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Sample records for insuficiencia respiratoria grave

  1. Graves' Disease

    MedlinePlus

    ... sheet Hashimoto's disease fact sheet Illnesses and disabilities Lupus fact sheet What is Graves' disease? What are the symptoms of Graves' disease? Who gets Graves' disease? What causes Graves' disease? How do I find out if ...

  2. Graves disease

    MedlinePlus

    ... is called hyperthyroidism . (An underactive thyroid leads to hypothyroidism .) Graves disease is the most common cause of ... radioactive iodine often will cause an underactive thyroid (hypothyroidism). Without getting the correct dosage of thyroid hormone ...

  3. Graves' ophthalmopathy.

    PubMed Central

    Wall, J R; Henderson, J; Strakosch, C R; Joyner, D M

    1981-01-01

    Graves' ophthalmopathy usually occurs in association with hyperthyroidism. Its occasional occurrence in the absence of thyroid disease suggests, however, that it may be a separate autoimmune disorder. While the evidence supporting an autoimmune pathogenesis is considerable for the ophthalmopathy, it is not so impressive as that for Graves' hyperthyroidism: orbital antibodies have not been convincingly demonstrated and autoantigens have not been identified. On the other hand, in patients with Graves' ophthalmopathy the orbital tissues and eye muscle membranes are infiltrated with lymphoid cells and show evidence of cell-mediated immune reactions. Although there is some evidence that binding of thyroid stimulating hormone fragments and thyroglobulin-antithyroglobulin immune complexes to eye muscle membranes may be important in the pathogenesis of the ophthalmopathy, this needs to be confirmed. The mechanism for the association of hyperthyroidism and ophthalmopathy is unknown, but the association likely reflects an influence of thyroid hormones on the immune system. In view of the autoimmune pathogenesis the logical treatment of Graves' ophthalmopathy appears to be immunosuppression. PMID:7011529

  4. [Graves' ophthalmopathy].

    PubMed

    Eckstein, A; Dekowski, D; Führer-Sakel, D; Berchner-Pfannschmidt, U; Esser, J

    2016-04-01

    Graves' orbitopathy (GO) is the main extrathyroidal manifestation of Graves' disease and the full clinical picture can impair the quality of life of the patients considerably. Active inflammation can often be effectively treated by intravenous steroids/immunosuppression, however does not lead to full remission, since inflammation rather quickly results in irreversible fibrosis and increase of orbital fat. Very important is the control of risk factors (smoking cessation, good control of thyroid function, selenium supplementation) to prevent progression to severe stages. Treatment should rely on a thorough assessment of activity and severity of GO. Rehabilitative surgery (orbital decompression, squint surgery, eyelid surgery) is needed in many patients to restore function and appearance. Anti-thyroid-stimulating hormone (TSH) receptor antibodies do specifically occur in these patients and correlate to the course of thyroid and eye disease. The levels of these antibodies can be used for treatment decisions at certain time points of the disease.

  5. Don Graves Remembered

    ERIC Educational Resources Information Center

    Romano, Tom

    2011-01-01

    Don Graves died Tuesday, September 28, 2010. In the early 1980s, Don blew open the door to teaching children to write. His qualitative research and subsequent 26 books transformed the teaching of writing in elementary schools. He showed how much could be learned by the simple, powerful strategy of sitting beside children and asking them about…

  6. Graves orbitopathy: a perspective.

    PubMed

    Perros, Petros; Krassas, Gerasimos E

    2009-06-01

    Advances in the past few years have helped clinicians understand some of the pathogenetic mechanisms of Graves orbitopathy (GO), particularly the role of receptors for TSH and insulin-like growth factor I in the orbit. Optimal treatment strategies have been formulated and published by the European Group on Graves' Orbitopathy, which are hoped to improve the management of patients with this condition. The administration of intravenous pulses of steroids has been established as a superior treatment approach compared with other steroid regimens. In addition, orbital radiotherapy was effective in a subgroup of patients with GO who had eye dysmotility. The use of immunotherapies for the treatment of GO is currently being explored; of these, rituximab has emerged as a promising new agent.

  7. Graves Registration Simulation.

    DTIC Science & Technology

    1987-11-01

    being evacuated to insure that personal effects are safeguarded and that the remains receive proper treatment while enroute. The vehicle transporting...documentation 20 Remove clothing and examine 15 Fingerprint remains 30 Perform detailed ID; consists of anatomical, dental, and/or skeletal charting...anatomical, skeletal . 9 Shroud remains. . 10 Prepare embossed plates and tags; attach. 11 Move remains to holding area. 12 Open grave. 13 Move remains to

  8. [Radiotherapy for Graves' ophthalmopathy].

    PubMed

    Kuhnt, T; Müller, A C; Janich, M; Gerlach, R; Hädecke, J; Duncker, G I W; Dunst, J

    2004-11-01

    Graves' ophthalmopathy (GO) is the most frequent extrathyroidal manifestation of Graves' disease, an autoimmune disorder of the thyroid, whereas the precise pathogenesis still remains unclear. In Hashimoto's thyroiditis the occurrence of proptosis is an extremely rare event. The therapy for middle and severe courses of GO shows in partly disappointing results, although several therapy modalities are possible (glucocorticoid therapy, radiotherapy, antithyroid drug treatment, surgery). All these therapies lead in only 40 - 70 % to an improvement of the pathogenic symptoms. An intensive interdisciplinary cooperation is necessary to satisfy the requirements for the treatment of Graves' ophthalmopathy. As a consequence of the very different results of the few of clinical studies that were accomplished with reference to this topic, treatment by radiotherapy in the management of the disease is presently controversially discussed. In the German-speaking countries the radiotherapy is, however, firmly established as a therapy option in the treatment of the moderate disease classes (class 2-5 according to NO SPECS), especially if diplopia is present. This article describes the sequences, dosages and fractionation schemes as well as the risks and side effects of the radiotherapy. Altogether, radiotherapy is assessed as an effective and sure method. The administration of glucocorticoids can take place before the beginning of or during the radiotherapy. For the success of treatment the correct selection of patients who may possibly profit from a radiotherapy is absolutely essential. By realising that GO proceeds normally over a period of 2-5 years, which is followed by a period of fibrotic alteration, the application of the radiotherapy in the early, active phase is indispensable. A precise explanation for the effects of radiotherapy in treatment of the GO does not exist at present. The determination of the most effective irradiation doses was made from retrospectively evaluated

  9. Epidemiology of Graves' orbitopathy.

    PubMed

    Putta-Manohar, Sudeep; Perros, Petros

    2010-03-01

    Thyroid orbitopathy is a relatively rare disease. Prevalence data are lacking and can only be estimated. The incidence of thyroid orbitopathy has been documented in one American study (16 cases per 100,000 population per year for females and 2.9 cases per 100,000 population for males). Thyroid orbitopathy can affect every race and age group. The majority of patients present in middle age with concurrent thyrotoxicosis due to Graves' disease. The onset of orbitopathy usually coincides with the hyperthyroidism, though the two may be asynchronous by months or sometimes years. A small proportion of patients with thyroid orbitopathy have primary hypothyroidism or are euthyroid. Female patients outnumber males by 2-5 to 1. Smoking increases the risk of thyroid orbitopathy up to 8-fold.

  10. Hashimoto's thyroiditis following Graves' disease.

    PubMed

    Umar, Husaini; Muallima, Nur; Adam, John M F; Sanusi, Harsinen

    2010-01-01

    Both Graves' disease and chronic thyroiditis (Hashimoto's thyroiditis) are autoimmune diseases of thyroid gland. Graves' disease is caused by stimulation of TSH receptor located on the thyroid gland by an antibody, which is known as TSH receptor antibody (TRAb). Furthermore, this may lead to hyperplasia and hyperfunction of the thyroid gland. On the contrary, the cause of Hashimoto's thyroiditis is thought due to a TSH stimulation-blocking antibody (TSBAb) which blocks the action of TSH hormone and subsequently brings damage and atrophy to thyroid gland. Approximately 15-20% of patients with Graves' disease had been reported to have spontaneous hypothyroidism resulting from the chronic thyroiditis (Hashimoto's disease). Pathogenesis for chronic thyroiditis following anti-thyroid drug treatment in patients with Graves' disease remains unclear. It has been estimated that chronic thyroiditis or Hashimoto's disease, which occurs following the Graves' disease episode is due to extended immune response in Graves' disease. It includes the immune response to endogenous thyroid antigens, i.e. thyroid peroxidase and thyroglobulin, which may enhance lymphocyte infiltration and finally causes Hashimoto's thyroiditis. We report four cases of chronic thyroiditis (Hashimoto's disease) in patients who have been previously diagnosed with Graves' hyperthyroidism. In three cases, Hashimoto's thyroiditis occurs in 7 to 25 years after the treatment of Grave's disease; while the other case has it only after few months of Grave's disease treatment. The diagnosis of Hashimoto's disease (chronic thyroiditis) was based on clinical manifestation, high TSHs level, positive thyroid peroxidase antibody and thyroglobulin antibody, and supported by positive results of fine needle aspiration biopsy. Moreover, the result of histopathological test has also confirmed the diagnosis in two cases. All cases have been successfully treated by levothyroxine treatment.

  11. Genetics Home Reference: Graves disease

    MedlinePlus

    ... develop an enlargement of the thyroid called a goiter. Depending on its size, the enlarged thyroid can ... Condition autoimmune hyperthyroidism Basedow disease Basedow's disease exophthalmic goiter Graves' disease toxic diffuse goiter Related Information How ...

  12. Natural history of graves' orbitopathy after treatment.

    PubMed

    Menconi, Francesca; Leo, Marenza; Sabini, Elena; Mautone, Teresa; Nardi, Marco; Sainato, Aldo; Sellari-Franceschini, Stefano; Vitti, Paolo; Marcocci, Claudio; Marinò, Michele

    2016-10-05

    Intravenous glucocorticoids are used for Graves' orbitopathy, alone or associated with/followed by additional treatments (orbital radiotherapy, orbital decompression, palpebral or eye surgery). However, the relation between associated/additional treatments and other variables with Graves' orbitopathy outcome following intravenous glucocorticoids is not clear. Thus, the present study was conducted to investigate retrospectively the impact of associated/additional treatments and other variables on Graves' orbitopathy outcome after intravenous glucocorticoids. We evaluated 226 untreated Graves' orbitopathy patients. Following first observation, patients were given intravenous glucocorticoids and re-examined after a median of 46.5 months. The end-points were the relation between Graves' orbitopathy outcome, outcome of NOSPECS score and of the single Graves' orbitopathy features with several variables, including associated/additional treatments. All Graves' orbitopathy features improved significantly after treatment. Overall, Graves' orbitopathy improved in ~60 % of patients (responders), whereas it was stable or worsened in ~40 % of patients (non-responders). Time between first and last observation and clinical activity score at first observation correlated significantly with Graves' orbitopathy outcome. The outcomes of NOSPECS, eyelid aperture, clinical activity score and diplopia correlated with time between the first and last observation. The NOSPECS outcome correlated with gender. The outcomes of proptosis, eyelid aperture and visual acuity correlated with orbital decompression. The outcome of diplopia correlated with orbital radiotherapy. Taking into account the limitations of retrospective investigations, our findings confirm that time (i.e. the natural history of Graves' orbitopathy) is a key factor in determining the long-term outcome of Graves' orbitopathy, radiotherapy is effective for diplopia, and orbital decompression is followed by an amelioration of

  13. [Novel treatment opportunities in Graves' orbitopathy].

    PubMed

    Erdei, Annamária; Gazdag, Annamária; Bodor, Miklós; Berta, Eszter; Katkó, Mónika; Ujhelyi, Bernadett; Steiber, Zita; Győry, Ferenc; Urbancsek, Hilda; Barna, Sándor; Galuska, László; Nagy, V Endre

    2014-08-17

    Graves' orbitopathy is the most common extrathyroidal manifestation of Graves' disease. Up to now, curative treatment modalities for the most severe sight-threatening cases have not been developed. Here the authors summarize the treatment protocol of Graves' orbitopathy and review novel therapeutic options. They review the literature on this topic and present their own clinical experience. The authors point out that anti-CD20 antibody could positively influence the clinical course of Graves' orbitopathy. Selenium is efficient in mild cases. Further prospective investigations are warranted.

  14. Biventricular Takotsubo cardiomyopathy in Graves hyperthyroidism.

    PubMed

    Perkins, Matthew J; Schachter, David T

    2014-03-01

    Graves hyperthyroidism is commonly seen in clinical practice and Takotsubo stress cardiomyopathy is an increasingly recognized cardiac complication of physical or emotional stress. We report the rare case of a patient with Graves hyperthyroidism that was complicated by severe biventricular takotsubo cardiomyopathy, which was demonstrated on heart catheterization. After appropriate pharmacologic treatment of her hyperthyroidism, she had complete resolution of her cardiomyopathy.

  15. Dermopathy of Graves' disease: Clinico-pathological correlation.

    PubMed

    Reddy, Sagili Vijaya Bhaskar; Gupta, Sushil Kumar; Jain, Manoj

    2012-05-01

    Dermopathy of Graves' disease is a classical, but uncommon extrathyroidal manifestation of Graves' disease. The images of a typical case of dermopathy of Graves' disease are presented along with clinico-pathological correlation.

  16. Dendritic cells in Graves' disease.

    PubMed

    Purnamasari, Dyah; Soewondo, Pradana; Djauzi, Samsuridjal

    2015-01-01

    Dendritic cells are major antigen-presenting cells (APC) that stimulate naive T cells, which induce adaptive immune responses. Graves' disease (GD) is an autoimmune disease characterized by the presence of autoantibodies against Thyroid Stimulating Hormone Receptor (TSHR). The autoantibodies bind with TSHR and stimulate thyroid hormone production. Dendritic cells are still the major APC in GD immune response although thyrocytes in GD can also express Major Histocompatibility Class (MHC) class II molecule. Studies about DC in GD have been conducted by isolating intra-thyroid DC or DC in peripheral circulation. Results of DC studies in GD are still controversial. Changes in number and profile of DC are found, which indicate altered immune response activity and defects of regulator T cell (Treg) in GD.

  17. Current treatment of Graves' disease

    SciTech Connect

    Harada, T.; Shimaoka, K.; Mimura, T.; Ito, K.

    1987-04-01

    In this review we have described the rationale for the appropriate treatment of patients with Graves' disease. Because the etiology of this disorder remains obscure, its management remains controversial. Since antithyroid drugs and radioiodine became readily available in the early 1950s, they have been widely used for the treatment of thyrotoxicosis, and the number of cases treated surgically has markedly decreased. However, almost four decades of experience have disclosed an unexpectedly high incidence of delayed hypothyroidism after radioiodine treatment and a low remission rate after antithyroid therapy. As a result, surgery is again being advocated as the treatment of choice. The three modalities of treatment have different advantages and disadvantages, and selection of treatment is of importance. In principle, we believe that for most patients a subtotal thyroidectomy should be performed after the patient has been rendered euthyroid by antithyroid drugs. We attempt to leave a thyroid remnant of 6 to 8 gm.36 references.

  18. [Differential diagnosis of Graves' orbitopathy. Case report].

    PubMed

    Erdei, Annamária; Steiber, Zita; Gazdag, Annamária; Bodor, Miklós; Berta, Eszter; Szász, Róbert; Szántó, Antónia; Ujhelyi, Bernadett; Barna, Sándor; Berényi, Ervin; Nagy, V Endre

    2016-02-21

    Graves' orbitopathy is the extrathyroidal manifestation of Graves' disease, which is the most common cause of exophthalmos. As eye symptoms usually coincide with the development of thyrotoxicosis, the diagnosis of the disease is rarely difficult. The aim of the authors was to summarize the differential diagnosis of Graves' orbitopathy based on literature review and presentation of their own four problematic cases on this topic. They conclude that symptoms similar to endocrine orbitopathy are present in other disorders. Endocrinologists need to be aware of these other conditions to avoid treatment failures.

  19. [Neonatal hyperthyroidism and maternal Graves disease].

    PubMed

    Ben Ameur, K; Chioukh, F Z; Marmouch, H; Ben Hamida, H; Bizid, M; Monastiri, K

    2015-04-01

    The onset of Graves disease during pregnancy exposes the neonate to the risk of hyperthyroidism. The newborn must be monitored and treatment modalities known to ensure early treatment of the newborn. We report on the case of an infant born at term of a mother with Graves disease discovered during pregnancy. He was asymptomatic during the first days of life, before declaring the disease. Neonatal hyperthyroidism was confirmed by hormonal assays. Hyperthyroidism was treated with antithyroid drugs and propranolol with a satisfactory clinical and biological course. Neonatal hyperthyroidism should be systematically sought in infants born to a mother with Graves disease. The absence of clinical signs during the first days of life does not exclude the diagnosis. The duration of monitoring should be decided according to the results of the first hormonal balance tests.

  20. Left ventricular noncompaction diagnosed following Graves' disease

    PubMed Central

    Habib, Habib; Hawatmeh, Amer; Rampal, Upamanyu; Shamoon, Fayez

    2016-01-01

    Isolated left ventricular noncompaction (LVNC) is a rare genetic cardiomyopathy. Clinical manifestations are variable; patients may present with heart failure symptoms, arrhythmias, and systemic thromboembolism. However, it can also be asymptomatic. When asymptomatic, LVNC can manifest later in life after the onset of another unrelated condition. We report a case of LVNC which was diagnosed following a hyperthyroid state secondary to Graves' disease. The association of LVNC with other noncardiac abnormalities including neurological, hematological, and endocrine abnormalities including hypothyroidism has been described in isolated case reports before. To the best of our knowledge, this is the first reported case of LVNC diagnosed following exacerbation in contractile dysfunction triggered by Graves' disease. PMID:27843800

  1. Elephantiasis Nostras Verrucosa: a rare thyroid dermopathy in Graves' disease.

    PubMed

    Kakati, S; Doley, B; Pal, S; Deka, U J

    2005-06-01

    Elephantiasis Nostras Verrucosa (ENV) is a rare form of pretibial myxedema, which is nearly always associated with Graves' disease. A case is presented here of Graves' disease who had elephantiasis variety of pre-tibial myxedema (PTM).

  2. Perspective view of Chapel from west at grave area A. ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Perspective view of Chapel from west at grave area A. Note squared English yew hedge that provides a backdrop for each of the four grave areas. - Flanders Field American Cemetery & Memorial, Wortegemseweg 117, Waregem, West Flanders (Belgium)

  3. Graves' disease: thyroid function and immunologic activity

    SciTech Connect

    Gossage, A.A.; Crawley, J.C.; Copping, S.; Hinge, D.; Himsworth, R.L.

    1982-11-01

    Patients with Graves' disease were studied for two years during and after a twelve-month course of treatment. Disease activity was determined by repeated measurements of thyroidal uptake of (/sup 99m/Tc)pertechnetate during tri-iodothyronine administration. These in-vivo measurements of thyroid stimulation were compared with the results of in-vitro assays of Graves, immunoglobulin (TSH binding inhibitory activity--TBIA). There was no correlation between the thyroid uptake and TBIA on diagnosis. Pertechnetate uptake and TBIA both declined during the twelve months of antithyroid therapy. TBIA was detectable in sera from 19 of the 27 patients at diagnosis; in 11 of these 19 patients there was a good correlation (p less than 0.05) throughout the course of their disease between the laboratory assay of the Graves, immunoglobulin and the thyroid uptake. Probability of recurrence can be assessed but sustained remission of Graves' disease after treatment cannot be predicted from either measurement alone or in combination.

  4. Finding the Heartbeat: Applying Donald Graves's Approaches and Theories

    ERIC Educational Resources Information Center

    Koshewa, Allen

    2011-01-01

    Donald Graves's early professional books inspired Koshewa to look more deeply into student writing during the 1980s, and to value all phases of the writing process. Graves's perspective on uncovering and celebrating voice elevated Koshewa's writing instruction to a new plane. In this article, he writes about the impact that Donald Graves's work…

  5. Severe eyelid oedema in Graves' ophthalmopathy.

    PubMed

    Anagnostis, Panagiotis; Adamidou, Fotini; Poulasouchidou, Maria; Karras, Spyridon

    2013-07-13

    We report a case of severe eyelid oedema due to Graves' ophthalmopathy (GO). The aim was to present a case report and review of the literature about eyelid oedema due to GO. The case report includes a history of patient data and literature review. The patient was offered intravenous methylprednisolone and gave consent. A dosage of 500 mg intravenous methylprednisolone once weekly for 6 weeks, followed by 250 mg intravenous methylprednisolone once weekly for 6 weeks, with a total treatment period of 12 weeks was given. Up to day, minor improvement has been observed. Severe eyelid oedema due to GO is a rare manifestation of Graves' disease. In cases of active and moderate-to-severe disease, treatment with intravenous glucorticoids is recommended alone or with orbital radiotherapy, followed by rehabilitative surgery.

