRESUMO
A 23-year-old girl with clinical and laboratory findings characteristic of chronic granulomatous disease is described. The patient was admitted to hospital because of severe disseminated aspergillosis. Studies of neutrophils showed normal phagocytosis but impaired microbicidal killing and a failure of the respiratory burst activity as measured by NBT-reduction, superoxide generation, chemiluminescence and antibody-dependent cell mediated cytotoxicity. Patient's neutrophils had normal chemotactic responsiveness but a marked impairment in the level of serum chemotactic activity was observed. Neutrophils from the parents and 2 maternal aunts showed normal values for all the determinations. The lack of evidence for a carrier state in all the family members studied together with the inability to detect a mixed population of neutrophils in our patient are in contrast with the Lyon's hypothesis of X-chromosome inactivation. Our findings suggest an autosomal recessive inheritance in this female with chronic granulomatous disease.
Assuntos
Doença Granulomatosa Crônica/imunologia , Adulto , Quimiotaxia , Citotoxicidade Imunológica , Eritrócitos/imunologia , Feminino , Doença Granulomatosa Crônica/genética , Humanos , Medições Luminescentes , Neutrófilos/imunologia , FagocitoseRESUMO
IL-10 is a cytokine with suppressive effects on (auto) antigen presentation and T-cell-mediated immune reactions, but is also capable of stimulating polyclonal IgG synthesis. Recent evidence suggests its involvement in multiple sclerosis (MS) and systemic lupus erythematosus (SLE). We assessed PBMNC IL-10 release in MS and SLE patients before and after in vivo prednisone or methylprednisolone treatment. The SLE patients showed a high level of IL-10 release by unstimulated PBMNCs, whereas the PHA-stimulated PBMNCs from MS patients produced large amounts of the cytokine.