  6. Diagnosis and classification of Graves' disease.

    PubMed

    Menconi, Francesca; Marcocci, Claudio; Marinò, Michele

    2014-01-01

    Graves' disease (GD) is an autoimmune disorder involving the thyroid gland, typically characterized by the presence of circulating autoantibodies that bind to and stimulate the thyroid hormone receptor (TSHR), resulting in hyperthyroidism and goiter. Organs other than the thyroid can also be affected, leading to the extrathyroidal manifestations of GD, namely Graves' ophthalmopathy, which is observed in ~50% of patients, and Graves' dermopathy and acropachy, which are quite rare. Presumably, the extrathyroidal manifestations of GD are due to autoimmunity against antigens common to the thyroid and other affected organs. Although its exact etiology remains to be completely understood, GD is believed to result from a complex interaction between genetic susceptibility and environmental factors. Clinically, GD is characterized by the manifestations of thyrotoxicosis as well as by its extrathyroidal features when present, the latter making the diagnosis almost unmistakable. In the absence of ophthalmopathy, the diagnosis is generally based on the association of hyperthyroidism and usually diffuse goiter confirmed with serum anti-TSHR autoantibodies (TRAbs). Hyperthyroidism is generally treated with anti-thyroid drugs, but a common long term treatment strategy in patients relapsing after a course of anti-thyroid drugs (60-70%), implies the use of radioactive iodine or surgery.

  7. Time-lapse resistivity surveys over simulated clandestine graves.

    PubMed

    Jervis, John R; Pringle, Jamie K; Tuckwell, George W

    2009-11-20

    The aim of this study was to develop a better understanding of how electrical resistivity surveys can be used to locate clandestine graves. Resistivity surveys were conducted regularly over three simulated clandestine graves containing a pig cadaver, no cadaver and a pig cadaver wrapped in tarpaulin, respectively. Additionally, soil and groundwater samples were collected from two more simulated graves outside the survey area. The grave containing a pig cadaver was detectable from a low resistivity anomaly in the survey data. Groundwater data suggest that the resistivity anomaly associated with the surveyed pig grave was caused by a localised increase in groundwater conductivity. Wrapping a cadaver was found to initially change the resistivity response of a grave to a high resistivity anomaly. Resistivity surveys did not detect the disturbed soil in the grave that did not contain a cadaver. Although soil samples showed grave soil to be more porous than undisturbed soil, the lack of response from the grave that did not contain a cadaver suggests that disturbed soil was not responsible for the resistivity anomalies observed in this study. Resistivity surveys successfully detected all graves containing cadavers throughout the study, whilst also showing the potential to eliminate the need for mass excavation in a genuine search.

  8. Graves' disease. Manifestations and therapeutic options

    SciTech Connect

    McFarland, K.F.; Saleeby, G.

    1988-03-01

    Graves' disease is the most common cause of hyperthyroidism. Clinical features include thyroid enlargement, eye signs, tachycardia, heat intolerance, emotional lability, weight loss, and hyperkinesis. Three modes of therapy are available. The preferences of the patient and physician are usually prime considerations in devising the therapeutic plan. Radioactive iodine is the most frequently used and safest method of treatment for adults. Antithyroid drugs are preferred for children and pregnant women. Surgery is usually reserved for patients in whom the other forms of treatment are not acceptable. Considerable patient education during the decision-making process enhances the success of the therapeutic plan.

  9. Graves Disease Is Associated With Endometriosis

    PubMed Central

    Yuk, Jin-Sung; Park, Eun-Ju; Seo, Yong-Soo; Kim, Hee Jin; Kwon, Seon-Young; Park, Won I.

    2016-01-01

    Abstract The aim of this cross-sectional study was to compare the prevalence of thyroid diseases between women with and without endometriosis. We established the endometriosis group according to diagnosis codes, surgery codes, and gonadotropin-releasing hormone agonist codes using the Korean Health Insurance Review and Assessment Service—National Inpatients Sample (HIRA-NIS) from 2009 to 2011. Four controls were randomly matched to each endometriosis case. Thyroid disease cases were selected using the thyroid disease diagnosis code (E0X). Among the 1,843,451 women sampled, 5615 had endometriosis; 22,460 controls were matched to the endometriosis cases. After adjustment for age and sampling year, Graves disease was associated with endometriosis (odds ratio [OR]: 2.52; 95% CI: 1.30–4.88; P < 0.01), while hypothyroidism was not (OR: 1.17; 95% CI: 0.90–1.52; P = 0.25). Autoimmune hypothyroidism was also not associated with endometriosis (OR: 1.61; 95% CI: 0.88–2.94; P = 0.12). This study revealed an association between Graves disease and endometriosis. PMID:26962803

  10. Donald Graves in Australia--"Children Want to Write ..."

    ERIC Educational Resources Information Center

    Walshe, R. D., Ed.

    The articles in this collection are intended to present a detailed picture of the work of Donald Graves and his associates at the Writing Process Laboratory (WPL) of the University of New Hampshire. The introduction provides an overview of the work of Graves and examines his views of beginning writing, writing conferences, revision, audience, and…

  11. YARD NO. 3 BASINS (GRAVING DOCKS), VIEW TO EASTNORTHEAST AT ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    YARD NO. 3 BASINS (GRAVING DOCKS), VIEW TO EAST-NORTHEAST AT THE SOUTH END OF THE CRANEWAY AND GALLERY BETWEEN BASINS NO. 1 AND 2, LOOKING ACROSS SOUTH END OF BASIN NO. 1 (THE WESTERN-MOST BASIN) - Rosie the Riveter National Historical Park, Graving Docks, Shipyard No. 3, Richmond, Contra Costa County, CA

  12. Nicotinamide phosphoribosyltransferase leukocyte overexpression in Graves' opthalmopathy.

    PubMed

    Sawicka-Gutaj, Nadia; Budny, Bartłomiej; Zybek-Kocik, Ariadna; Sowiński, Jerzy; Ziemnicka, Katarzyna; Waligórska-Stachura, Joanna; Ruchała, Marek

    2016-08-01

    To investigate the role of NAMPT/visfatin in euthyroid patients with Graves' disease without (GD) and with Graves' ophthalmopathy (GO), we analyzed NAMPT leukocyte expression and its serum concentration. This was a single-center, cross-sectional study with consecutive enrollment. In total, 149 patients diagnosed with Graves' disease were enrolled in the study. We excluded subjects with hyper- or hypothyroidism, diabetes mellitus, other autoimmune disorders, active neoplastic disease, and infection. The control group was recruited among healthy volunteers adjusted for age, sex, and BMI with normal thyroid function and negative thyroid antibodies. Serum levels of visfatin, TSH, FT4, FT3, antibodies against TSH receptor (TRAb), antithyroperoxidase antibodies, antithyroglobulin antibodies, fasting glucose, and insulin were measured. NAMPT mRNA leukocyte expression was assessed using RT-qPCR. NAMPT/visfatin serum concentration was higher in GD (n = 44) and GO (n = 49) patients than in the control group (n = 40) (p = 0.0275). NAMPT leukocyte expression was higher in patients with GO (n = 30) than in GD patients (n = 27) and the control group (n = 29) (p < 0.0001). Simple linear regression analysis revealed that NAMPT/visfatin serum concentration was significantly associated with GD (β = 1.5723; p = 0.021). When NAMPT leukocyte expression was used as a dependent variable, simple regression analysis found association with TRAb, fasting insulin level, HOMA-IR, GD, and GO. In the stepwise multiple regression analysis, we confirmed the association between higher serum NAMPT/visfatin level and GD (coefficient = 1.5723; p = 0.0212), and between NAMPT leukocyte expression and GO (coefficient = 2.4619; p = 0.0001) and TRAb (coefficient = 0.08742; p = 0.006). Increased NAMPT leukocyte expression in patients with GO might suggest a presently undefined role in the pathogenesis of GO.

  13. 75 FR 13140 - Native American Graves Protection and Repatriation Review Committee: Nomination Solicitation

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-18

    ... National Park Service Native American Graves Protection and Repatriation Review Committee: Nomination Solicitation AGENCY: National Park Service, Interior. ACTION: Native American Graves Protection and... nominations for one member of the Native American Graves Protection and Repatriation Review Committee....

  14. 75 FR 65030 - Native American Graves Protection and Repatriation Review Committee: Nomination Solicitation

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-21

    ... National Park Service Native American Graves Protection and Repatriation Review Committee: Nomination Solicitation AGENCY: National Park Service, Interior. ACTION: Native American Graves Protection and... nominations for two members of the Native American Graves Protection and Repatriation Review Committee....

  15. Graves' Disease that Developed Shortly after Surgery for Thyroid Cancer.

    PubMed

    Yu, Hea Min; Park, Soon Hyun; Lee, Jae Min; Park, Kang Seo

    2013-09-01

    Graves' disease is an autoimmune disorder that may present with various clinical manifestations of hyperthyroidism. Patients with Graves' disease have a greater number of thyroid nodules and a higher incidence of thyroid cancer compared with patients with normal thyroid activity. However, cases in which patients are diagnosed with recurrence of Graves' disease shortly after partial thyroidectomy for thyroid cancer are very rare. Here we report a case of hyperthyroid Graves' disease that occurred after partial thyroidectomy for papillary thyroid cancer. In this case, the patient developed hyperthyroidism 9 months after right hemithyroidectomy, and antithyroglobulin autoantibody and thyroid stimulating hormone receptor stimulating autoantibody were positive. Therefore, we diagnosed Graves' disease on the basis of the laboratory test results and thyroid ultrasonography findings. The patient was treated with and maintained on antithyroid drugs. The mechanism of the recurrence of Graves' disease in this patient is still unclear. The mechanism may have been the improper response of the immune system after partial thyroidectomy. To precisely determine the mechanisms in Graves' disease after partial thyroidectomy, further studies based on a greater number of cases are needed.

  16. Orbital dissection defatting technique for Graves disease.

    PubMed

    Hecht, S D; Guibor, P; Wolfley, D; Wiggs, E O

    1984-04-01

    Five patients with Graves disease and bilateral proptosis were treated with different incisional approaches. They all underwent orbital decompression by removal of the anterior medial orbital walls, the anterior ethmoidal sinuses, the orbital floors, and multiple incisions of the orbital periosteums . The defatting technique, which consists of applying manual anterior orbital pressure with alternate removing of small lobules of fat, was added when it was intraoperatively decided by Hertel exophthalmometer measurement that more decompression was needed. It is estimated that one-third more reduction in proptosis resulted. An average total decrease in proptosis of 9 mm per orbit occurred. Both visual accuities and visual fields returned to normal. The only important complication was the development of hypertropia in down gaze in one patient. A potential value of this technique is its use with orbital floor decompression alone. It may be possible to avoid removing the medial and lateral walls of the orbit, thereby decreasing complications. Defatting may also be a valuable addition in those rare cases where all decompression techniques available are needed to affect an adequate decompression.

  17. Delineation of graves using electrical resistivity tomography

    NASA Astrophysics Data System (ADS)

    Nero, Callistus; Aning, Akwasi Acheampong; Danuor, Sylvester K.; Noye, Reginald M.

    2016-03-01

    A suspected old royal cemetery has been surveyed at the Kwame Nkrumah University of Science and Technology (KNUST) campus, Kumasi, Ghana using Electrical Resistivity Tomography (ERT) with the objective of detecting graves in order to make informed decisions with regard to the future use of the area. The survey was conducted on a 10,000 m2 area. Continuous Vertical Electrical Sounding (CVES) was combined with the roll along technique for 51 profiles with 1 m probe separation separated by 2 m. Inverted data results indicated wide resistivity variations ranging between 9.34 Ωm and 600 Ωm in the near surface. Such heterogeneity suggests a disturbance of the soil at this level. Both high (≥ 600 Ωm) and low resistivity (≤ 74.7 Ωm) anomalies, relative to background levels, were identified within the first 4 m of the subsurface. These were suspected to be burial tombs because of their rectangular geometries and resistivity contrasts. The results were validated with forward numerical modeling results. The study area is therefore an old cemetery and should be preserved as a cultural heritage site.

  18. Concurrence of Grave's disease and Hashimoto's thyroiditis.

    PubMed Central

    Sato, T; Takata, I; Taketani, T; Saida, K; Nakajima, H

    1977-01-01

    Early histological changes in the thyroid gland were examined in 30 patients with juvenile thyrotoxicosis, by means of needle biopsy. Based on the degree of lymphocytic infiltration and degenerative changes in follicular epithelium, results were classified into four groups. A: hyperplastic changes without cellular infiltration (6 patients, 20%); B: hyperplastic changes with areas of focal thyroiditis less than 30% of specimen (10 patients, 33%); C: those with 30 to 60% areas ot thyroiditis (10 patients, 33%); D: almost diffuse thyroiditis (4 patients, 13%). Moderate to severe lymphocytic thyroiditis was frequently present in the early stage of hyperplastic thyroid glands. The clinical significance of the 4 histological groups was evaluated. Neither clinical signs nor routine laboratory tests could differentiate these groups except group D, in which thyrotoxic signs were mild and transient. However, serum antithyroid antibodies tended to increase in accordance with severity of thyroiditis. The rate of remission was high in groups C and D, whereas relapse was frequent in group A. These results suggest that Grave's disease and chronic lymphocytic thyroiditis are closely related in the early stage of thyrotoxicosis in children, and that the clinical course may be considerably altered by the degree of associated thyroiditis. Images Fig. 1 Fig. 2 Fig. 3 Fig. 3 PMID:580172

  19. Chronic idiopathic urticaria and Graves' disease.

    PubMed

    Ruggeri, R M; Imbesi, S; Saitta, S; Campennì, A; Cannavò, S; Trimarchi, F; Gangemi, S

    2013-01-01

    Chronic urticaria is a common condition characterized by recurrent episodes of mast cell-driven wheal and flare-type skin reactions lasting for more than 6 weeks. In about 75% of cases, the underlying causes remain unknown, and the term chronic idiopathic urticaria (CIU) is used to emphasize that wheals develop independently of identified external stimuli. Although CIU affects about 1.0% of the general population, its etiopathogenesis is not yet well understood. It is now widely accepted that in many cases CIU should be regarded as an autoimmune disorder caused by circulating and functionally active IgG autoantibodies specific for the IgE receptor (FceRI) present on mast cells and basophils or for IgE itself. The well-known association of CIU with other autoimmune processes/diseases represents further indirect evidence of its autoimmune origin. Autoimmune thyroid diseases, especially autoimmune thyroiditis, represent the most frequently investigated diseases in association with CIU. Here we review this topic with particular regard to the association between Graves' disease and CIU. The possible pathogenetic mechanisms and the clinical implications of such an association are discussed.

  20. Fly Ash: From Cradle to Grave

    USGS Publications Warehouse

    Ellis, Margaret S.; Affolter, Ronald H.

    2007-01-01

    The Energy Resources Program of the U.S. Geological Survey promotes and supports coal research to improve the understanding of the coal endowment of the United States. This results in geologically based, non-biased energy information products for policy and decision makers, land and resource managers, other federal and state agencies, the domestic energy industry, foreign governments, nongovernmental groups, academia, and other scientists. A more integrated approach to our coal quality work involves what we call a 'cradle to grave' approach. These types of studies focus not on just one aspect of the coal but rather on how or where different quality parameters form and (or) occur and what happens to them through the mining, production, transport, utilization and waste disposal process. An extensive suite of coal quality analyses, mineralogical, petrology, and leaching investigations are determined on samples taken from the different phases of the coal utilization process. This report consists of a tutorial that was given on June 10, 2007 at the 32nd International Technical Conference on Coal Utilization & Fuel Systems, The Power of Coal, Clearwater Coal Conference in Clearwater, Florida, USA. This tutorial covers how these studies are conducted and the importance of providing improved, comprehensive, science-based data sets for policy and decision makers.

  1. 1. OVERVIEW WITH WILLIAM MORRIS GRAVE MONUMENT, THE INSCRIPTION ON ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    1. OVERVIEW WITH WILLIAM MORRIS GRAVE MONUMENT, THE INSCRIPTION ON WHICH READS: 'GOD'S FINGER TOUCHED HIM AND HE SLEPT.' - Pratt Mines, Fraternal Cemetery, Crest of Sheridan Road, Irish Hill, Birmingham, Jefferson County, AL

  2. Development of Graves' disease following radiation therapy in Hodgkin's disease

    SciTech Connect

    Loeffler, J.S.; Tarbell, N.J.; Garber, J.R.; Mauch, P.

    1988-01-01

    Radiation-related thyroid dysfunction is a common occurrence in patients with Hodgkin's disease treated with mantle field radiation. Although chemical and clinical hypothyroidism are most commonly seen, Graves' disease has also been described. We have examined the records of 437 surgically staged patients who received mantle field irradiation between April 1969 and December 1980 to ascertain the frequency of manifestations of Graves' disease. Within this group, seven patients developed hyperthyroidism accompanied by ophthalmic findings typical of those seen in Graves' disease. The actuarial risk of developing Graves' disease at 10 years following mantle irradiation for Hodgkin's disease was 3.3% in female patients and 1% in male patients in this study. The observed/expected ratios were 5.9 and 5.1 for female and male patients, respectively. This observed risk significantly exceeded that seen in the general population.

  3. Successful treatment of Graves disease in pregnancy with Lugol's iodine.

    PubMed

    Jamieson, A; Semple, C G

    2000-02-01

    We report a case of Grave's disease in pregnancy complicated by intolerance of standard antithyroid drug therapy. We describe the success of prolonged use of organic iodine as a primary treatment prior to surgical intervention.

  4. Dissociative disorder due to Graves' hyperthyroidism: a case report.

    PubMed

    Mizutani, Kaoru; Nishimura, Katsuji; Ichihara, Atsuhiro; Ishigooka, Jun

    2014-01-01

    We report the case of a 20-year-old Japanese woman with no psychiatric history with apparent dissociative symptoms. These consisted of amnesia for episodes of shoplifting behaviors and a suicide attempt, developing together with an exacerbation of Graves' hyperthyroidism. Patients with Graves' disease frequently manifest various psychiatric disorders; however, very few reports have described dissociative disorder due to this disease. Along with other possible causes, for example, encephalopathy associated with autoimmune thyroid disease, clinicians should be aware of this possibility.

  5. Human lymphocyte antigens (HLA) and Graves' disease in Turkey.

    PubMed

    Orhan, Y; Azezli, A; Carin, M; Aral, F; Sencer, E; Molvalilar, S

    1993-09-01

    To evaluate the association of HLA types with Turkish patients with Graves' disease, HLA typing, clinical findings, and thyroid antibodies were correlated. The HLA types, clinical findings (ophthalmopathy and age at onset), and thyroid stimulating hormone (TSH) receptor (TRAb) and antithyroid microsomal antibodies (MAb) were analyzed. Seventy Turkish patients with Graves' disease and 306 control subjects were assessed. Serological HLA typing was performed in HLA A, B, C, DR, and DQ loci. There was a significantly increased prevalence of HLA B8, B49, DR3, DR4, and DR10 in Graves' disease. The association of Graves' disease with HLA DR3 was found to be less strong than previously described. The HLA DR4 antigen may contribute to the predisposition of Graves' disease in Turkey. The results suggest that HLA B7, B13, DR7, DQw2, and DQw3 may confer a protective effect for Graves' disease in Turkey. Patients carrying HLA B12, B18, and B44 haplotypes had a tendency to develop the disease at a later age. The difference from the other studies may be the result of the selection of the controls; in part, of the variability in serological typing reagents; and, also, of the rather weak HLA associations with the disease.

  6. Increase of peripheral B lymphocytes in Graves' disease.

    PubMed Central

    Mori, H; Amino, N; Iwatani, Y; Kabutomori, O; Asari, S; Motoi, S; Miyai, K; Kumahara, Y

    1980-01-01

    Peripheral T and B lymphocytes were examined in autoimmune thyroid diseases. The percentages of T and B lymphocytes were calculated from the proportions of E and EAC rosette-forming cells and peroxidase-positive cells determined by micromethods. In thyrotoxic Graves' disease, the percentage of T cells was significantly lower, and the percentage of B cells was higher than in normal controls. The absolute count of B lymphocytes was also markedly increased. The serum levels of thyroid hormones showed a significant correlation with the percentage of B cells and an inverse correlation with that of T cells in untreated cases of Graves' disease. Similar abnormalities of lymphocyte subpopulations were observed in patients with thyrotoxic Graves' disease under drug therapy, but the proportions and absolute counts of T and B lymphocytes were normal in euthyroid patients with Graves' disease, either under drug therapy or in remission. No abnormalities in T and B cells were found in Hashimoto's disease. The data indicate that the main feature of the abnormality of the lymphocyte subpopulations in thyrotoxic Graves' disease is an increase of B lymphocytes. The reasons for the discrepancy between our results and those of earlier reports and for the B cell abnormality in Graves' disease are discussed. PMID:6970099

  7. Preclinical models of Graves' disease and associated secondary complications.

    PubMed

    Moshkelgosha, Sajad; So, Po-Wah; Diaz-Cano, Salvador; Banga, J Paul

    2015-01-01

    Autoimmune thyroid disease is the most common organ-specific autoimmune disorder which consists of two opposing clinical syndromes, Hashimoto's thyroiditis and Graves' (hyperthyroidism) disease. Graves' disease is characterized by goiter, hyperthyroidism, and the orbital complication known as Graves' orbitopathy (GO), or thyroid eye disease. The hyperthyroidism in Graves' disease is caused by stimulation of function of thyrotropin hormone receptor (TSHR), resulting from the production of agonist antibodies to the receptor. A variety of induced mouse models of Graves' disease have been developed over the past two decades, with some reproducible models leading to high disease incidence of autoimmune hyperthyroidism. However, none of the models show any signs of the orbital manifestation of GO. We have recently developed an experimental mouse model of GO induced by immunization of the plasmid encoded ligand binding domain of human TSHR cDNA by close field electroporation that recapitulates the orbital pathology in GO. As in human GO patients, immune mice with hyperthyroid or hypothyroid disease induced by anti-TSHR antibodies exhibited orbital pathology and chemosis, characterized by inflammation of orbital muscles and extensive adipogenesis leading to expansion of the orbital retrobulbar space. Magnetic resonance imaging of the head region in immune mice showed a significant expansion of the orbital space, concurrent with proptosis. This review discusses the different strategies for developing mouse models in Graves' disease, with a particular focus on GO. Furthermore, it outlines how this new model will facilitate molecular investigations into pathophysiology of the orbital disease and evaluation of new therapeutic interventions.

  8. Hyperparathyroidism after radioactive iodine therapy for Graves disease

    SciTech Connect

    Esselstyn, C.B. Jr.; Schumacher, O.P.; Eversman, J.; Sheeler, L.; Levy, W.J.

    1982-11-01

    The association of external ionizing radiation to the head and neck and the subsequent development of hyperfunctioning parathyroid glands has been documented in recent years. This also has been demonstrated experimentally in animals. Despite the numbers of patients with Graves disease who have been treated with radioactive iodine, there are no reports in the literature of parathyroid surgery for hyperparathyroidism secondary to earlier treatment with radioactive iodine for Graves disease. This report describes the operative and pathologic findings in four patients with hyperparathyroidism. These patients had previously been treated with radioactive iodine for Graves disease. The pathologic findings at surgery included in three cases a single enlarged hyperplastic gland consistent with a parathyroid adenoma. One patient had hyperplasia of all four glands. The two largest glands and halves of the two remaining glands were removed. In a long-term follow-up of children and adolescents treated with radioactive iodine for Graves disease, Levy and Schumacher found calcium elevations in 10 of 159 patients. The increased incidence of hyperparathyroidism following radioactive iodine treatment for Graves disease in children and adolescents would seem several times higher than normal. Whether adults who have radioactive iodine treatment for Graves disease have a similar increase incidence is not known. Meanwhile it would seem reasonable to suggest that patients whose hyperthyroidism is treated with radioactive iodine should have their serum calcium levels determined at 5-year intervals.

  9. Color-flow Doppler sonography in Graves disease: "thyroid inferno".

    PubMed

    Ralls, P W; Mayekawa, D S; Lee, K P; Colletti, P M; Radin, D R; Boswell, W D; Halls, J M

    1988-04-01

    Graves disease is a common diffuse abnormality of the thyroid gland usually characterized by thyrotoxicosis. We performed color-flow Doppler sonography in 16 patients with Graves disease and compared the results with those in 15 normal volunteers and 14 patients with other thyroid diseases (eight with multinodular goiter, four with focal masses, and two with papillary thyroid carcinoma). All 16 Graves disease patients exhibited a pulsatile pattern we call "thyroid inferno." This pattern consists of multiple small areas of intrathyroidal flow seen diffusely throughout the gland in both systole and diastole. In systole, both high-velocity flow (color coded white) and lower velocity flow (color coded red and blue) were noted. In diastole, fewer areas of flow and lower velocity flow were noted. Patients with Graves disease also exhibited color flow around the periphery of the gland. The inferno pattern did not occur in normal subjects or in patients with other thyroid diseases. On occasion, focal areas of intrathyroidal flow were detected in patients with multinodular goiter and focal thyroid masses. High-resolution gray-scale images did not show the small vascular channels from which the flow signal originated. Color-flow Doppler sonography shows promise as a cost-effective, noninvasive technique for diagnosing Graves disease.

  10. Vitamin D and Graves' disease: a meta-analysis update.

    PubMed

    Xu, Mei-Yan; Cao, Bing; Yin, Jian; Wang, Dong-Fang; Chen, Kai-Li; Lu, Qing-Bin

    2015-05-21

    The association between vitamin D levels and Graves' disease is not well studied. This update review aims to further analyze the relationship in order to provide an actual view of estimating the risk. We searched for the publications on vitamin D and Graves' disease in English or Chinese on PubMed, EMBASE, Chinese National Knowledge Infrastructure, China Biology Medical and Wanfang databases. The standardized mean difference (SMD) and 95% confidence interval (CI) were calculated for the vitamin D levels. Pooled odds ratio (OR) and 95% CI were calculated for vitamin D deficiency. We also performed sensitivity analysis and meta-regression. Combining effect sizes from 26 studies for Graves' disease as an outcome found a pooled effect of SMD = -0.77 (95% CI: -1.12, -0.42; p < 0.001) favoring the low vitamin D level by the random effect analysis. The meta-regression found assay method had the definite influence on heterogeneity (p = 0.048). The patients with Graves' disease were more likely to be deficient in vitamin D compared to the controls (OR = 2.24, 95% CI: 1.31, 3.81) with a high heterogeneity (I2 = 84.1%, p < 0.001). We further confirmed that low vitamin D status may increase the risk of Graves' disease.

  11. Pathogenesis and treatment of the ophthalmopathy associated with Graves' disease.

    PubMed

    Velkeniers, B; Salu, P

    1992-01-01

    The pathogenesis and etiology of the ophthalmopathy associated with Graves' disease still remains to be elucidated. There is, however, general consensus that the extraocular muscles are the principal site of the autoimmune response and that the main changes are in the interstitium. The primary target seems to be the fibroblasts which are stimulated as a result of cytokine release by the activated T-cells that accumulate in the muscles. Increased production of glycosaminoglycans and collagen by fibroblasts, attracts water to the interstitium and produces interstitial oedema. The frequent association of Graves' thyroid disease and ophthalmopathy favours the hypothesis of antibodies cross-reacting with antigens of orbit and thyroid. Although cross-reactivity is very attractive, the nature of the involved antigen remains unknown. Since Graves' ophthalmopathy is an autoimmune disorder, many immunomodulatory agents have been used in the treatment of this disorder. Anti-inflammatory and immunosuppressive treatment modalities will be reviewed.

  12. An update on the medical treatment of Graves' hyperthyroidism.

    PubMed

    Marinò, Michele; Latrofa, Francesco; Menconi, Francesca; Chiovato, Luca; Vitti, Paolo

    2014-11-01

    Medical treatment of Graves' hyperthyroidism is based on the use of thionamides; namely, methimazole and propylthiouracil. In the past, methimazole was preferred by European endocrinologists, whereas propylthiouracil was the first choice for the majority of their North American colleagues. However, because of the recent definition of a better side-effect profile, methimazole is nowadays the first choice world while. Although thionamides are quite effective for the short-term control of Graves' hyperthyroidism, a relatively high proportion of patients relapses after thionamide withdrawal. Other possible medical treatments, include iodine and compounds containing iodine, perchlorate, lithium (as an adjuvant in patients undergoing radioiodine therapy), β-adrenergic antagonists, glucocorticoids, and some new molecules still under investigation. Management of Graves' hyperthyroidism using thionamides as well as the other available medical treatments is here reviewed in detail, with a special mention of situations such as pregnancy and lactation, as well as neonatal and fetal thyrotoxicosis.

  13. Graves' Disease Pharmacotherapy in Women of Reproductive Age.

    PubMed

    Prunty, Jeremy J; Heise, Crystal D; Chaffin, David G

    2016-01-01

    Graves' disease is an autoimmune disorder in which inappropriate stimulation of the thyroid gland results in unregulated secretion of thyroid hormones resulting in hyperthyroidism. Graves' disease is the most common cause of autoimmune hyperthyroidism during pregnancy. Treatment options for Graves' disease include thioamide therapy, partial or total thyroidectomy, and radioactive iodine. In this article, we review guideline recommendations for Graves' disease treatment in women of reproductive age including the recent guideline from the American College of Obstetricians and Gynecologists. Controversy regarding appropriate thioamide therapy before, during, and after pregnancy is reviewed. Surgical and radioactive iodine therapy considerations in this patient population are also reviewed. In patients who may find themselves pregnant during therapy or develop Graves' disease during their pregnancy, consideration should be given to the most appropriate treatment course for the mother and fetus. Thioamide therapy should be used with either propylthiouracil or methimazole at appropriate doses that target the upper range of normal to slightly hyperthyroid to avoid creating hypothyroidism in the fetus. Consideration should also be given to the adverse effects of thioamide, such as agranulocytosis and hepatotoxicity, with appropriate patient consultation regarding signs and symptoms. Individuals who wish to breastfeed their infants while taking thioamide should receive the lowest effective dose. Surgery should be reserved for extreme cases and limited to the second trimester, if possible. Radioactive iodine therapy may be used in nonpregnant individuals, with limited harm to future fertility. Radioactive iodine therapy should be withheld in pregnant women and those who are actively breastfeeding. Clinicians should keep abreast of developments in clinical trials and evidence-based recommendations regarding Graves' disease in reproductive-age women for any changes in evidence

  14. Peripartum cardiomyopathy in a patient with Graves' disease.

    PubMed

    Kajiya, Takashi; Lee, Souki; Yamashita, Makoto; Sasaki, Yuichi; Kamizono, Yusuke; Imamura, Masakazu; Toyonaga, Koichi; Toda, Hitoshi; Koriyama, Nobuyuki; Tei, Chuwa

    2010-11-05

    Peripartum cardiomyopathy (PPCM) is a rare life-threatening cardiomyopathy of unknown etiology that occurs during the peripartum period in previously healthy women. Autoimmune and viral factors have been suggested to be involved in PPCM. Here we describe a patient with Graves' disease, which is one of the organ-specific autoimmune diseases, who developed acute heart failure due to PPCM at 2 weeks after her first delivery. The patient recovered completely with conservative treatment for heart failure. An association between PPCM and Graves' disease has not been reported before. PPCM may be an organ-specific autoimmune disease, so the coexistence of other autoimmune diseases should be considered in PPCM patients.

  15. Long-term follow-up of ophthalmic Graves' disease.

    PubMed Central

    Agapitos, P J; Hart, I R

    1987-01-01

    Sixteen patients with ophthalmic Graves' disease (clinically euthyroid with ophthalmopathy or exophthalmos) were followed up for 4.3 to 14.3 (mean 9.1) years to determine whether thyroid dysfunction developed and whether their ophthalmopathy progressed, regressed or remained stable. Five patients (31%) manifested hyperthyroidism or hypothyroidism, all before the end of the fifth year of follow-up. The ophthalmopathy was mild, and none of the patients required specific treatment. The thyroid function of patients with ophthalmic Graves' disease should be periodically monitored for at least 5 years. PMID:3815199

  16. Advances in the pharmacological treatment of Graves' orbitopathy.

    PubMed

    Ruchała, Marek; Sawicka-Gutaj, Nadia

    2016-07-01

    Graves' orbitopathy has a deteriorating effect on patients' appearance and vision, thus significantly decreases their quality of life. A multidisciplinary team of endocrinologists, ophthalmologists, head and neck surgeons, nuclear medicine physicians, radiologists, and psychologists should constitute a standard health care team for those patients. It is vital that the therapy is based on an individual approach, with patients being well informed and involved in the decision-making process. Generally, traditional therapies include immunosuppression with steroids, orbital irradiation and surgical decompression. Novel treatment modalities include: biological agents, somatostatin analogs, antioxidants, methotrexate. Better insight into pathogenesis of Graves' orbitopathy is the only chance for targeted therapy development.

  17. Les Hemorragies Gastroduodenales de Stress Chez le Brule Grave

    PubMed Central

    Siah, S.; Fouadi, F.E.; Ababou, K.; Nassim Sabah, T.; Ihrai, I.

    2008-01-01

    Summary Les Auteurs rapportent trois observations d'hémorragies gastroduodénales de stress chez le brûlé grave. Ils rappellent l'importance des mesures thérapeutiques qui doivent être prises chez le brûlé grave, comme le traitement du choc, du sepsis, des plaies et de la douleur, la nutrition entérale précoce et l'oxygénothérapie. Tout cela permet de réduire les facteurs de risque de survenue d'une hémorragie gastroduodénale de stress. PMID:21991137

  18. Ethmoidectomy decompression for the treatment of Graves' optic neuropathy.

    PubMed

    Hurwitz, J J; Freeman, J L; Eplett, C J; Fliss, D M; Avram, D R

    1992-10-01

    When orbital decompression becomes necessary in Graves' optic neuropathy, medial wall decompression is a necessary component of the decompression procedure. The ethmoidectomy approach allows more direct visualization of the posterior ethmoids and sphenoids to effect maximum decompression. This is particularly important in cases in which computed tomography shows the medial rectus muscle to be enlarged posteriorly in the orbit. The procedure provides excellent visualization of the medial rectus. As with any medial wall decompression procedure, postoperative restriction of horizontal motility is a frequent complication, often necessitating more than one subsequent operation. The authors describe their experience with the procedure in 25 patients with Graves' optic neuropathy.

  19. View from south/southeast at Chapel of grave area C, south ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    View from south/southeast at Chapel of grave area C, south rond point, and grave area D. Note flagstone path and steps leading to rond point from Chapel. - Flanders Field American Cemetery & Memorial, Wortegemseweg 117, Waregem, West Flanders (Belgium)

  20. 1. OVERVIEW, LOOKING WEST, TOMBSTONES, STATUES AND GRAVE PLOTS OF ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    1. OVERVIEW, LOOKING WEST, TOMBSTONES, STATUES AND GRAVE PLOTS OF THE DUCHOCK, MOSKO, BENKO AND OTHER FAMILIES OF THIS FORMER COAL MINING AREA SETTLED BY CZECH AND SLAVIC MINERS IN THE 1880S AND 1890S - St. Michael's Cemetery, Brookside Road, Brookside, Jefferson County, AL

  1. Correlating video meteors with GRAVES radio detections from the UK

    NASA Astrophysics Data System (ADS)

    Fleet, R.

    2015-01-01

    The area of meteor ablation layer illuminated by the GRAVES radar is low on the horizon from southern UK. A number of simultaneous video meteor and radio detections suggested that it was possible to record common events despite the unfavorable relative positions. This was investigated further to see what the constraints are and whether there is any prospect of obtaining useful data.

  2. The exhumation of a World War II Jewish grave.

    PubMed

    Chagowski, W; Madro, R

    1999-01-01

    The results of the exhumation of a mass grave from the time of the World War II are presented. In the course of exhumation it was established that the subjects were 190 individuals (men, women and children) of Jewish origin. All had died a violent death due to gunshot or mechanical injury.

  3. 38 CFR 38.631 - Graves marked with a private headstone or marker.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2011-07-01 2011-07-01 false Graves marked with a... VETERANS AFFAIRS (CONTINUED) NATIONAL CEMETERIES OF THE DEPARTMENT OF VETERANS AFFAIRS § 38.631 Graves... marker for the grave of a decedent described in paragraph (b) of this section, but only if the...

  4. 75 FR 9429 - Native American Graves Protection and Repatriation Review Committee: Meetings

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-02

    ... National Park Service Native American Graves Protection and Repatriation Review Committee: Meetings AGENCY... Advisory Committee Act, 5 U.S.C. Appendix (1988), of three meetings of the Native American Graves... Review Committee was established in Section 8 of the Native American Graves Protection and...

  5. 38 CFR 38.631 - Graves marked with a private headstone or marker.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Graves marked with a... VETERANS AFFAIRS (CONTINUED) NATIONAL CEMETERIES OF THE DEPARTMENT OF VETERANS AFFAIRS § 38.631 Graves... marker for the grave of a decedent described in paragraph (b) of this section, but only if the...

  6. 38 CFR 38.631 - Graves marked with a private headstone or marker.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2013-07-01 2013-07-01 false Graves marked with a... VETERANS AFFAIRS (CONTINUED) NATIONAL CEMETERIES OF THE DEPARTMENT OF VETERANS AFFAIRS § 38.631 Graves... marker for the grave of a decedent described in paragraph (b) of this section, but only if the...

  7. 76 FR 69282 - Native American Graves Protection and Repatriation Review Committee: Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-08

    ... National Park Service Native American Graves Protection and Repatriation Review Committee: Meeting AGENCY... Advisory Committee Act, 5 U.S.C. Appendix (1988), of a meeting of the Native American Graves Protection and... Committee was established in Section 8 of the Native American Graves Protection and Repatriation Act of...

  8. 78 FR 21410 - Native American Graves Protection and Repatriation Review Committee: Meetings

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-10

    ... National Park Service Native American Graves Protection and Repatriation Review Committee: Meetings AGENCY... Federal Advisory Committee Act, 5 U.S.C. Appendix (1988), of two meetings of the Native American Graves... Advisory Committee Act, 5 U.S.C. Appendix (1988), of two meetings of the Native American Graves...

  9. 38 CFR 38.631 - Graves marked with a private headstone or marker.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2012-07-01 2012-07-01 false Graves marked with a... VETERANS AFFAIRS (CONTINUED) NATIONAL CEMETERIES OF THE DEPARTMENT OF VETERANS AFFAIRS § 38.631 Graves... marker for the grave of a decedent described in paragraph (b) of this section, but only if the...

  10. 77 FR 7180 - Native American Graves Protection and Repatriation Review Committee: Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-10

    ... National Park Service Native American Graves Protection and Repatriation Review Committee: Meeting AGENCY... Advisory Committee Act, 5 U.S.C. Appendix (1988), of two meetings of the Native American Graves Protection..., 2012. The Review Committee was established in Section 8 of the Native American Graves Protection...

  11. 38 CFR 38.631 - Graves marked with a private headstone or marker.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2014-07-01 2014-07-01 false Graves marked with a... VETERANS AFFAIRS (CONTINUED) NATIONAL CEMETERIES OF THE DEPARTMENT OF VETERANS AFFAIRS § 38.631 Graves... marker for the grave of a decedent described in paragraph (b) of this section, but only if the...

  12. Les trois accents: aigu, grave et circonflexe (2e partie) (The Three Accents: Acute, Grave and Circumflex. 2nd Part).

    ERIC Educational Resources Information Center

    Csecsy, Madeleine

    1981-01-01

    Discusses the correspondence between French phonology and spelling with regard to the role of accents. Refers the reader to the first part of the essay (n162, Jul 1981), then analyzes vowel harmony, free variation, the diacritic function of the grave accent, and the etymologic function of the circumflex accent. (MES)

  13. Habitat Evaluation Procedures Report; Graves Property - Yakama Nation.

    SciTech Connect

    Ashley, Paul; Muse, Anthony

    2008-02-01

    A habitat evaluation procedures (HEP) analysis was conducted on the Graves property (140 acres) in June 2007 to determine the number of habitat units to credit Bonneville Power Administration (BPA) for providing funds to acquire the property as partial mitigation for habitat losses associated with construction of McNary Dam. HEP surveys also documented the general ecological condition of the property. The Graves property was significantly damaged from past/present livestock grazing practices. Baseline HEP surveys generated 284.28 habitat units (HUs) or 2.03 HUs per acre. Of these, 275.50 HUs were associated with the shrubsteppe/grassland cover type while 8.78 HUs were tied to the riparian shrub cover type.

  14. Imaging studies for diagnosing Graves' orbitopathy and dysthyroid optic neuropathy.

    PubMed

    Gonçalves, Allan C Pieroni; Gebrim, Eloísa M M S; Monteiro, Mário L R

    2012-11-01

    Although the diagnosis of Graves' orbitopathy is primarily made clinically based on laboratory tests indicative of thyroid dysfunction and autoimmunity, imaging studies, such as computed tomography, magnetic resonance imaging, ultrasound and color Doppler imaging, play an important role both in the diagnosis and follow-up after clinical or surgical treatment of the disease. Imaging studies can be used to evaluate morphological abnormalities of the orbital structures during the diagnostic workup when a differential diagnosis versus other orbital diseases is needed. Imaging may also be useful to distinguish the inflammatory early stage from the inactive stage of the disease. Finally, imaging studies can be of great help in identifying patients prone to develop dysthyroid optic neuropathy and therefore enabling the timely diagnosis and treatment of the condition, avoiding permanent visual loss. In this paper, we review the imaging modalities that aid in the diagnosis and management of Graves' orbitopathy, with special emphasis on the diagnosis of optic nerve dysfunction in this condition.

  15. Concomitant Graves hyperthyroidism with thyrotrophin-secreting pituitary adenoma.

    PubMed

    Lee, Ming-Tsang; Wang, Chih-Yuan

    2010-04-01

    The relationship of autoimmune thyroid disease and TSH-producing pituitary tumor is rarely found. We report two patients with hyperthyroidism, a 27-year-old man and a 28-year-old woman, who were diagnosed with Graves hyperthyroidism with elevated free thyroxine (FT4), suppressed TSH and positive thyrotropin receptor autoantibodies. After treatment with antithyroid drugs, FT4 did not return to normal, and serum TSH levels were found to be above-normal range. Pituitary tumors were subsequently found via pituitary magnetic resonance imaging (MRI). We suggest that Graves hyperthyroidism concomitant with TSH-producing pituitary tumor be kept in mind, as it may confuse the therapeutic course of hyperthyroidism and make it more complicated.

  16. Case report of Graves' disease manifesting with odynophagia and heartburn.

    PubMed

    Evsyutina, Yulia; Trukhmanov, Alexander; Ivashkin, Vladimir; Storonova, Olga; Godjello, Elina

    2015-12-28

    Graves' disease is an autoimmune disease, which can manifest with a variety of extrathyroidal clinical syndromes like ophthalmopathy, pretibial myxedema (dermopathy), acropathy, cardiomyopathy, and encephalopathy. Though quite rare, this disease can also manifest with gastrointestinal symptoms such as dysphagia, heartburn, nausea, vomiting and diarrhea. We report a clinical case of Graves' disease manifesting with dysfunction of the esophagus and heartburn in a 61-year-old man. In the muscular layer of the esophagus we found dystrophic changes led to its atony, which was documented by endoscopy and high-resolution manometry. The pathology features of esophageal symptoms were: focal proliferation of the basal cells, vascular distension, and dystrophy of the epithelial cells. Antithyroid treatment led to decrease of all clinical symptoms after 5 d of Thiamazole administration. Complete restoration of peristalsis in the esophagus, according to manometry, was observed in 1 mo after initiation of treatment.

  17. Drug-induced graves disease from CTLA-4 receptor suppression.

    PubMed

    Borodic, Gary; Hinkle, David M; Cia, Yihong

    2011-01-01

    Monoclonal antibody, ipilimumab, useful for treatment of metastatic melanoma, blocks CTLA-4 mediated T-cell suppression and can also cause a Graves ophthalmopathy like syndrome. Epidemiologic study has linked variant polymorphisms of CTLA-4 receptor gene to the presence of thyroid eye disease. The combination of these observations suggests CTLA-4 mediated T-cell functions are important to the pathogenesis of thyroid-associated eye disease.

  18. Painful Archeology: Excavating Saddam’s Mass Graves

    DTIC Science & Technology

    2006-03-01

    Painful Archeology : Excavating Saddam’s Mass Graves Strategic Insights, Volume V, Issue 3 (March 2006) by Abbas Kadhim[1] Strategic Insights is...discovery. There are sacred tombs for the pious, artifacts for archeological thieves, weapons for terrorists, and oil for capitalists. However, for...or a skeleton of an adult with a skull of an adolescent, al wrapped in a manner below the dignity of the suffering the victim endured or the agony of

  19. Graves' disease in a dialysis dependent chronic renal failure patient

    PubMed Central

    Nair, C. G.; Jacob, P.; Menon, R.; Babu, M. J. C.

    2014-01-01

    Thyroid hormone level may be altered in chronic renal failure patients. Low levels of thyroxine protect the body from excess protein loss by minimizing catabolism. Hyperthyroidism is rarely encountered in end-stage dialysis dependent patients. Less than 10 well-documented cases of Graves' disease (GD) are reported in literature so far. We report a case of GD in a patient on dialysis. PMID:25484538

  20. Heterogeneity of failure of visual acuity in Graves' disease.

    PubMed Central

    Sachdev, Y.; Chatterji, J. C.; Sharma, R. C.

    1979-01-01

    The eye manifestations of Graves' disease are usually mild and self-limiting. Occasionally they follow a progressive course leading to visual loss and total blindness. The ocular manifestations bear no relationship to the metabolic state and may appear before, during or after onset of thyrotoxicosis. Characteristically they become evident at about the time of onset of hypermetabolism. Various factors responsible for the failure of visual acuity are discussed with case illustrations. PMID:314108

  1. Quantitative macroinvertebrate survey of Pen Branch and Indian Grave Branch

    SciTech Connect

    Not Available

    1989-02-01

    A total of 80 species were collected at all sites on Pen Branch and Indian Grave Branch during the 28 day period for colonization of the multiplate artificial substrate samplers. The two upstream sites demonstrated the highest species richness. During the sampling interval a release of significant proportion entered Indian Grave Branch, affecting all downstream sites. This effect was most severe at sites 3, 4, and 7, apparently resulting in heavy scouring of the multiplate samplers. Nevertheless, much colonization did occur at sites 3 and 4, with hydropsychid caddisflies, blackflies and midges predominant. At sites 5 and 6 a greater degree of recovery was noted, due to the lessened scouring in the broad floodplain. These downstream sites had significant numbers of mayflies along with the numerous midges. Considered overall, colonization during the period since the K Reactor has ceased releasing thermal effluent into Pen Branch and Indian Grave Branch has been substantial, introducing a substantial proportion of the species known from other nearby streams. 29 tabs.

  2. Enhanced thyroid iodine metabolism in patients with triiodothyronine-predominant Graves' disease

    SciTech Connect

    Takamatsu, J.; Hosoya, T.; Naito, N.; Yoshimura, H.; Kohno, Y.; Tarutani, O.; Kuma, K.; Sakane, S.; Takeda, K.; Mozai, T.

    1988-01-01

    Some patients with hyperthyroid Graves' disease have increased serum T3 and normal or even low serum T4 levels during treatment with antithyroid drugs. These patients with elevated serum T3 to T4 ratios rarely have a remission of their hyperthyroidism. The aim of this study was to investigate thyroid iodine metabolism in such patients, whom we termed T3-predominant Graves' disease. Mean thyroid radioactive iodine uptake was 51.0 +/- 18.1% ( +/- SD) at 3 h, and it decreased to 38.9 +/- 20.1% at 24 h in 31 patients with T3-predominant Graves' disease during treatment. It was 20.0 +/- 11.4% at 3 h and increased to 31.9 +/- 16.0% at 24 h in 17 other patients with hyperthyroid Graves' disease who had normal serum T3 and T4 levels and a normal serum T3 to T4 ratio during treatment (control Graves' disease). The activity of serum TSH receptor antibodies was significantly higher in the patients with T3-predominant Graves' disease than in control Graves' disease patients. From in vitro studies of thyroid tissue obtained at surgery, both thyroglobulin content and iodine content in thyroglobulin were significantly lower in patients with T3-predominant Graves' disease than in the control Graves' disease patients. Thyroid peroxidase (TPO) activity determined by a guaiacol assay was 0.411 +/- 0.212 g.u./mg protein in the T3-predominant Graves' disease patients, significantly higher than that in the control Graves' disease patients. Serum TPO autoantibody levels determined by immunoprecipitation also were greater in T3-predominant Graves' disease patients than in control Graves' disease patients. Binding of this antibody to TPO slightly inhibited the enzyme activity of TPO, but this effect of the antibody was similar in the two groups of patients.

  3. Hiccup: an extremely rare presentation of thyrotoxicosis of graves' disease.

    PubMed

    Ahmed, Feroze; Ganie, Mohammed Ashraf; Shamas, Nasir; Wani, Mohammad; Parray, Irshad

    2011-03-01

    Persistent hiccup is a rare but potentially severe condition that can be symptomatic of a variety of diseases or idiopathic. Most episodes last only a few minutes and are self-limited, but hiccup can get persistent and become a real problem for physician and patient alike. The center of hiccup may be activated by a great variety of stimuli travelling along different nerve pathways and bring different effecter responses. We report a case of persistent hiccup as a presentation of impending thyroid storm of Graves' disease. Though the condition is rare, clinicians should remain alert to the possibility of this diagnosis.

  4. Graves' Patient with Thymic Expression of Thyrotropin Receptors and Dynamic Changes in Thymic Hyperplasia Proportional to Graves' Disease Activity.

    PubMed

    Song, Young Shin; Won, Jae-Kyung; Kim, Mi Jeong; Lee, Ji Hyun; Kim, Dong-Wan; Chung, June-Key; Park, Do Joon; Park, Young Joo

    2016-05-01

    Thymic hyperplasia is frequently observed in Graves' disease. However, detectable massive enlargement of the thymus is rare, and the mechanism of its formation has remained elusive. This case showed dynamic changes in thymic hyperplasia on serial computed tomography images consistent with changes in serum thyrotropin receptor (TSH-R) antibodies and thyroid hormone levels. Furthermore, the patient's thymic tissues underwent immunohistochemical staining for TSH-R, which demonstrated the presence of thymic TSH-R. The correlation between serum TSH-R antibody levels and thymic hyperplasia sizes and the presence of TSH-R in her thymus suggest that TSH-R antibodies could have a pathogenic role in thymic hyperplasia.

  5. Graves' Ophthalmopathy: VISA versus EUGOGO Classification, Assessment, and Management

    PubMed Central

    Barrio-Barrio, Jesús; Sabater, Alfonso L.; Bonet-Farriol, Elvira; Velázquez-Villoria, Álvaro; Galofré, Juan C.

    2015-01-01

    Graves' ophthalmopathy (GO) is an autoimmune inflammatory disorder associated with thyroid disease which affects ocular and orbital tissues. GO follows a biphasic course in which an initial active phase of progression is followed by a subsequent partial regression and a static inactive phase. Although the majority of GO patients have a mild, self-limiting, and nonprogressive ocular involvement, about 3–7% of GO patients exhibit a severe sight-threatening form of the disease due to corneal exposure or compressive optic neuropathy. An appropriate assessment of both severity and activity of the disease warrants an adequate treatment. The VISA (vision, inflammation, strabismus, and appearance), and the European Group of Graves' Orbitopathy (EUGOGO) classifications are the two widely used grading systems conceived to assess the activity and severity of GO and guide the therapeutic decision making. A critical analysis of classification, assessment, and management systems is reported. A simplified “GO activity assessment checklist” for routine clinical practice is proposed. Current treatments are reviewed and management guidelines according to the severity and activity of the disease are provided. New treatment modalities such as specific monoclonal antibodies, TSH-R antagonists, and other immunomodulatory agents show a promising outcome for GO patients. PMID:26351570

  6. Clinical update: treatment of hyperthyroidism in Graves' ophthalmopathy.

    PubMed

    Azzam, Ibrahim; Tordjman, Karen

    2010-03-01

    The presence of thyroid eye disease (TED) may influence the treatment of hyperthyroidism in patients with Graves' disease. Moreover, treatment of hyperthyroidism may affect the course of Graves' ophthalmopathy (GO). We review the literature and summarise recent knowledge about the impact of treatment modality for hyperthyroidism in GO. Anti-thyroid drugs (ATDs) remain the simplest and safest way to treat hyperthyroidism in patients with GO, but they are associated with a high relapse rate of hyperthyroidism and they have no effect on the course of GO. Radioactive iodine (RAI) treatment may be associated with exacerbation of GO especially in high risk patients, when glucocorticoid prophylaxis may be indicated. Large prospective trials are still lacking to define the exact effect of RAI on the course of GO, particularly in relation to other known risk factors. Likewise, clear guidelines for prophylactic glucocorticoid therapy are needed. RAI should be cautiously used in patients with more severe ophthalmopathy and concomitant I.V glucocorticoids should be considered. Thyroid surgery, whether total or subtotal thyroidectomy, has no effect on the course of ophthalmopathy. However, total thyroid ablation that combines surgery with radioactive iodine, as a means of achieving thyroid antigen disappearance, is increasingly gaining attention for the treatment of patients with GO, especially those undergoing thyroid surgery, but also for those with severe unresponsive ophthalmopathy. Studies supporting this approach are awaited.

  7. Radioiodine-induced hypothyroidism in Graves' disease: factors associated

    SciTech Connect

    Cunnien, A.J.; Hay, I.D.; Gorman, C.A.; Offord, K.P.; Scanlon, P.W.

    1982-11-01

    A retrospective analysis was done of the records of 454 patients who received their first /sup 131/I treatment for Graves' disease during six periods covering 1951 to 1978. In the earliest group, 3% of patients were hypothyroid 3 mo after /sup 131/I use, and 40% were hypothyroid at 1 yr. In the most recent group, 36% of patients were hypothyroid at 3 mo and 91% were myxedematous at 1 yr. Although no obvious trends were noted, whether in the number of patients pretreated with thionamide drugs, in the mean 24-hr /sup 131/I uptake, or in the calculated dose of /sup 131/I (muCi/estimated gram of thyroid tissue) during the years of the study, the initial mean dose of /sup 131/I administered increased from 8.1 mCi in the earliest group to 13.8 mCi in the latest group. Concurrently, estimates of gland size increased from a mean of 26 g in the first group to 43 g in the last. If, in patients with Graves' disease, the thyroid gland size did not truly increase during the years of the study, the increasing occurrence of early hypothyroidism seen after /sup 131/I use may reflect the conscious or unconscious decision to use larger doses of /sup 131/I calculated on the basis of inflated estimates of thyroid gland weight.

  8. The 2016 European Thyroid Association/European Group on Graves' Orbitopathy Guidelines for the Management of Graves' Orbitopathy

    PubMed Central

    Bartalena, Luigi; Baldeschi, Lelio; Boboridis, Kostas; Eckstein, Anja; Kahaly, George J.; Marcocci, Claudio; Perros, Petros; Salvi, Mario; Wiersinga, Wilmar M.; Adamidou, Fotini; Anagnostis, Panagiotis; Ayvaz, Goksun; Azzolini, Claudio; Boschi, Antonella; Bournaud, Claire; Clarke, Lucy; Currò, Nicola; Daumerie, Chantal; Dayan, Colin; Fuhrer, Dagmar; Konuk, Onur; Marinò, Michele; Morris, Daniel; Nardi, Marco; Pearce, Simon; Pitz, Susanne; Rudovsky, Gottfried; Vannucchi, Guia; Vardanian, Christine; von Arx, Georg

    2016-01-01

    Graves' orbitopathy (GO) is the main extrathyroidal manifestation of Graves' disease, though severe forms are rare. Management of GO is often suboptimal, largely because available treatments do not target pathogenic mechanisms of the disease. Treatment should rely on a thorough assessment of the activity and severity of GO and its impact on the patient's quality of life. Local measures (artificial tears, ointments and dark glasses) and control of risk factors for progression (smoking and thyroid dysfunction) are recommended for all patients. In mild GO, a watchful strategy is usually sufficient, but a 6-month course of selenium supplementation is effective in improving mild manifestations and preventing progression to more severe forms. High-dose glucocorticoids (GCs), preferably via the intravenous route, are the first line of treatment for moderate-to-severe and active GO. The optimal cumulative dose appears to be 4.5-5 g of methylprednisolone, but higher doses (up to 8 g) can be used for more severe forms. Shared decision-making is recommended for selecting second-line treatments, including a second course of intravenous GCs, oral GCs combined with orbital radiotherapy or cyclosporine, rituximab or watchful waiting. Rehabilitative treatment (orbital decompression surgery, squint surgery or eyelid surgery) is needed in the majority of patients when GO has been conservatively managed and inactivated by immunosuppressive treatment. PMID:27099835

  9. The 2016 European Thyroid Association/European Group on Graves' Orbitopathy Guidelines for the Management of Graves' Orbitopathy.

    PubMed

    Bartalena, Luigi; Baldeschi, Lelio; Boboridis, Kostas; Eckstein, Anja; Kahaly, George J; Marcocci, Claudio; Perros, Petros; Salvi, Mario; Wiersinga, Wilmar M

    2016-03-01

    Graves' orbitopathy (GO) is the main extrathyroidal manifestation of Graves' disease, though severe forms are rare. Management of GO is often suboptimal, largely because available treatments do not target pathogenic mechanisms of the disease. Treatment should rely on a thorough assessment of the activity and severity of GO and its impact on the patient's quality of life. Local measures (artificial tears, ointments and dark glasses) and control of risk factors for progression (smoking and thyroid dysfunction) are recommended for all patients. In mild GO, a watchful strategy is usually sufficient, but a 6-month course of selenium supplementation is effective in improving mild manifestations and preventing progression to more severe forms. High-dose glucocorticoids (GCs), preferably via the intravenous route, are the first line of treatment for moderate-to-severe and active GO. The optimal cumulative dose appears to be 4.5-5 g of methylprednisolone, but higher doses (up to 8 g) can be used for more severe forms. Shared decision-making is recommended for selecting second-line treatments, including a second course of intravenous GCs, oral GCs combined with orbital radiotherapy or cyclosporine, rituximab or watchful waiting. Rehabilitative treatment (orbital decompression surgery, squint surgery or eyelid surgery) is needed in the majority of patients when GO has been conservatively managed and inactivated by immunosuppressive treatment.

  10. 48 CFR 352.242-72 - Native American Graves Protection and Repatriation Act.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 48 Federal Acquisition Regulations System 4 2012-10-01 2012-10-01 false Native American Graves... and Clauses 352.242-72 Native American Graves Protection and Repatriation Act. As prescribed in 342.302(c)(4), the Contracting Officer shall insert the following clause: Native American...

  11. 48 CFR 352.242-72 - Native American Graves Protection and Repatriation Act.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 4 2011-10-01 2011-10-01 false Native American Graves... and Clauses 352.242-72 Native American Graves Protection and Repatriation Act. As prescribed in 342.302(c)(4), the Contracting Officer shall insert the following clause: Native American...

  12. 77 FR 74874 - Native American Graves Protection and Repatriation Review Committee: Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-18

    ... National Park Service Native American Graves Protection and Repatriation Review Committee: Meeting AGENCY... Graves Protection and Repatriation Review Committee (Review Committee). This meeting will be open to the... Advisory Committee Act, 5 U.S.C. Appendix (1988), of a telephonic meeting of the Native American...

  13. 48 CFR 352.242-72 - Native American Graves Protection and Repatriation Act.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 48 Federal Acquisition Regulations System 4 2013-10-01 2013-10-01 false Native American Graves... and Clauses 352.242-72 Native American Graves Protection and Repatriation Act. As prescribed in 342.302(c)(4), the Contracting Officer shall insert the following clause: Native American...

  14. 48 CFR 352.242-72 - Native American Graves Protection and Repatriation Act.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Native American Graves... and Clauses 352.242-72 Native American Graves Protection and Repatriation Act. As prescribed in 342.302(c)(4), the Contracting Officer shall insert the following clause: Native American...

  15. 48 CFR 352.242-72 - Native American Graves Protection and Repatriation Act.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 48 Federal Acquisition Regulations System 4 2014-10-01 2014-10-01 false Native American Graves... and Clauses 352.242-72 Native American Graves Protection and Repatriation Act. As prescribed in 342.302(c)(4), the Contracting Officer shall insert the following clause: Native American...

  16. Strategies for Using Information Technology to Improve Institutional Performance: An Interview with William H. Graves

    ERIC Educational Resources Information Center

    Morrison, James L.; Graves, William H.

    2005-01-01

    This article presents an interview with William H. Graves, a professor emeritus of mathematics at the University of North Carolina (UNC) at Chapel Hill. From 1989 to 1997, he also served UNC as senior technology officer (under various titles) and as founder and director of the Institute for Academic Technology. Graves took leave from the…

  17. Stressful life events in the pathogenesis of Graves' disease.

    PubMed

    Radosavljević, V R; Janković, S M; Marinković, J M

    1996-06-01

    A case-control study was conducted in order to assess possible relationships between life events and Graves' disease. The study included 100 newly diagnosed patients with Graves' disease and 100 controls matched with respect to sex, age ( +/- 2 years) and type of residence (rural, urban). Paykel's Interview for Recent Life Events (a semistructured research interview covering 61 life events) was administered to each subject. In comparison with controls, the patients claimed to have had significantly more life events in the 12 months preceding the diagnosis (p = 0.0001). The following eight life events were significantly more prevalent among patients than controls: change in time spent on work (much overtime work, second job, much less work than usual) (McNemar = 12.04; RR = 7.00; 95%CI = 2.35-20.80; p = 0.0001), unemployment for at least 1 month (McNemar = 4.00; RR = 8.00; 95%CI = 1.04-61.39; p = 0.039), arguments with one's superior at work or a co-worker (McNemar = 4.50; RR = 3.50; 95%CI = 1.10-11.08; p = 0.031). change in the work conditions (new company division, new chief, large reorganization) (McNemar = 4.26; RR = 4.00; 95%CI = 1.07-14.92; p = 0.035), increased arguments with spouse (McNemar = 6.75; RR = 11.00; 95%CI = 1.82-66.44; p = 0.006), increased arguments with fiancé/fiancée or a steady date (McNemar = 4.00; RR = 8.00; 95%CI = 1.04-61.39; p = 0.039), hospitalization of a family member for serious illness (McNemar = 3.76; RR = 3.25; 95%CI = 1.01-10.68; p = 0.049) and moderate financial difficulties (McNemar = 8.50; RR = 3.25; 95%CI = 1.47-7.16; p = 0.003). Our findings indicate that life events may be a risk factor for Graves' disease.

  18. Primary biliary cirrhosis associated with Graves' disease in a male patient.

    PubMed

    Suzuki, Yuji; Ishida, Kazuyuki; Takahashi, Hiroshi; Koeda, Norihiko; Kakisaka, Keisuke; Miyamoto, Yasuhiro; Suzuki, Akiko; Takikawa, Yasuhiro

    2016-04-01

    Primary biliary cirrhosis (PBC), which predominantly affects women, has been associated with various autoimmune diseases. Although hypothyroidism accompanying PBC is well documented, the concomitance of PBC and hyperthyroidism is rare. Herein, we report the case of a 62-year-old man who was diagnosed with PBC several years after the development of Graves' disease. This is the first case of a male patient developing PBC with Graves' disease. Both serum alanine aminotransferase levels and serum thyroid hormone levels were normalized after the administration of thiamazole for Graves' disease. However, the cholestatic liver enzyme abnormalities continued, indicating that the PBC was actualized by the administration of thiamazole. After starting ursodeoxycholic acid treatment, cholestatic liver enzyme abnormalities improved. Taken together, when a cholestatic pattern of liver enzymes is observed during follow-up for Graves' disease, an association between Graves' disease and PBC should be considered as a differential diagnosis.

  19. Identification process in mass graves from the Spanish Civil War II.

    PubMed

    Ríos, Luis; García-Rubio, Almudena; Martínez, Berta; Alonso, Andrea; Puente, Jorge

    2012-06-10

    The identification process of a mass grave from the Spanish Civil War (1936-1939) is presented. The presumed location of the grave, as well as the presumed number and identities of the persons buried in the grave were obtained exclusively from witnesses' and relatives' testimonies. In agreement with the testimonies, the grave was located at the indicated location and five skeletons were exhumed. Also in agreement with the testimonies, the osteological and DNA study led investigators to propose the identification of two kin groups, a father and his son and a pair of brothers. But the genetic study did not support the identification of a fifth man presumed to have been buried in the grave. The differences and similarities between this case and another case reported earlier are discussed.

  20. Management plan and delivery of care in Graves' ophthalmopathy patients.

    PubMed

    Yang, Morgan; Perros, Petros

    2012-06-01

    Most patients with Graves' orbitopathy have mild disease that requires no or minimal intervention. For the minority of patients with moderate or severe disease, multiple medical and surgical treatments may be required at different stages. It is crucial that such patients are monitored closely and treatments applied with care in the right sequence. Medical treatments should be used as early as possible and only during the active phase of the disease. Rehabilitative surgery is indicated in the inactive phase of the disease and should follow the sequence: surgical decompression followed by eye muscle surgery, followed by lid surgery. Delivery of care in a coordinated fashion that makes use of best available expertise is important and best implemented through a Combined Thyroid Eye clinic.

  1. A Pediatric Case of Cowden Syndrome with Graves' Disease

    PubMed Central

    Fernandes, Vera; Martins, Sofia; Antunes, Ana; Marques, Olinda; Carvalho, José Luís; Correia-Pinto, Jorge; Meireles, Carla; Ferreira, Ana Margarida

    2017-01-01

    Cowden syndrome (CS) is a rare dominantly inherited multisystem disorder, characterized by an extraordinary malignant potential. In 80% of cases, the human tumor suppressor gene phosphatase and tensin homolog (PTEN) is mutated. We present a case of a 17-year-old boy with genetically confirmed CS and Graves' disease (GD). At the age of 15, he presented with intention tremor, palpitations, and marked anxiety. On examination, he had macrocephaly, coarse facies, slight prognathism, facial trichilemmomas, abdominal keratoses, leg hemangioma, and a diffusely enlarged thyroid gland. He started antithyroid drug (ATD) therapy with methimazole and, after a 2-year treatment period without achieving a remission status, a total thyroidectomy was performed. Diagnosis and management of CS should be multidisciplinary. Thyroid disease is frequent, but its management has yet to be fully defined. The authors present a case report of a pediatric patient with CS and GD and discuss treatment options. PMID:28251007

  2. [The necklace from the 660 grave in Megara Iblea].

    PubMed

    Verger, Stéphane

    2011-01-01

    The article analyzes the 660 grave in Megara Iblea, a Greek colony in Sicily, in which a woman has been buried. On her breast a magnificent neckless was found, made of amulets recalling the travel of the sun during the summer solstice. Some objects allude to solar cults (a cock; round pendants), others seem to came from Gallia and Macedonia (summer far West and East), others recall archeological contexts such as tombs in Marvinci, in the Vardar Valley, and allude to relations with female practices of medicine and magic and to female roles characterized by extraordinary powers, due to being descendants of the Sun god. These solar symbols, joint with the discovery of many little objects, typical of children burials, allow to hypotize a relation with the cult of Mater Matuta and seem to point out a difficult or anomalous pregnancy or birth.

  3. Monitoring controlled graves representing common burial scenarios with ground penetrating radar

    NASA Astrophysics Data System (ADS)

    Schultz, John J.; Martin, Michael M.

    2012-08-01

    Implementing controlled geophysical research is imperative to understand the variables affecting detection of clandestine graves during real-life forensic searches. This study focused on monitoring two empty control graves (shallow and deep) and six burials containing a small pig carcass (Sus scrofa) representing different burial forensic scenarios: a shallow buried naked carcass, a deep buried naked carcass, a deep buried carcass covered by a layer of rocks, a deep buried carcass covered by a layer of lime, a deep buried carcass wrapped in an impermeable tarpaulin and a deep buried carcass wrapped in a cotton blanket. Multi-frequency, ground penetrating radar (GPR) data were collected monthly over a 12-month monitoring period. The research site was a cleared field within a wooded area in a humid subtropical environment, and the soil consisted of a Spodosol, a common soil type in Florida. This study compared 2D GPR reflection profiles and horizontal time slices obtained with both 250 and 500 MHz dominant frequency antennae to determine the utility of both antennae for grave detection in this environment over time. Overall, a combination of both antennae frequencies provided optimal detection of the targets. Better images were noted for deep graves, compared to shallow graves. The 250 MHz antenna provided better images for detecting deep graves, as less non-target anomalies were produced with lower radar frequencies. The 250 MHz antenna also provided better images detecting the disturbed ground. Conversely, the 500 MHz antenna provided better images when detecting the shallow pig grave. The graves that contained a pig carcass with associated grave items provided the best results, particularly the carcass covered with rocks and the carcass wrapped in a tarpaulin. Finally, during periods of increased soil moisture levels, there was increased detection of graves that was most likely related to conductive decompositional fluid from the carcasses.

  4. Association between Polymorphisms in the TSHR Gene and Graves' Orbitopathy

    PubMed Central

    Jurecka-Lubieniecka, Beata; Ploski, Rafal; Kula, Dorota; Szymanski, Konrad; Bednarczuk, Tomasz; Ambroziak, Urszula; Hasse-Lazar, Kornelia; Hyla-Klekot, Lidia; Tukiendorf, Andrzej; Kolosza, Zofia; Jarzab, Barbara

    2014-01-01

    Background Graves' orbitopathy (GO) as well as Graves' disease (GD) hyperthyroidism originate from an autoimmune reaction against the common auto-antigen, thyroid-stimulating hormone receptor (TSHR). GO phenotype is associated with environmental risk factors, mainly nicotinism, as well as genetic risk factors which initiate an immunologic reaction. In some patients GO is observed before diagnosis of GD hyperthyroidism, while it can also be observed far after diagnosis. The intensity of GO symptoms varies greatly in these patients. Thus, the pathogenesis of GD and GO may correlate with different genetic backgrounds, which has been confirmed by studies of correlations between GO and polymorphisms in cytokines involved in orbit inflammation. The aim of our analysis was to assess genetic predisposition to GO in young patients (age of diagnosis ≤30 years of age), for whom environmental effects had less time to influence outcomes than in adults. Methods 768 GD patients were included in the study. 359 of them had clinically evident orbitopathy (NOSPECS ≥2). Patients were stratified by age at diagnosis. Association analyses were performed for genes with a known influence on development of GD - TSHR, HLA-DRB1, cytotoxic T-lymphocyte antigen 4 (CTLA4) and lymphoid protein tyrosine phosphatase (PTPN22). Results The rs179247 TSHR polymorphism was associated with GO in young patients only. In young GO-free patients, allele A was statistically more frequent and homozygous carriers had a considerable lower risk of disease incidence than patients with AG or GG genotypes. Those differences were not found in either elderly patients or the group analyzed as a whole. Conclusions Allele A of the rs179247 polymorphism in the TSHR gene is associated with lower risk of GO in young GD patients. PMID:25061884

  5. THERAPY OF ENDOCRINE DISEASE: Endocrine dilemma: management of Graves' orbitopathy.

    PubMed

    Campi, Irene; Vannucchi, Guia; Salvi, Mario

    2016-09-01

    Management of Graves' orbitopathy (GO) must be based on the correct assessment of activity and severity of the disease. Activity is usually assessed with the Clinical Activity Score, whereas severity is classified according to a European Group On Graves' Orbitopathy (EUGOGO) consensus statement as mild, moderate-to-severe, and sight-threatening. Myopathic and chronic congestive forms are uncommon clinical presentations of GO. Restoration and maintenance of stable euthyroidism are recommended in the presence of GO.In moderate-to-severe disease, steroids have been widely employed and have shown to possess an anti-inflammatory activity, but about 20-30% of patients are not responsive and present recurrence. Some novel immunosuppressors have already been employed in clinical studies and have shown interesting results, although the lack of randomized and controlled trials suggests caution for their use in clinical practice. Potential targets for therapy in GO are the thyroid-stimulating hormone and the insulin-like growth factor 1 receptor on the fibroblasts, inflammatory cytokines, B and T cells, and the PIK3/mTORC1 signaling cascades for adipogenesis. A recent open study has shown that tocilizumab, an anti-sIL-6R antibody, inactivates GO. Consistent reports on the efficacy of rituximab have recently been challenged by randomized controlled trials.As the main goal of treatment is the well-being of the patient, the therapeutic strategy should be addressed to better suit the patient needs, more than improving one or more biological parameters. The increasing availability of new therapies will expand the therapeutic options for GO patients and allow the clinician to really personalize the treatment to better suit the patients' personal needs.

  6. Identification process in mass graves from the Spanish Civil War I.

    PubMed

    Ríos, Luis; Ovejero, José Ignacio Casado; Prieto, Jorge Puente

    2010-06-15

    The identification process of human skeletal remains exhumed from a mass grave from the Spanish Civil War (1936-1939) is presented. Information regarding the presumptive location of the grave and the presumptive number and identities of the persons buried in the grave was collected from interviews and written records from relatives and witnesses, as well as from research at the penitentiary archive. Antemortem individual data were collected from testimonies, and from research from penitentiary, army and civil archives. The consistency between data obtained from testimonies, archives, archaeology and osteology allowed a targeted approach to DNA typing based on the assumption of the finding of a closed synchronic group. Two were the first genetic studies requested: the first study focused in the identification of a family group presumptively buried in the grave, compatible with a group of four skeletons that were associated on the basis of dental non-metric traits; the second study focused on the identification of the youngest person presumptively buried at the grave, compatible with the biologically youngest skeleton exhumed. A complete match between 16 Y-STR loci was observed for the four skeletons, as well as a match between mtDNA profiles of the biologically youngest skeleton and the sister of the youngest person presumptively known to be buried in the grave. These results, together with the accumulated evidence, led to propose the identification of these five persons. To date, identifications have been proposed for 17 out of 46 skeletons exhumed from the grave.

  7. Advances in treatment of active, moderate-to-severe Graves' ophthalmopathy.

    PubMed

    Wiersinga, Wilmar M

    2017-02-01

    Graves' ophthalmopathy is defined as autoimmune inflammation of extraocular muscles and orbital fat or connective tissue, usually in patients with Graves' disease. About one in 20 patients with Graves' hyperthyroidism has moderate-to-severe Graves' ophthalmopathy. Corticosteroids have been the mainstay of treatment, but new evidence about immune mechanisms has provided a basis to explore other drug classes. Intravenous methylprednisolone pulses are more effective and better tolerated than oral prednisone in the treatment of active, moderate-to-severe Graves' ophthalmopathy. Rituximab has also been suggested as a possible replacement for intravenous corticosteroids. Two randomised controlled trials of rituximab reached seemingly contradictory conclusions-rituximab was not better with respect to the primary outcome (clinical activity score) than placebo in one trial (which, however, was confounded by rather long Graves' ophthalmopathy duration), but was slightly better than intravenous methylprednisolone pulses in the other (disease flare-ups occurred only in the latter group). On the basis of evidence published so far, rituximab cannot replace intravenous methylprednisolone pulses, but could have a role in corticosteroid-resistant cases. Open-label studies of tumour-necrosis-factor-α blockade had limited efficacy, but other studies showed that interleukin-6 receptor antibodies were effective. Results of randomised controlled trials investigating the efficacy of the IGF-1 receptor antibody teprotumumab and the interleukin-6 receptor antibody tocilizumab are expected shortly. Approaches that target the causal mechanism of Graves' ophthalmopathy (antibodies or antagonists that block thyroid-stimulating-hormone receptors) also look promising.

  8. Experiments to Detect Clandestine Graves from Interpreted High Resolution Geophysical Anomalies

    NASA Astrophysics Data System (ADS)

    Molina, C. M.; Hernandez, O.; Pringle, J.

    2013-05-01

    This project refers to the search for clandestine sites where possibly missing people have been buried based on interpreted near surface high resolution geophysical anomalies. Nowadays, there are thousands of missing people around the world that could have been tortured and killed and buried in clandestine graves. This is a huge problem for their families and governments that are responsible to warranty the human rights for everybody. These people need to be found and the related crime cases need to be resolved. This work proposes to construct a series of graves where all the conditions of the grave, human remains and related objects are known. It is expected to detect contrasting physical properties of soil to identify the known human remains and objects. The proposed geophysical methods will include electrical tomography, magnetic and ground penetrating radar, among others. Two geographical sites will be selected to located and build standard graves with contrasting weather, soil, vegetation, geographic and geologic conditions. Forward and inverse modeling will be applied to locate and enhance the geophysical response of the known graves and to validate the methodology. As a result, an integrated geophysical program will be provided to support the search for clandestine graves helping to find missing people that have been illegally buried. Optionally, the methodology will be tested to search for real clandestine graves.

  9. Profiling the decomposition odour at the grave surface before and after probing.

    PubMed

    Forbes, S L; Troobnikoff, A N; Ueland, M; Nizio, K D; Perrault, K A

    2016-02-01

    Human remains detection (HRD) dogs are recognised as a valuable and non-invasive search method for remains concealed in many different environments, including clandestine graves. However, the search for buried remains can be a challenging task as minimal odour may be available at the grave surface for detection by the dogs. Handlers often use a soil probe during these searches in an attempt to increase the amount of odour available for detection, but soil probing is considered an invasive search technique. The aim of this study was to determine whether the soil probe assists with increasing the abundance of volatile organic compounds (VOCs) available at the grave surface. A proof-of-concept method was developed using porcine remains to collect VOCs within the grave without disturbing the burial environment, and to compare their abundance at the grave surface before and after probing. Detection and identification of the VOC profiles required the use of comprehensive two-dimensional gas chromatography-time-of-flight mass spectrometry (GC×GC-TOFMS) due to its superior sensitivity and selectivity for decomposition odour profiling. The abundance of decomposition VOCs was consistently higher within the grave environment compared to the grave surface, except when the grave surface had been disturbed, confirming the reduced availability of odour at the grave surface. Although probing appeared to increase the abundance of VOCs at the grave surface on many of the sampling days, there were no clear trends identified across the study and no direct relationships with the environmental variables measured. Typically, the decomposition VOCs that were most prevalent in the grave soil were the same VOCs detected at the grave surface, whereas the trace VOCs detected in these environments varied throughout the post-burial period. This study highlighted that probing the soil can assist with releasing decomposition VOCs but is likely correlated to environmental and burial variables

  10. Clinical efficacy of Yingliu treatment for Graves disease

    PubMed Central

    Yang, Hua; Bi, Xiaojuan; Tang, Hong; Zeng, Juanhua; Cong, Yilei; Wu, Tengfei; Chen, Qiuye

    2015-01-01

    Objective: To observe the clinical efficacy and safety of the traditional Chinese medicine (TCM) mixture Yingliu combined with methimazole medication for the treatment of Graves disease (GD). Method: In a randomized, paralleled control study, 92 GD patients were randomized into a Yingliu mixture treatment and a control treatment group, both receiving methimazole. Both treatments lasted for 12 weeks and outcome parameter were thyroid function, thyroid autoantibodies, TCM symptome scores and safety indicators. Results: The clinical efficiency of the Yingliu mixture-methimazole combination was 92.5% vs. 82.5% (P < 0.05) of the solely methimazole medication group. After 12 weeks treatments the Yingliu mixture in combination with methimazole improved free triiodothyronine (FT3), free tetraiodothyronine (FT4), thyroid-stimulating hormone (TSH) receptor antibody (TRAb) and thyroglobulin antibody (TGAb) values significantly more than methimazole alone and TCM symptome scores were significant lower after 12 week treatment in the Yingliu mixture- methimazole group (P < 0.05). The thyroid enlargement (21 vs. 10, P < 0.05), fatigue (39 vs. 30, P < 0.01) and dry mouth symptoms (37 vs. 29, P < 0.05) were superior improved in the Yingliu than in the control medication group, respectively. There was no significant difference regarding safety evaluations between both treatment groups (P = 0.499). Conclusion: Yingliu mixture as combined medication with methimazole can significantly improve the outcome of a solely methimazole application for GD treatments. PMID:26131218

  11. Cradle-to-Grave Logistic Technologies for Exploration Missions

    NASA Technical Reports Server (NTRS)

    Broyan, James L.; Ewert, Michael K.; Shull, Sarah

    2013-01-01

    Human exploration missions under study are very limited by the launch mass capacity of exiting and planned vehicles. The logistical mass of crew items is typically considered separate from the vehicle structure, habitat outfitting, and life support systems. Consequently, crew item logistical mass is typically competing with vehicle systems for mass allocation. NASA is Advanced Exploration Systems (AES) Logistics Reduction and Repurposing (LRR) Project is developing four logistics technologies guided by a systems engineering cradle-to-grave approach to enable used crew items to augment vehicle systems. Specifically, AES LRR is investigating the direct reduction of clothing mass, the repurposing of logistical packaging, the processing of spent crew items to benefit radiation shielding and water recovery, and the conversion of trash to propulsion supply gases. The systematic implementation of these types of technologies will increase launch mass efficiency by enabling items to be used for secondary purposes and improve the habitability of the vehicle as the mission duration increases. This paper provides a description, benefits, and challenges of the four technologies under development and a status of progress at the mid ]point of the three year AES project.

  12. [Graves' disease: ultrasonographic, color Doppler and histological aspects].

    PubMed

    Messina, G; Viceconti, N; Trinti, B

    1997-11-01

    The aim of the present work was to study the relationship between thyroid low echogenicity, the thyroid blood flow by color-Doppler (CD) and histological features in patients with Graves' disease (GD). Thyroid ultrasonography and CD was performed on 28 patients with GD. In 5 patients has been compared CD with histology. The thyroid volume was higher in 100% of patients with GD at the onset rather than in euthyroidism. Diffuse hypoechogenicity of the thyroid was discovered in 100% of patients with GD at the onset and it persisted in 57.1% of patients that became euthyroid after therapy. Qualitative CD resulted in different patterns that were classified as follow: pattern A ("thyroid inferno") in 17 patients (60.7%); pattern B (mildly increased of parenchymal blood flow) in 11 patients (39.3%). In the 5 histological proven cases, in the pattern A (3 cases) there was a diffuse microfollicular hyperplasia with functional activation notes. There was lymphocytic infiltration. While in the pattern B (two cases) there were a non-follicular hypercellular nodule with pseudocapsule and rare colloid. We conclude that there are two different histological types with different CD patterns in GD.

  13. Decrease of peripheral large granular lymphocytes in Graves' disease.

    PubMed Central

    Iwatani, Y; Amino, N; Kabutomori, O; Mori, H; Tamaki, H; Motoi, S; Izumiguchi, Y; Miyai, K

    1984-01-01

    Peripheral large granular lymphocytes (LGL) were enumerated in normal subjects and patients with autoimmune thyroid diseases. In normal subjects, the percentage of LGL was significantly lower in women (mean +/- s.d., 17.0 +/- 3.6%; n = 35; P less than 0.05) than in men (19.5 +/- 5.3%; n = 20). In untreated patients with thyrotoxic Graves' disease (GD), both the percentage (11.5 +/- 2.7%; n = 12; P less than 0.001) and the absolute count (244 +/- 102/mm3; P less than 0.01) of LGL were significantly lower than those in normal women (17.0 +/- 3.6% and 334 +/- 122/mm3; n = 35). No significant differences from normal controls were observed in the percentages or absolute counts of LGL in patients with euthyroid GD under treatment or in euthyroid or hypothyroid patients with Hashimoto's disease (HD). The percentage of LGL was inversely correlated with the serum levels of T4 and T3 and the free T4 index, but not with the titre of anti-thyroid antibodies, the size of goitre or the degree of proptosis in the group of untreated patients with GD and HD. The decreased levels of LGL in thyrotoxic patients with GD may be related to the self-perpetuation of thyrotoxicosis in patients with this disease. Images Fig. 1 PMID:6546360

  14. Thyroid "vise" in an infant with neonatal Graves' disease.

    PubMed

    Regelmann, Molly O; Sullivan, Corinne K; Rapaport, Robert

    2013-10-01

    On the rare occasion when neonatal goiter is the cause of airway compromise, it typically presents with a palpable neck mass. In the setting of maternal Graves' disease (GD), fetal and neonatal goiters are most commonly caused by maternal treatment with antithyroid medication, and the goiter resolves within days of initiation of thyroxine replacement in the neonate. We describe an atypical presentation of a patient with severe neonatal GD born to a euthyroid mother at 35 weeks' gestational age with respiratory compromise, symptoms of hyperthyroidism, and a nonpalpable thyroid gland. The mother had a history of GD treated with radioactive iodine ablation; during the pregnancy she was treated with levothyroxine throughout and propylthiouracil beginning at 5 months' gestation, for fetal tachycardia. Laboratory testing after birth confirmed neonatal GD. The patient was treated with methimazole, Lugol's solution, and levothyroxine, and the patient remained euthyroid from day of life 10. After multiple extubation attempts failed, the patient was found on visualization studies to have a large, predominantly posterior, "vise-like" goiter encasing the larynx and upper trachea. The patient was successfully extubated, and all medications were discontinued on day of life 60. The patient remained euthyroid 1 month after discontinuation of treatment. The patient's atypical presentation illustrates the need for early neck imaging in patients with neonatal GD and respiratory distress, especially when the thyroid gland is not palpable. Treatment options for resolving a goiter due to neonatal GD are not clear.

  15. Optimal iodine-131 dose for eliminating hyperthyroidism in Graves' disease

    SciTech Connect

    Nordyke, R.A.; Gilbert, F.I. Jr. )

    1991-03-01

    Since hypothyroidism is commonplace after treatment of Graves' disease with radioiodine, the goal should be cure of hyperthyroidism rather than avoidance of hypothyroidism. To find the optimal dose to accomplish cure, we treated 605 patients with stepwise increasing doses of 3, 4, 5, 6, 8, and 10 mCi, analyzing the relationship of dose, age, sex, gland weight, and thyroidal uptake to cure. Estimates of cure at doses above 10 mCi were made from the literature. Cure was directly related to dose between 5 and 10 mCi. There was no significant relationship between cure and age (chi-square, p = 0.74), sex (chi-square, p = 0.12), and 24-hr uptake if over 30% (chi-square for slope, p greater than 0.10). Cure and gland weight had an inverse relationship (chi-square for slope, 0.01 less than p less than 0.02). We concluded that the optimal 131I dose for curing hyperthyroidism is approximated by starting with 10 mCi and increasing it for unusually large glands or for special patient circumstances.

  16. Sheehan's syndrome co-existing with Graves' disease.

    PubMed

    Arpaci, D; Cuhaci, N; Saglam, F; Ersoy, R; Cakir, B

    2014-01-01

    Sheehan's syndrome (SS), which is an important cause of hypopituitarism, is common in developing countries. The most common presentation is the absence of lactation and amenorrhea. Hypothyroidism rather than hyperthyroidism is the usual expected phenomenon in SS. Postpartum hyperthyroidism is also common and Graves' disease (GD) is an important cause of postpartum hyperthyroidism. Here we report a case of a 22-year-old female patient in our clinic presented symptoms of amenorrhea, lack of lactation, palpitations and sweating. Her physical examination revealed goiter, moist skin and proptosis. Her laboratory evaluation showed suppressed thyroid stimulating hormone, elevated levels of free thyroxine and free triiodothyronine. Thyroid antibodies were positive. Tec 99m thyroid scintigraphy results were gland hyperplasia and increased uptake consistent with GD. She gave birth 7 months ago; after delivery she had a history of prolonged bleeding, amenorrhea and inability to lactate. She had hypogonadotropic hypogonadism, hyperprolactinemia and growth hormone deficiency. Serum cortisol and adrenocorticotropic hormone levels were normal. Her magnetic resonance imaging was empty sella. Our diagnosis was GD co-existing with SS. GD with concomitant hypopituitarism is rare but has been described previously, but there are no reports of GD occurring with SS. In this case study, we report a patient with GD associated with SS.

  17. Soilwater Conductivity Analysis to Date and Locate Clandestine Graves of Homicide Victims.

    PubMed

    Pringle, Jamie K; Cassella, John P; Jervis, John R; Williams, Anna; Cross, Peter; Cassidy, Nigel J

    2015-07-01

    In homicide investigations, it is critically important that postmortem interval and postburial interval (PBI) of buried victims are determined accurately. However, clandestine graves can be difficult to locate; and the detection rates for a variety of search methods (ranging from simple ground probing through to remote imaging and near-surface geophysics) can be very low. In this study, simulated graves of homicide victims were emplaced in three sites with contrasting soil types, bedrock, and depositional environments. The long-term monthly in situ monitoring of grave soil water revealed rapid increases in conductivity up to 2 years after burial, with the longest study evidencing declining values to background levels after 4.25 years. Results were corrected for site temperatures and rainfall to produce generic models of fluid conductivity as a function of time. The research suggests soilwater conductivity can give reliable PBI estimates for clandestine burials and therefore be used as a grave detection method.

  18. Thyroid function. Pathogenesis of Graves ophthalmopathy--a role for TSH-R?

    PubMed

    Wall, Jack R

    2014-05-01

    A new study highlights the complexities of anti-TSH-receptor antibody function and the differences between adult and paediatric patients with Graves disease, adding to the controversy regarding the possible role of these antibodies in the development of ophthalmopathy.

  19. Anterior pituitary cell antibodies detected in Hashimoto's thyroiditis and Graves' disease.

    PubMed

    Kobayashi, I; Inukai, T; Takahashi, M; Ishii, A; Ohshima, K; Mori, M; Shimomura, Y; Kobayashi, S; Hashimoto, A; Sugiura, M

    1988-10-01

    An immunofluorescence study using unfixed cryostat sections of rat pituitary glands was carried out on sera from 34 patients with Hashimoto's thyroiditis, 28 patients with Graves' disease, 10 patients with thyroid adenoma and 50 healthy subjects. After absorption of sera with rat liver tissues, 19 of 34 patients retained reactivity to anterior pituitary cell antibodies (PCA, 55.8%). On the other hand, immunofluorescence in anterior pituitary cells was faint and detected in only 2 of 28 patients with Graves' disease (7.1%) after absorption of their sera with rat liver aceton powder. A similar result was also obtained when PCA were compared in the sera of Hashimoto's thyroiditis and Graves' disease with high titers of thyroid microsomal autoantibodies. PCA were detected neither in the sera of patients with thyroid adenoma nor in the healthy subjects. The present study suggests that PCA were considerably more prevalent in Hashimoto's thyroiditis than in Graves' disease.

  20. Une mucormycose faciale compliquant une angiocholite grave: à propos d’un cas

    PubMed Central

    Lakhdar, Karim; Houari, Naoufal; Elbouazzaoui, Abderrahim; Ameuraoui, Taoufik; Boukatta, Brahim; Sbai, Hicham; Kanjaa, Nabil

    2016-01-01

    Les mucormycoses sont des infections fongiques opportunistes survenant chez des patients immunodéprimés. C’est une affection grave compromettant le pronostic vital. Même diagnostiquée précocement, la mortalité des mucormycoses atteint 50%. Nous rapportons le cas d’une mucormycose chez une patiente diabétique hospitalisée en réanimation pour angiocholite grave. L’évolution était fatale. PMID:28293362

  1. Thyroid Follicular Carcinoma in a Fourteen-year-old Girl with Graves' Disease.

    PubMed

    Kojima-Ishii, Kanako; Ihara, Kenji; Ohkubo, Kazuhiro; Matsuo, Terumichi; Toda, Naoko; Yamashita, Hiroyuki; Kono, Shinji; Hara, Toshiro

    2014-04-01

    Here we present the case of a 14-yr-old girl who developed thyroid follicular carcinoma accompanied by Graves' disease. She was diagnosed with Graves' disease at 10 yr of age and soon achieved a euthyroid state after starting treatment. When she was 13 yr of age, her hyperthyroidism and goiter worsened despite medical therapy. Multiple nodules were found in her enlarged thyroid gland by ultrasonography. Her serum Tg level seemed within the normal range. She underwent near-total thyroidectomy for control of thyroid function. Histopathological study demonstrated that multiple oxyphilic follicular neoplasms were surrounded by the thyroid tissue compatible with Graves' disease. Capsular invasion was identified in one of the nodules, and thus the histological diagnosis was minimally invasive follicular carcinoma. She did not have signs suggesting metastasis, and has had no relapse for 18 mo after the operation. Although some previous studies showed a high prevalence of thyroid cancer with an aggressive nature in adult patients with Graves' disease, few reports about thyroid cancer accompanied by Graves' disease are available in children. The present case, however, suggests that careful investigation is needed when we detect thyroid nodules or progressive thyroid enlargement, especially in children with Graves' disease.

  2. Refractory Graves' Disease Successfully Cured by Adjunctive Cholestyramine and Subsequent Total Thyroidectomy.

    PubMed

    Yang, Yeoree; Hwang, Seawon; Kim, Minji; Lim, Yejee; Kim, Min Hee; Lee, Sohee; Lim, Dong Jun; Kang, Moo Il; Cha, Bong Yun

    2015-12-01

    The three major forms of treatment for Graves thyrotoxicosis are antithyroid drugs, radioactive iodine therapy and thyroidectomy. Surgery is the definitive treatment for Graves thyrotoxicosis that is generally recommended when other treatments have failed or are contraindicated. Generally, thyrotoxic patients should be euthyroid before surgery to minimize potential complications which usually requires preoperative management with thionamides or inorganic iodine. But several cases of refractory Graves' disease have shown resistance to conventional treatment. Here we report a 40-year-old female patient with Graves' disease who complained of thyrotoxic symptoms for 7 months. Her thyroid function test and thyroid autoantibody profiles were consistent with Graves' disease. One kind of thionamides and β-blocker were started to control her disease. However, she was resistant to nearly all conventional medical therapies, including β-blockers, inorganic iodine, and two thionamides. She experienced hepatotoxicity from the thionamides. What was worse is her past history of serious allergic reaction to corticosteroids, which are often used to help control symptoms. A 2-week regimen of high-dose cholestyramine improved her uncontrolled thyrotoxicosis and subsequent thyroidectomy was successfully performed. In conclusion, cholestyramine could be administered as an effective and safe adjunctive agent for preoperative preparation in patients with severe hyperthyroid Graves's disease that is resistant to conventional therapies.

  3. Refractory Graves' Disease Successfully Cured by Adjunctive Cholestyramine and Subsequent Total Thyroidectomy

    PubMed Central

    Yang, Yeoree; Hwang, Seawon; Kim, Minji; Lim, Yejee; Kim, Min-Hee; Lee, Sohee; Kang, Moo-Il; Cha, Bong-Yun

    2015-01-01

    The three major forms of treatment for Graves thyrotoxicosis are antithyroid drugs, radioactive iodine therapy and thyroidectomy. Surgery is the definitive treatment for Graves thyrotoxicosis that is generally recommended when other treatments have failed or are contraindicated. Generally, thyrotoxic patients should be euthyroid before surgery to minimize potential complications which usually requires preoperative management with thionamides or inorganic iodine. But several cases of refractory Graves' disease have shown resistance to conventional treatment. Here we report a 40-year-old female patient with Graves' disease who complained of thyrotoxic symptoms for 7 months. Her thyroid function test and thyroid autoantibody profiles were consistent with Graves' disease. One kind of thionamides and β-blocker were started to control her disease. However, she was resistant to nearly all conventional medical therapies, including β-blockers, inorganic iodine, and two thionamides. She experienced hepatotoxicity from the thionamides. What was worse is her past history of serious allergic reaction to corticosteroids, which are often used to help control symptoms. A 2-week regimen of high-dose cholestyramine improved her uncontrolled thyrotoxicosis and subsequent thyroidectomy was successfully performed. In conclusion, cholestyramine could be administered as an effective and safe adjunctive agent for preoperative preparation in patients with severe hyperthyroid Graves's disease that is resistant to conventional therapies. PMID:26394731

  4. Spontaneous Improvement of Untreated Mild Graves' Ophthalmopathy: Rundle's Curve Revisited

    PubMed Central

    Menconi, Francesca; Profilo, Maria Antonietta; Leo, Marenza; Sisti, Eleonora; Altea, Maria Antonietta; Rocchi, Roberto; Latrofa, Francesco; Nardi, Marco; Vitti, Paolo; Marcocci, Claudio

    2014-01-01

    Background: According to Rundle's curve, Graves' ophthalmopathy (GO) worsens during an initial phase up to a peak of maximum severity, then improves and reaches a static plateau, with the activity curve preceding the severity curve by a few months. To our knowledge, no studies have tried to replicate Rundle's curve, and very few have investigated the natural history of GO. Here, we studied GO natural history retrospectively and tried to identify factors that may affect it. Methods: A total of 65 patients with untreated GO underwent an eye assessment after a median of seven months after the appearance of GO and then after a median of 40 months. The primary endpoints were the variation of the single GO features and of the NOSPECS score, as well as the overall outcome of GO. The secondary endpoint was the influence of several variables (age, sex, smoking, GO and thyroid disease duration, thyroid treatment, thyroid status, thyroid volume, anti-TSH receptor autoantibodies) on the outcome of GO. Results: The majority of patients had mild, minimally active GO, and only five had a Clinical Activity Score (CAS) >3. There was a significant reduction of CAS (p<0.0001) and NOSPECS (p=0.01) between the first and last observation, with a timing pattern resembling Rundle's curve. This difference was confirmed even when patients with a CAS >3 at first observation were excluded. At the last observation, 50.8% of patients had improved, 33.8% had remained stable, and 15.4% had worsened moderately or substantially. The overall outcome of GO was not affected by any of the variables under examination. Conclusions: In confirmation of Rundle's observations, untreated GO improves spontaneously with time in the majority of patients, with an activity peak between 13 and 24 months, which may have implications in determining the proper timing of GO treatments. PMID:23980907

  5. Prognostic factors in the radiotherapy of Graves' ophthalmopathy

    SciTech Connect

    Petersen, I.A.; Kriss, J.P.; McDougall, I.R.; Donaldson, S.S. )

    1990-08-01

    Between April 1968 and February 1988, 311 patients with symptomatic and progressive Graves' ophthalmopathy were treated with megavoltage orbital radiotherapy. The patients were divided into three groups: I treated with 20 Gy/2 weeks; II treated with 30 Gy/3 weeks, and III received 20 Gy/2 weeks. The degree of eye involvement was evaluated numerically before and after therapy for each of five parameters: soft tissue signs, proptosis, eye muscle impairment, corneal involvement, and sight loss. Pre-treatment and current thyroid diagnosis and status were also noted. To evaluate the effects of radiotherapy alone, follow-up was terminated at the time any eye surgery was done; for those not treated surgically the minimum follow-up was 12 months. Because there were significant demographic differences between the patient groups, the results of each group were analyzed separately. A stepwise linear regression analysis was performed to determine if there were any significant variables affecting outcome. Based on these data formulae were derived which enable outcome to be predicted in any patient. Before therapy more than 90% of patients in all groups had soft tissue and eye muscle involvement, whereas 65-75% had proptosis and about half 50% had some degree of sight loss. Radiotherapy arrested progression of ophthalmic parameters in all but 1-6% of the patients. Objective and symptomatic improvement was noted for all parameters assessed, but there was marked individual variability. The best responses were noted for soft tissue, corneal involvement, and sight loss; however over half the patients had some improvement in eye muscle function and proptosis. Factors which resulted in less favorable outcome included male gender, advanced age, need for concurrent therapy for hyperthyroidism, and no history of hyperthyroidism. No complications have been observed.

  6. Current trends in the management of Graves' disease

    SciTech Connect

    Solomon, B.; Glinoer, D.; Lagasse, R.; Wartofsky, L. )

    1990-06-01

    Members of the American Thyroid Association were invited to participate in a survey of the management of Graves' disease. One primary case and several variations were provided, which differed in respect to age, sex, goiter size, severity, etc. The questionnaire was based on the format used in a similar survey of members of the European Thyroid Association. The aim of the survey was to determine (1) how expert thyroidologist employ diagnostic procedures for this disorder, and (2) the choice of therapy of the three treatment options and its manner of implementation. Questionnaires were sent only to clinically active members. The overall response rate was 62%. Data analysis was possible on 52% of members surveyed and was performed using SPSS and a specific Fortran program. In the laboratory evaluation of the primary case a radioiodine uptake, scan, serum total T4, and basal TSH were requested by 92%, 47%, 83%, and 66%, respectively, with 84% of respondents using an ultrasensitive TSH assay. For management of the primary case, radioiodine treatment was the first choice of 69% of the respondents. Antithyroid drugs were used briefly (3-7 days) before 131I by 28%, whereas 41% said they would employ thioureas after 131I. Of those using 131I, 66% tailored the dose to achieve euthyroidism as the goal of therapy, while 34% aimed for hypothyroidism requiring T4 replacement. Only 30% of respondents chose thioureas as a first line of treatment (72% propylthiouracil; 28% tapazole). The duration of drug therapy was a predetermined fixed interval for 80% of the respondents, with 90% treating for 1-2 yr. Other specific trends in diagnostic approach and therapeutic preferences were identified for the eight variations on the primary case problem.

  7. Predicting relapse following medical therapy for Graves' disease

    SciTech Connect

    McKillop, J.H.; Wilson, R.; Pearson, D.W.; Cuthbert, G.F.; Jenkins, C.; Caine, S.; Thomson, J.A.

    1984-01-01

    In 40 patients with Graves' disease (35 female, 5 male; mean age at presentation = 38 yrs) the authors examined the ability of thyroidal /sup 99m/Tc uptake and serum thyroid stimulating immunoglobins (TSI) to identify patients who would relapse after a course of medical therapy. Serum TSI and 20 minute thyroidal /sup 99m/Tc uptake were estimated every 3 months during a 12 month course of carbimazole and tri iodothyronine. TSI levels were estimated by inhibition of receptor binding and expressed as an index (normal value <25). 17 patients (Group 1) remained biochemically euthyroid for at least 1 year after cessation of therapy. 23 (Group II) developed recurrent thyrotoxicosis. Thyroid hormone level did not differ between Groups I and II at presentation. /sup 99m/Tc uptake did not differ significantly in the two groups at presentation and overlap of values persisted throughout therapy. 3 patients had undetectable TSI levels at presentation and throughout follow-up. In the remaining 37, TSI levels at presentation were significantly higher in Group II and all 7 patients with initial values >80 relapsed. After 12 months therapy a TSI level of >25 was present in 1 Group I patient and 16 Group II patients who had detectable TSI at presentation. /sup 99m/Tc uptake was a poor predictor of relapse of thyrotoxicosis. A very high TSI level at presentation (>80) was associated with relapse. An abnormal TSI on completion of 12 months medical therapy had a sensitivity of 86% and a specificity of 94% for prediction of relapse of thyrotoxicosis in the subsequent year.

  8. Prise en charge des traumatismes graves du rein

    PubMed Central

    Lakmichi, Mohamed Amine; Jarir, Redouane; Sadiki, Bader; Zehraoui; Bentani; Wakrim, Bader; Dahami, Zakaria; Moudouni; Sarf, Ismail

    2015-01-01

    Les traumatismes graves du rein de grade III, IV et V selon la classification de l'Amercan Society for Surgery For Trauma (ASST) sont plus rares et se retrouvent dans 5% des cas en moyenne. Leur prise en charge est souvent délicate, nécessitant alors des centres expérimentés dotés de moyen adéquats d'imagerie (scanner spiralé). Cependant, durant ces dernières années, la prise en charge de ces traumatismes a évolué vers une attitude de moins en moins chirurgicale grâce à l’évolution des techniques de la radiologie interventionnelle, de l'endourologie et des moyens de surveillance aux urgences et de réanimation. L'objectif de cette étude est d’évaluer notre expérience dans la prise en charge des traumatismes rénaux de haut grade. Notre étude rétrospective porte sur 25 cas de traumatismes grave du rein de grade III, IV et V selon la classification de l'ASST, colligés entre Janvier 2002 et Juin 2009 au service d'urologie du centre Hospitalier Universitaire Mohammed VI, Université Cadi Ayyad de Marrakech, Maroc. Nous avons étudié les données épidémiologiques, les signes cliniques et biologiques à l'admission (état de choc hémorragique, taux d'hémoglobine), les données radiologiques (échographie et scanner), les lésions associées, la prise en charge thérapeutique et les complications. L’âge moyen de nos patients était de 24,9 ans 15 et 58 ans, avec une prédominance masculine (sex-ratio = 7, 3). Le rein droit était intéressé dans 15 cas (60%). Le traumatisme rénal était fermé dans 15 cas, et ouvert par arme blanche dans 10 cas. Huit patients se sont présentés en état de choc hémorragique (32%). Une anémie inférieur à 10g /100ml a été observée dans 10 cas (40%). L'uroscanner fait systématiquement à l'admission a retrouvé un grade III (10 cas), grade IV (13 cas) et grade V (2 cas). La prise en charge a consisté en une exploration chirurgicale avec néphrectomie chez 2 cas de Grade IV pour une instabilité h

  9. Genetic associations of the thyroid stimulating hormone receptor gene with Graves diseases and Graves ophthalmopathy: A meta-analysis

    PubMed Central

    Xiong, Haibo; Wu, Mingxing; Yi, Hong; Wang, Xiuqing; Wang, Qian; Nadirshina, Sophia; Zhou, Xiyuan; Liu, Xueqin

    2016-01-01

    Graves’ disease (GD) is a common thyroid disease, and Graves ophthalmopathy(GO) is the most common extra-thyroidal manifestation of GD. Genetic associations of the thyroid stimulating hormone receptor (TSHR) gene with GD and GO have been studied in different population groups for a long time. We aimed to obtain a more precise estimation of the effects of TSHR single nucleotide polymorphisms (SNPs) on GD/GO using a meta-analysis. Publications were searched on Pub Med and EMBASE up to December 30, 2015. Eight studies involving three SNPs (rs179247, rs12101255, and rs2268458), which included 4790 cases and 5350 controls, met the selection criteria. The pooled odds ratios (OR) and the 95% confidence intervals (CI) were estimated. SNPs rs179247 (dominant model [GG + GA vs. AA]: OR = 0.66, 95%CI: 0.61–0.73, P = 0.000, I2 = 0%) and rs12101255 (dominant model [TT + TC vs. CC]: OR = 1.67, 95%CI: 1.53–1.83, P = 0.000, I2 = 0%) were significantly associated with GD in all of the genetic models. TSHR rs12101255 and rs2268458 polymorphisms had no association between GO and GD (GD without GO). The results indicate that rs179247 and rs12101255 are likely to be genetic biomarkers for GD. Further studies with different population groups and larger sample sizes are needed to confirm the genetic associations of the TSHR gene with GD/GO. PMID:27456991

  10. Enhancement of soluble CD28 levels in the serum of Graves' disease.

    PubMed

    Sun, Zhongwen; Yi, Lixian; Tao, Hong; Huang, Jingfang; Jin, Zhenghong; Xiao, Yang; Feng, Caiyun; Sun, Jing

    2014-01-01

    Graves' disease is an autoimmune disease of the thyroid gland mediated by T cells. CD28, a member of costimulatory molecules, plays a pivotal role in regulating T-cell responses. Plasma-soluble CD28 is one form of CD28 in peripheral blood. To investigate the concentrations of soluble CD28 in patients with Graves' disease, we used a sensitive dual monoclonal antibody sandwich enzyme-linked immunosorbent assay (ELISA) to detect the soluble form of CD28. Our results suggested that mean concentrations of soluble CD28 in plasma of patients with Graves' disease were 1.79 ±1.52 ng/ml, and levels of soluble CD28 in healthy subjects were only 0.83 ±1.35 ng/ml. Concentrations of soluble CD28 detected in patients with Graves' disease were significantly higher than those of healthy subjects (p < 0.01). Moreover, there was a significant positive correlation between the concentrations of soluble CD28 in plasma and levels of FT3 (r = 0.663), FT4 (r = 0.624) and TRAb (r = 0.728) in serum, but a negative correlation was found between sCD28 levels and TSH (r = -0.726). Through in vitro experiments we observed that engagement of soluble CD28 protein and B7-1/B7-2 molecules expressed on dendritic cells could exert the secretion of cytokine IL-6, which may promote the production of autoantibody and aggravate Graves' disease. Therefore, aberrant elevation of plasma-soluble CD28 in patients with Graves' disease may reflect the dysregulation of immune system, and may serve as a useful biomarker in Graves' disease diagnosis.

  11. Partial prediction of postpartum Graves' thyrotoxicosis by sensitive bioassay for thyroid-stimulating antibody measured in early pregnancy.

    PubMed

    Ide, Akane; Amino, Nobuyuki; Nishihara, Eijun; Kudo, Takumi; Ito, Mitsuru; Kimura, Yukiko; Tatsumi, Nobuya; Yamazaki, Mineo; Miyauchi, Akira

    2016-10-29

    Graves' disease often occurs after delivery. However, it has been difficult to predict who will develop Graves' hyperthyroidism. We attempted to predict postpartum onset of Graves' disease by measuring anti-TSH receptor antibodies (TRAb) and thyroid-stimulating antibodies (TSAb) in early pregnancy. TRAb was measured by a third generation assay and TSAb was measured by a newly developed sensitive bioassay. In 690 early pregnant women, 2 showed borderline TRAb positive reactions. However, none of them developed Graves' disease after delivery. Thirty-eight of 690 pregnant women were positive for anti-thyroid peroxidase antibodies (TPOAb) and 4 were positive for TSAb. Two of these 4 women developed postpartum Graves' hyperthyroidism. These findings indicate that the third generation TRAb assay was not useful, but that the sensitive TSAb bioassay was moderately useful for predicting the postpartum onset of Graves' hyperthyroidism.

  12. Long-term sequential monitoring of controlled graves representing common burial scenarios with ground penetrating radar: Years 2 and 3

    NASA Astrophysics Data System (ADS)

    Schultz, John J.; Walter, Brittany S.; Healy, Carrie

    2016-09-01

    Geophysical techniques such as ground-penetrating radar (GPR) have been successfully used for forensic searches to locate clandestine graves and physical evidence. However, additional controlled research is needed to fully understand the applicability of this technology when searching for clandestine graves in various environments, soil types, and for longer periods of time post-burial. The purpose of this study was to determine the applicability of GPR for detecting controlled graves in a Spodosol representing multiple burial scenarios for Years 2 and 3 of a three-year monitoring period. Objectives included determining how different burial scenarios are factors in producing a distinctive anomalous response; determining how different GPR imagery options (2D reflection profiles and horizontal time slices) can provide increased visibility of the burials; and comparing GPR imagery between 500 MHz and 250 MHz dominant frequency antennae. The research site contained a grid with eight graves representing common forensic burial scenarios in a Spodosol, a common soil type of Florida, with six graves containing a pig carcass (Sus scrofa). Burial scenarios with grave items (a deep grave with a layer of rocks over the carcass and a carcass wrapped in a tarpaulin) produced a more distinctive response with clearer target reflections over the duration of the monitoring period compared to naked carcasses. Months with increased precipitation were also found to produce clearer target reflections than drier months, particularly during Year 3 when many grave scenarios that were not previously visible became visible after increased seasonal rainfall. Overall, the 250 MHz dominant frequency antenna imagery was more favorable than the 500 MHz. While detection of a simulated grave may be difficult to detect over time, long term detection of a grave in a Spodosol may be possible if the disturbed spodic horizon is detected. Furthermore, while grave visibility increased with the 2D

  13. Two adolescent patients with coexistent Graves' disease and Moyamoya disease in Korea

    PubMed Central

    Cheon, Chong Kun; Kim, Su Yung

    2014-01-01

    Moyamoya disease is a cerebrovascular condition that results in the narrowing of the vessels of the circle of Willis and collateral vessel formation at the base of the brain. Although relationships between Graves' disease and cerebrovascular accidents in Moyamoya disease are obscure, the coexistence of the two diseases is noteworthy. Moyamoya disease has been rarely reported in adolescent patients with thyrotoxicosis. Recently, we encountered two adolescent Korean patients with Moyamoya disease associated with Graves' disease who presented with episodic right-sided hemiparesis and syncope. These two girls who had Graves' disease had no history of other diseases or head trauma. A thyroid function test revealed a euthyroid state and a high thyroid-stimulating hormone (TSH) receptor antibody titer at that time. The patients were diagnosed with Moyamoya disease based on brain magnetic resonance angiography and cerebral four-vessel angiography. The patients underwent cranial revascularization by encephalo-duroarterio-synangiosis as soon as a diagnosis was made, which resulted in successful symptom resolution. They fared well and had no additional neurological symptoms as of their last follow-up visits. Here, we report these two cases of confirmed Moyamoya disease complicated by Graves' disease with a review of the literature, and discuss the possible association between the two diseases. To our knowledge, this is the first report in South Korea on Moyamoya disease associated with Graves' disease in adolescents with a euthyroid. PMID:25076974

  14. Magnetic Ghosts: Mineral Magnetic Measurements On Roman and Anglo-saxon Graves

    NASA Astrophysics Data System (ADS)

    Linford, N.

    The location of inhumations, in the absence of ferrous grave goods, often presents a considerable challenge to archaeological geophysics given the small physical size of the features and the slight contrast between the fill of the grave and the surround- ing subsoil. Even during excavation, the identification of graves may be complicated where site conditions do not favour the preservation of human skeletal remains and often only a subtle soil stain is likely to survive. A recent initiative in the United King- dom has seen the formation of the Buried Organic Matter Decomposition Integrated with Elemental Status (BODIES) research group, to examine the decomposition of organic artefacts in ancient graves with respect to localised changes in pH, redox po- tential and nutrient status. This paper presents initial results from a limited mineral magnetic study of two grave sites in an attempt to ascertain whether the decomposi- tion of organic remains may lead to a detectable magnetic signature within the soil. Results from a series of isothermal, hysteresis and magneto-thermal experiments will be presented together with surface magnetometer and topsoil susceptibility surveys.

  15. Prevalence of increased intraocular pressure in Graves' disease--evidence of frequent subclinical ophthalmopathy.

    PubMed

    Gamblin, G T; Harper, D G; Galentine, P; Buck, D R; Chernow, B; Eil, C

    1983-02-24

    Graves' exophthalmos is frequently associated with elevated intraocular pressure on upgaze. Eighty patients with Graves' disease were evaluated prospectively by applanation tonometry to assess the prevalence of ophthalmopathy in this disorder. Whereas 21 (26 per cent) of the 80 patients had exophthalmos, 61 (76 per cent) had abnormal intraocular pressure (delta greater than or equal to 3 mm Hg). All patients with exophthalmos had elevated intraocular pressure on upgaze; 40 (68 per cent) of 59 patients without proptosis had abnormal pressure readings. The mean interval between the onset of Graves' disease and this study was 6.3 +/- 1.0 years (S.E.M.) for those patients who had exaggerated positional changes in intraocular pressure, as compared with 3.0 +/- 1.0 years for those with normal intraocular pressure (P less than 0.005). All but 1 of 15 patients in whom the diagnosis of Graves' disease had been documented 10 or more years earlier had increased intraocular pressure on upgaze. We conclude that Graves' ophthalmopathy is more common than is recognized clinically and that eye involvement is an inevitable complication of the disease.

  16. [Pulmonary carcinomatous lymphangitis: presentation as acute pneumopathy. Report of two cases].

    PubMed

    Ré, D P; Cazaux, A; Cambursano, V H; Zaya, A; Cortez, J R

    2013-01-01

    Introducción: La linfangitis carcinomatosa(LC) representa el 6-8% de las metástasis pulmonares. Existe evidencia de que puede ser una condición oncológicamente tratable, con impacto sobre la progresión de la disnea y lesiones radiológicas, con mejoría de la sobrevida. Se describen dos casos con el objetivo de inducir la sospecha de esta entidad ante un paciente con datos de neumopatía aguda. Métodos: Caso 1: mujer 32 años, disnea progresiva y tos de dos semanas de evolución sin respuesta a antibióticos. Taquipnea, aumento del trabajo respiratorio, crepitantes bibasales. Insuficiencia respiratoria. Radiografía: radiopacidadalvéolointersticialbibasal. Se inicia tratamiento para neumonía grave de la comunidad. Evoluciona desfavorablemente con requerimiento de ARM y desenlace fatal. Caso 2: mujer 46 años, disnea progresiva y tos de una semana de evolución. Taquipnea, subcrepitantes difusos.Insuficiencia respiratoria. Radiografía: radiopacidadintersticionodulillar difusa, con imagen radiopaca homogénea en vértice derecho.

  17. Papillary thyroid microcarcinoma in Graves' disease presenting as a cystic neck mass.

    PubMed

    Patil, Milind; Kamalanathan, Sadishkumar; Sahoo, JayaPrakash; Vivekanandan, Muthupillai; Kate, Vikram; Pandit, Nandini; Badhe, Bhawana

    2015-01-01

    The presentation of papillary thyroid microcarcinoma (PTMC) as a solitary cystic neck mass is uncommon. Additionally, its association with Graves' disease is very rare. We report a case of occult PTMC, who presented with a cystic neck mass in the background of Graves' disease without any goiter. Imaging like ultrasound of neck, single photon emission computed tomography-CT (SPECT-CT), and technetium scan failed to detect any lesion in the thyroid, which was picked up only by the contrast-enhanced computed tomography (CECT) of neck. The patient underwent total thyroidectomy with right modified lymph node dissection. Our case highlights the presentation of metastatic PTMC as a differential diagnosis of a cystic neck mass even in a patient with Graves' disease without any thyroid enlargement.

  18. A Study of Human Leukocyte D Locus Related Antigens in Graves' Disease

    PubMed Central

    Farid, Nadir R.; Sampson, Laura; Noel, Elke P.; Barnard, John M.; Mandeville, Robert; Larsen, Bodil; Marshall, William H.; Carter, Nicholas D.

    1979-01-01

    An association between Graves' disease and the human leukocyte antigen (HLA) system has previously been reported. The disease was more strongly associated with the HLA D locus antigen Dw3 than with HLA B8. Products of the HLA D locus are determined by the interaction of test cells with standard typing lymphocytes, a technically difficult procedure. Recently, it has been possible to type serologically for D locus related (DRw) specificities on peripheral bone marrow-derived (B) lymphocytes. Blood B lymphocytes from 50 unrelated controls and 41 patients with Graves' disease were typed for seven HLA DRw specificities. 28 patients with Graves' disease (68%) were positive for DRw3, in contrast to 14 controls (28%); whereas only 21 patients (50%) were HLA B8 positive, compared with 13 (26%) controls. Thus, positivity for DRw3 afforded a relative risk for Graves' disease of 5.5, whereas that for HLA B8 amounted to 3.0. Additionally, a family with multiple cases of Graves' disease in which the disease was previously shown to be inherited with the haplotype, was linked to DRw2, which suggests that the susceptibility to the disease was inherited in association with that antigen. Two HLA B/glyoxalase recombination events were observed in this family; in both instances HLA DRw followed HLA B. This study thus demonstrates that the disease susceptibility gene for Graves' disease is in strong linkage disequilibrium with DRw3; however, it may be associated with other DRw specificities and inherited within family units in association with them. PMID:105012

  19. [Treatment of hyperthyroidism due to Graves' disease: what is the recommended antithyroid drug during pregnancy?].

    PubMed

    Caron, P

    2013-05-01

    Clinical hyperthyroidism during the first trimester of pregnancy due to Graves' disease can be associated with maternal, obstetrical and fetal complications, indicating an active treatment to restore normal thyroid function. Antithyroid drugs are the first line treatment in pregnant women with hyperthyroidism. Due to the increased congenital malformations reported in neonates after first-trimester carbimazole/methimazole treatment and propylthiouracil associated hepatotoxicity, the recommended treatment for pregnant women with hyperthyroid Graves' disease is propylthiouracil during the first trimester of pregnancy and following the first trimester, consideration should be given switching to carbimazole/methimazole during the second part of gestation.

  20. Association of Primary Biliary Cirrhosis-autoimmune Hepatitis Overlap Syndrome with Immune Thrombocytopenia and Graves' Disease.

    PubMed

    Koyamada, Ryosuke; Higuchi, Takakazu; Kitada, Ayako; Nakagawa, Tomoko; Ikeya, Takashi; Okada, Sadamu; Fujita, Yoshiyuki

    2015-01-01

    A 54-year-old woman suffering from pruritus for five years was diagnosed to have Graves' disease and immune thrombocytopenia (ITP) associated with primary biliary cirrhosis (PBC)-autoimmune hepatitis (AIH) overlap syndrome, which was confirmed histologically after a prompt recovery in the platelet count number following steroid therapy. The association between PBC-AIH overlap syndrome and ITP has been rarely reported and the additional association with Graves' disease has not yet been reported. An underlying global derangement of autoimmunity or shared genetic susceptibility was suspected.

  1. Ocular Changes and Approaches of Ophthalmopathy in Basedow – Graves- Parry- Flajani Disease

    PubMed Central

    SARACI, George; TRETA, Anamaria

    2011-01-01

    ABSTRACT Basedow-Graves disease is an autoimmune condition with multiple local and systemic aspects. Among these, oculopathy has a major impact on patient's life from both functional and esthetic point of view. Basedow-Graves oculopathy requires an appropriate positive and differential diagnosis using clinical and imagistic approaches. Treatment is always required in moderate or severe forms and it begins with simple general points and continues with medical and surgical therapies. Current article stresses upon the most characteristic clinical signs of thyroidian ophthalmopathy and the required current therapeutic approaches. PMID:22205899

  2. Postpartum thyrotoxicosis in a patient with Graves' disease. Association with low radioactive iodine uptake

    SciTech Connect

    Eckel, R.H.; Green, W.L.

    1980-04-11

    A patient with previously diagnosed Graves' hyperthyroidism had a transient episode of thyrotoxicosis three months postpartum. This was associated with a diffusely enlarged thyroid gland, a rise in antithyroid microsomal antibody titer, a 24-hour radioactive iodine uptake (RAIU) of 1%, and an aspiration biopsy specimen suggestive of chronic lymphocytic thyroiditis. An alternative cause for the depressed RAIU was not discovered. This case would suggest that patients with previously diagnosed Graves' disease can have thyrotoxicosis without an enhanced RAIU and that the postpartum thyrotoxin syndrome may involve an immunologic injury causing a release of performed thyroid hormone.

  3. TSH receptor antibody titers measured with a third-generation assay did not reflect the activity of Graves' ophthalmopathy in untreated Japanese Graves' disease patients.

    PubMed

    Mukasa, Koji; Yoshimura Noh, Jaeduk; Kouzaki, Ai; Ohye, Hidemi; Kunii, Yo; Watanabe, Natsuko; Yoshihara, Ai; Matsumoto, Masako; Suzuki, Miho; Ito, Koichi

    2016-01-01

    TSH receptor antibody (TRAb) titer has been reported to be correlated with Graves' ophthalmopathy (GO). However, the correlation between GO activity and TRAb titer assessed with a third-generation assay has not been reported. We enrolled 238 untreated Graves' disease patients who came to the outpatient clinic of Ito Hospital and 28 patients who were euthyroid. All of the patients were assessed for GO by an ophthalmologist within 3 months of their initial visit to Ito Hospital. Clinical activity score (CAS), short inversion time inversion recovery (STIR), and sum of the maximum external orbital muscle areas (SEOMA) on a frontal sectional magnetic resonance imaging (MRI). The TRAb titer was significantly higher in patients with inactive ophthalmopathy (the inactive-GO group) than in patients with active ophthalmopathy (the active-GO group) (17.7 ± 13.5 IU/L vs. 13.0 ± 13.1 IU/L, p=0.0082). The SEOMA values were not correlated with TRAb titer. The prevalence of active-GO was higher in euthyroid patients than in hyperthyroid patients although the difference was not significant. In conclusion, TRAb titer measured with a third-generation assay dose not correlate with GO activity based on MRI findings in untreated Graves' disease patients, and the prevalence of active-GO is higher in euthyroid patients with lower TRAb titers than in hyperthyroid patients.

  4. Isolated primary amyloidosis of the inferior rectus muscle mimicking Graves' orbitopathy.

    PubMed

    Monteiro, Mário Luiz Ribeiro; Gonçalves, Allan Christian Pieroni; Bezerra, Alanna Mara Pinheiro Sobreira

    2016-01-01

    The diagnosis of Graves' orbitopathy is usually straightforward. However, orbital diseases that mimick some clinical signs of Graves' orbitopathy may cause diagnostic confusion, particularly when associated to some form of thyroid dysfunction. This report describes the rare occurrence of localized inferior rectus muscle amyloidosis in a patient with autoimmune hypothyroidism, who was misdiagnosed as Graves' orbitopathy. A 48-year-old man complained of painless progressive proptosis on the left side and intermittent vertical diplopia for 6 months. The diagnosis of Graves' orbitopathy was entertained after magnetic resonance imaging revealing a markedly enlarged, tendon-sparing inferior rectus enlargement on the left side, and an autoimmune hypothyroidism was disclosed on systemic medical workup. After no clinical improvement with treatment, the patient was referred to an ophthalmologist and further investigation was performed. The presence of calcification in the inferior rectus muscle on computed tomography, associated with the clinical findings led to a diagnostic biopsy, which revealed amyloid deposition. This report emphasizes that a careful evaluation of atypical forms of Graves' orbitopathy may be crucial and should include, yet with rare occurrence, amyloidosis in its differential diagnosis. RESUMO O diagnóstico de orbitopatia de Graves usualmente é fácil de ser estabelecido. No entanto, doenças da órbita que simulam alguns sinais clínicos da orbitopatia de Graves podem levar à confusão diagnóstica, particularmente quando associada à alguma forma de disfunção tireoidiana. Relatamos a ocorrência rara de amiloidose localizada no músculo reto inferior em paciente com hipotireoidismo autoimune, que recebeu inicialmente o diagnóstico errôneo de orbitopatia de Graves. Paciente masculino, 48 anos, com queixa de proptose progressiva e indolor do lado esquerdo e diplopia vertical intermitente há 6 meses. O diagnóstico de orbitopatia de Graves foi

  5. A Cross-cultural Assessment of the Maitland Graves Design Judgment Test Using U.S. and Nigerian Students.

    ERIC Educational Resources Information Center

    Uduehi, Joseph

    1995-01-01

    Reiterates the criticism that the Maitland Graves Design Judgment Test is inadequate in measuring aesthetic judgment as defined by Graves, especially in a cross-cultural setting. United States students consistently scored highest. Nonetheless, all students responded favorably to three factors: symmetry, three-dimensionality, and complex design.…

  6. "Why Didn't I Know about This Book When I Started?": In Memory of Donald Graves and Arthur Applebee

    ERIC Educational Resources Information Center

    Petrosky, Anthony; Mihalakis, Vivian

    2016-01-01

    This essay explores Donald Graves' groundbreaking research of the 1980s. We show how Graves' approach to the teaching of writing built on his sensitive appreciation of the ways children actually engage in the composing process when they are given the opportunity to produce writing that is meaningful to them. However, the issue for us is not simply…

  7. Symmetric increased skeletal muscular uptake of F-18 fluoro-deoxyglucose: A clue for the diagnosis of Graves' disease.

    PubMed

    Santhosh, Sampath; Mittal, Bhagwant Rai; Kashyap, Raghava; Bhattacharya, Anish; Singh, Baljinder

    2011-07-01

    F-18 fluoro-deoxyglucose (FDG) uptake in the thyroid and thymus is well reported in patients with Graves' disease. Incidental skeletal muscle uptake has also been reported in other non-musculoskeletal (benign and malignant) pathologies. We report a patient of Graves' disease showing symmetrical skeletal muscle uptake but no thyroidal or thymus uptake of FDG.

  8. 78 FR 16295 - Native American Graves Protection and Repatriation Review Committee: Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-14

    ... submissions are to be sent to: Sherry_Hutt@nps.gov . Mailed submissions are to be sent to: Designated Federal...). Electronic submissions are to be sent to: Sherry_Hutt@nps.gov . 2. By mail, on a single compact disc... 27, 2013. Sherry Hutt, Designated Federal Officer, Native American Graves Protection and...

  9. [Management of Grave's disease in the tropics (experience at Bouffard Army Hospital Center in Djibouti].

    PubMed

    Coulet, O; Kraemer, P; Leyral, G; Cloatre, G

    2004-01-01

    Based on their experience in managing Grave's disease at the Bouffard Army Hospital Center within the local health care context in Djibouti, the authors advocate surgery as the first line treatment. Medical and economical factors supporting this preference are discussed so that readers can adapt them to his own local context.

  10. Tinea corporis overlying the thyroid gland after radioiodine (131I) treatment of Graves' disease

    SciTech Connect

    Moreno, A.J.; Hartshorne, M.F.; Yedinak, M.A.; Crooks, L.A.; Fox, B.J.

    1986-04-01

    A case of tinea corporis involving the skin overlying the thyroid gland is described in a 36-year-old man who had received radioiodine treatment for Graves' disease. The dermatophytosis mimicked a delayed roentgen erythema. Radiation to the dermis may have locally altered the cell-mediated immunity and predisposed this patient to the dermatophytosis.

  11. Squamous cell carcinoma of the eyelid masquerading as 'malignant' ophthalmopathy of Graves's disease.

    PubMed Central

    Ford, H C; Delahunt, J W; Teague, C A

    1983-01-01

    A patient with Graves's disease is described in whom the periorbital changes of severe ophthalmopathy and iatrogenic Cushing's syndrome delayed the diagnosis of a squamous cell carcinoma of the eyelid. It is suggested that the immunosuppressive therapy which the patient received may have enhanced the growth of a pre-existing malignancy. Images PMID:6688354

  12. Increased frequencies of nuocytes in peripheral blood from patients with Graves' hyperthyroidism.

    PubMed

    Ji, Xiaoyun; Bie, Qingli; Liu, Yingzhao; Chen, Jianguo; Su, Zhaoliang; Wu, Yumin; Ying, Xinyu; Yang, Huijian; Wang, Shengjun; Xu, Huaxi

    2014-01-01

    Newly identified nuocytes play an important role in Th2 cell mediated immunity such as protective immune responses to helminth parasites, allergic asthma and chronic rhinosinusitis. However, the contributions of nuocytes in the occurrence and development of Graves' hyperthyroidism remains unknown. Previous studies found that there was a predominant Th2 phenotype in patients with Graves' hyperthyroidism, it might relate to polarization of nuocytes. Nuocytes were defined by transcription factor RORα, various cell surface markers (T1/ST2, IL-17RB, ICOS, CD45) and associated cytokines. In this study, these cells related genes or molecules in PBMC from patients with Graves' hyperthyroidism were measured, and the potential correlation between them was analyzed. The expression levels of T1/ST2, IL-17RB, ICOS, IL-5 and IL-13, which represented nuocytes associated molecules were significantly increased in patients, meanwhile, the RORα mRNA also had a tendency to increase. In addition, IFN-γ and T-bet (Th1 related cytokine and transcription factor) were obviously decreased, and there was a positive correlation between IL-17RB and IL-13. These results suggested that there were polarized nuocytes in Graves' hyperthyroidism patients, and which closely related to the down-regulation of Th1 cells or relatively advantage of Th2 differentiation.

  13. Educational Interventions Targeted at Minors in Situations of Grave Social Vulnerability and Their Families

    ERIC Educational Resources Information Center

    de la Caba Collado, Mariangeles; Rojas, Isabel Bartau

    2010-01-01

    The aim of this article is to outline and assess an educational intervention programme targeted at improving the skills of families and the personal and social development of children living in situations of grave social vulnerability. The sample comprised 10 families during the first phase of the intervention and six during the second. The…

  14. Review of Mouse Models of Graves' Disease and Orbitopathy-Novel Treatment by Induction of Tolerance.

    PubMed

    Ungerer, Martin; Faßbender, Julia; Li, Zhongmin; Münch, Götz; Holthoff, Hans-Peter

    2017-04-01

    Various approaches have been used to model human Graves' disease in mice, including transfected fibroblasts, and plasmid or adenoviral immunisations with the extracellular A subunit of the human thyrotropin receptor (TSHR). Some of these models were only observed for a short time period or were self-limiting. A long-term model for human Graves' disease was established in mice using continuing immunisations (4-weekly injections) with recombinant adenovirus expressing TSHR. Generation of TSHR binding cAMP-stimulatory antibodies, thyroid enlargement and alterations, elevated serum thyroxin levels, tachycardia and cardiac hypertrophy were maintained for at least 9 months in all Ad-TSHR-immunised mice. Here, we show that these mice suffer from orbitopathy, which was detected by serial orbital sectioning and histomorphometry. Attempts to treat established Graves' disease in preclinical mouse model studies have included small molecule allosteric antagonists and specific antagonist antibodies which were isolated from hypothyroid patients. In addition, novel peptides have been conceived which mimic the cylindrical loops of the TSHR leucine-rich repeat domain, in order to re-establish tolerance toward the antigen. Here, we show preliminary results that one set of these peptides improves or even cures all signs and symptoms of Graves' disease in mice after six consecutive monthly injections. First beneficial effects were observed 3-4 months after starting these therapies. In immunologically naïve mice, administration of the peptides did not induce any immune response.

  15. Multiple Fractures in Patient with Graves' Disease Accompanied by Isolated Hypogonadotropic Hypogonadism

    PubMed Central

    Yi, Hyon-Seung; Kim, Ji Min; Ju, Sang Hyeon; Lee, Younghak; Kim, Hyun Jin

    2016-01-01

    Isolated hypogonadotropic hypogonadism (IHH) is known to decrease bone mineral density due to deficiency of sex steroid hormone. Graves' disease is also an important cause of secondary osteoporosis. However, IHH does not preclude the development of primary hyperthyroidism caused by Graves' disease, leading to more severe osteoporosis rapidly. Here, we describe the first case of 35-year-old Asian female patient with IHH accompanied by Graves' disease and osteoporosis-induced multiple fractures. Endocrine laboratory findings revealed preserved anterior pituitary functions except for secretion of gonadotropins and showed primary hyperthyroidism with positive autoantibodies. Sella magnetic resonance imaging showed slightly small sized pituitary gland without mass lesion. Dual energy X-ray absorptiometry revealed severe osteoporosis in lumbar spine and femur neck of the patient. Plain film radiography of the pelvis and shoulder revealed a displaced and nondisplaced fracture, respectively. After surgical fixation with screws for the femoral fracture, the patient was treated with antithyroid medication, calcium, and vitamin D until now and has been recovering fairly well. We report a patient of IHH with Graves' disease and multiple fractures that is a first case in Korea. PMID:26981520

  16. EJERCICIO Y LA DETECCION DEL MAL AGUDO DE MONTAÑA GRAVE

    PubMed Central

    Garófoli, Adrián; Montoya, Paola; Elías, Carlos; Benzo, Roberto

    2012-01-01

    El Mal Agudo de Montaña (MAM) es un conjunto de síntomas inespecíficos padecidos por sujetos que ascienden rápidamente desde baja a alta altura sin adecuada aclimatación. Usualmente es autolimitado, pero las formas graves (edema pulmonar y cerebral) pueden causar la muerte. La hipoxemia exagerada en reposo está relacionada con el desarrollo de MAM pero su valor predictivo es limitado. Dado que el ejercicio en altura se acompaña de mayor hipoxemia y síntomas, postulamos el valor predictivo de un simple test de ejercicio para pronosticar MAM grave. Se estudió el valor predictivo de la saturación de oxígeno en reposo y ejercicio submáximo a 2 700m y 4 300m en 63 sujetos que ascendían al cerro Aconcagua (6 962m). Se consideró desaturación de oxígeno con ejercicio a una disminución >=5% respecto al reposo. Se utilizó la escala de Lake-Louise para establecer la presencia de MAM grave. 6 sujetos presentaron MAM grave (9.5%) y requirieron evacuación. La saturación de oxígeno en reposo a 2 700m no fue significativa para clasificar sujetos que luego desarrollaron MAM grave. Por el contrario, la asociación de desaturación durante el ejercicio a 2 700m más la saturación inapropiada en reposo a 4 300m fue significativa para clasificar a los sujetos que desarrollaron MAM grave con un valor predictivo positivo de 80% y un valor predictivo negativo del 97%. Nuestros resultados son relevantes para el montañismo y sugieren la adición de un simple test de ejercicio en la predicción del MAM grave. PMID:20228017

  17. CD28/CTLA-4/ICOS haplotypes confers susceptibility to Graves' disease and modulates clinical phenotype of disease.

    PubMed

    Pawlak-Adamska, Edyta; Frydecka, Irena; Bolanowski, Marek; Tomkiewicz, Anna; Jonkisz, Anna; Karabon, Lidia; Partyka, Anna; Nowak, Oskar; Szalinski, Marek; Daroszewski, Jacek

    2017-01-01

    Graves' disease, an autoimmune disease with heterogeneous symptoms including Graves' orbitopathy, has a combined genetic/environmental background, where variations within CD28/CTLA-4/ICOS genes are considered as disease markers.Association of CD28c.17+3T>C(rs3116496), CTLA-4g.319C>T(rs5742909), CTLA-4c.49A>G(rs231775), CTLA-4g.*642AT(8_33), CT60(rs3087243), Jo31(rs11571302), ICOSc.1554+4GT(8_15) polymorphisms with susceptibility to Graves' disease and clinical outcome was investigated. The study group comprised of 561 Polish Caucasians, including 172 unrelated Graves' disease patients. CTLA-4c.49A>G, CTLA-4g.319C>T, and CT60 were genotyped by PCR-RFLP; Jo31 and CD28c.17+3C>T by minisequencing; CTLA-4g.*642AT(8_33) and ICOSc.1554+4GT(8_15)-PCR and fluorescence-based technique. CD28c.17+3T>C(rs3116496)T/CTLA-4g.319C>T(rs5742909)C/CTLA-4c.49A>G(rs231775)G/CTLA-4g.*642AT(8_33)(AT16-21)/CT60(rs3087243)G/Jo31(rs11571302)G/ICOSc.1554+4GT(8_15)(m) and TCA(AT<16)GT(m) haplotypes increased risk of Graves' disease, especially in males, as well as overall Graves' orbitopathy development with severe outcome. TCG(AT16-21)GG(l) haplotype increased risk of Graves' disease and reduced the chance of successful medical treatment. Although this haplotype was mainly observed in patients without signs of Graves' orbitopathy, if Graves' orbitopathy developed it favored a Graves' orbitopathy outcome. Haplotype TCA(AT>21)GT(m) increased Graves' disease risk in women and, in all patients, was linked to Graves' disease without Graves' orbitopathy. TCG(AT<16)GG(m) haplotype was predominantly observed in patients without Graves' orbitopathy, whereas TCA(AT16-21)GG(m) was absent in those patients. TCA(AT16-21)GG(m) occurred in patients with a mild Graves' orbitopathy outcome. The marker CTLA-4g.*642AT(8_33) was the only independent Graves' disease risk factor, whereas CT60 was an independent factor for disease progression. Sporadic Graves' disease was related to presence of CTLA-4c.49A>G[A] and

  18. Anti-CD38 autoimmunity in patients with chronic autoimmune thyroiditis or Graves' disease

    PubMed Central

    Antonelli, A; Fallahi, P; Nesti, C; Pupilli, C; Marchetti, P; Takasawa, S; Okamoto, H; Ferrannini, E

    2001-01-01

    Autoantibodies directed against human CD38 (an enzyme catalysing the interconversion of NAD+ and cyclic ADP-ribose) have been demonstrated recently in patients with type 2 diabetes. We tested 220 consecutive Caucasian patients with autoimmune chronic thyroiditis, 104 patients with Graves' disease, 220 subjects from the general population (control I) and 78 healthy control subjects not affected by thyroid autoimmune disorders (control II) for the presence of anti-CD38 autoimmunity. Using Western blot analysis and optical densitometry, a specific band corresponding to human recombinant CD38 was identified in the serum of several subjects. By defining anti-CD38 positivity as a standardized optical reading >3 s.d. higher than the mean value of control I, 10·4% of patients with thyroiditis and 7·7% of Graves' patients were anti-CD38 positive (P = 0·0009 versus 1·8% of control I). Similarly, 13·1% of patients with thyroiditis and 10·5% of Graves' patients had a standardized optical reading >3 s.d. higher than the mean value of the subjects not affected by thyroid autoimmune disorders (P = 0·002 versus 1·2% of control II). Anti-CD38 autoimmunity did not differ between euthyroid, hyperthyroid or hypothyroid patients or between patients with or without thyroid hypoechogenicity. Anti-CD38 autoantibodies were associated with higher levels of circulating antithyroid-peroxidase antibodies (P = 0·03) and they were more frequent in Graves' patients with ophthalmopathy (P < 0·05). Anti-CD38 autoantibodies are a new autoimmune marker in chronic autoimmune thyroiditis and Graves' disease. The specific role of CD38 and its autoantibodies in the modulation of thyroid cell function or growth remains to be investigated. PMID:11737057

  19. Evidence that TSH Receptor A-Subunit Multimers, Not Monomers, Drive Antibody Affinity Maturation in Graves' Disease

    PubMed Central

    Aliesky, Holly A.; Chen, Chun-Rong; McLachlan, Sandra M.

    2015-01-01

    Context: The TSH receptor (TSHR) A-subunit shed from the cell surface contributes to the induction and/or affinity maturation of pathogenic TSHR autoantibodies in Graves' disease. Objective: This study aimed to determine whether the quaternary structure (multimerization) of shed A-subunits influences pathogenic TSHR autoantibody generation. Design: The isolated TSHR A-subunit generated by transfected mammalian cells exists in two forms; one (active) is recognized only by Graves' TSHR autoantibodies, the second (inactive) is recognized only by mouse monoclonal antibody (mAb) 3BD10. Recent evidence suggests that both Graves' TSHR autoantibodies and mAb 3BD10 recognize the A-subunit monomer. Therefore, if the A-subunit monomer is an immunogen, Graves' sera should have antibodies to both active and inactive A-subunits. Conversely, restriction of TSHR autoantibodies to active A-subunits would be evidence of a role for shed A-subunit multimers, not monomers, in the pathogenesis of Graves' disease. Therefore, we tested a panel of Graves' sera for their relative recognition of active and inactive A-subunits. Results: Of 34 sera from unselected Graves' patients, 28 were unequivocally positive in a clinical TSH binding inhibition assay. None of the latter sera, as well as 8/9 sera from control individuals, recognized inactive A-subunits on ELISA. In contrast to Graves' sera, antibodies induced in mice, not by shedding from the TSHR holoreceptor, but by immunization with adenovirus expressing the free human A-subunit, were directed to both the active and inactive A-subunit forms. Conclusions: The present study supports the concept that pathogenic TSHR autoantibody affinity maturation in Graves' disease is driven by A-subunit multimers, not monomers. PMID:25856215

  20. Review and Hypothesis: Does Graves' Disease Develop in Non-Human Great Apes?

    PubMed Central

    Alpi, Kristine; Rapoport, Basil

    2011-01-01

    Background Graves' disease, caused by stimulatory thyrotropin receptor (TSHR) autoantibodies, has not been observed in animals. In contrast, Hashimoto's thyroiditis develops in chickens, rats, mice, dogs, and marmosets. Attempts to induce an immune response in mice to the luteinizing-hormone receptor suggested that autoantigen glycosylation was one parameter involved in breaking self-tolerance. Over evolution, TSHR glycosylation increased from three asparagine-linked-glycans (N-glycans) in fish to six N-glycans in humans and great apes. All other placental mammals lack one N-glycan in the shed TSHR A-subunit, the primary Graves' disease autoantigen. We hypothesized that (a) lesser TSHR A-subunit glycosylation reduces immunogenicity, accounting for the absence of Graves' disease in most placental mammals; (b) due to human-like A-subunit glycosylation, Graves' disease might arise in great apes. Here, we review and analyze the literature on this subject and report the results of a survey of veterinarians at primate centers and zoos in North America. Summary Previous experimental data from induced TSHR antibodies in mice support a role for A-subunit glycosylation in breaking self-tolerance. An extensive search of the great-ape literature revealed five reports of noncongenital thyroid dysfunction, four with hypothyroidism and one with hyperthyroidism. The latter was a gorilla who was treated with anti-thyroid drugs but is now deceased. Neither serum nor thyroid tissue from this gorilla were available for analysis. The survey of veterinarians revealed that none of the 979 chimpanzees in primate research centers had a diagnosis of noncongenital thyroid dysfunction and among ∼1100 great apes (gorillas, orangutans, and chimpanzees) in U.S. zoos, only three were hypothyroid, and none were hyperthyroid. Conclusions Graves' disease appears to be either very rare or does not occur in great apes based on the literature and a survey of veterinarians. Although the available data

  1. The effects of plasma from patients with Graves' disease on foetal mouse hearts in organ culture.

    PubMed Central

    Nathan, A. W.; Longmore, D. B.; Havard, C. W.; Dandona, P.

    1983-01-01

    Plasma, obtained during plasma exchange therapy, from 3 euthyroid patients with Graves' disease and severe progressive exophthalmos induced an increase in heart rate and then early death when applied to foetal mouse hearts maintained in isolated organ culture. All plasma samples which induced an increase in foetal heart rate had high titres of thyroid stimulating immunoglobulins. Plasma samples obtained after exchange had a much diminished effect. These studies may indicate a previously unrecognized non-thyroidal action of the abnormal immunoglobulins associated with Graves' disease and suggest that chronic thyroid heart disease may be due, at least in part, to the effect of these immunoglobulins especially when not associated with elevated thyroid hormones concentrations. PMID:6139124

  2. Psychological problems in the family members of gravely traumatised patients admitted into an intensive care unit.

    PubMed

    Pérez-San Gregorio, M A; Blanco-Picabia, A; Murillo-Cabezas, F; Domínguez-Roldán, J M; Sánchez, B; Núñez-Roldán, A

    1992-01-01

    The aim of these studies was the analysis of the psychological repercussions on the closest members of families of 76 gravely traumatised patients admitted into the Intensive Care Unit (ICU) of the Hospital Universitario de Rehabilitación y Traumatología "Virgen del Rocio", Sevilla (Spain). An investigation based on social information and the Clinical Analysis Questionnaire was used. The sample of family members was composed of 42 women and 34 men, with an average age of 41.3 years (SD +/- 12.8). Results showed that (a) more than 50% of the family members of gravely traumatised patients admitted into an ICU showed symptoms of depression, (b) the women scored more points in hypochondria, suicidal depression, anxious depression, low-energy depression, guilt-resentment, apathy-withdrawal, paranoia, schizophrenia, psychasthenia and psychological disadjustment, and (c) in general terms, the psychological characteristics of the families were far from the norm of the control group.

  3. Pseudomonas aeruginosa ecthyma gangrenosum in a woman with recurrent Graves' disease.

    PubMed

    Zhu, Cheng-Yao; Zhang, Guo-Xue; Yu, Zuo-Zhong; Li, Zhao-Jun; Fan, Yi-Ming

    2014-04-01

    A 35-year-old woman with postoperative recurrent Graves' disease presented with a 5-day history of a red swelling on the right cheek associated with 4 days of remittent hyperpyrexia. Investigations revealed fever, a gangrenous ulcer on the right cheek, submandibular lymphadenopathy, and thyroid gland enlargement. Her white blood cell count, immunoglobulins, and lymphocyte subsets were unremarkable. Thyroid function tests showed low thyroid-stimulating hormone, high free thyroxine, and elevated radioactive iodine uptake. Repeated pus cultures grew Pseudomonas aeruginosa, but blood cultures were negative. An ill-demarcated erythematous plaque occurred on the right leg on hospital day 3. She was treated with intravenous antibiotics with topical gentamicin, recombinant bovine basic fibroblast growth factor, and radioiodine therapy with anti-thyroid drugs. The ulcer healed leaving a depressed scar at 35 days after discharge. This patient may represent the first case of P. aeruginosa ecthyma gangrenosum and cellulitis in postoperative recurrent Graves' disease.

  4. Correlation of stress with outcome of radioiodine therapy for Graves disease

    SciTech Connect

    Stewart, T.; Rochon, J.; Lenfestey, R.; Wise, P.

    1985-06-01

    Between November 1965 and December 1983, 293 patients were treated for Graves disease using /sup 131/I. All patients were asked to identify a stressful event antedating the onset of overt clinical symptoms. Eighty-one patients were able to do this (27.6%). Two hundred forty-four patients received a single treatment, 49 required two or more treatments. Patients with stress initiating the symptoms of Graves disease became hypothyroid earlier, 50% at 12 mo compared with 36 mo for the nonstress group. At 10 yr 5% of the stress group remained euthyroid compared with 17% nonstress. The authors conclude that stress in the 12 mo or less before the onset of clinical symptoms potentiates the development of hypothyroidism induced by a standard dose of radioiodine.

  5. Management of patients with Graves' orbitopathy: initial assessment, management outside specialised centres and referral pathways.

    PubMed

    Perros, Petros; Dayan, Colin M; Dickinson, A Jane; Ezra, Daniel; Estcourt, Stephanie; Foley, Peter; Hickey, Janis; Lazarus, John H; MacEwen, Caroline J; McLaren, Julie; Rose, Geoffrey E; Uddin, Jimmy; Vaidya, Bijay

    2015-04-01

    Graves' orbitopathy (GO) is uncommon, but responsible for considerable morbidity. A coordinated approach between healthcare professionals is required in order to meet the needs of patients. Early diagnosis can be achieved by a simple clinical assessment. Low-cost effective interventions can be initiated by generalists, which may improve outcomes. Moderate-to-severe GO should be referred to specialised centres. Recommendations for clinical diagnosis, initial management and referral pathways are highlighted.

  6. Socioeconomic Disparities in the Presentation and Treatment of Graves' Disease and Thyroid Eye Disease.

    PubMed

    Vargason, Caroline W; Chelnis, James G; Barahimi, Behin I; Mawn, Louise A

    2016-01-01

    Thyroid eye disease (TED) is an inflammatory, autoimmune orbitopathy with multifactorial etiology. Clinical presentation of TED spans a range from mild surface irritation to vision threatening compressive optic neuropathy. Potential vision loss underscores the importance of understanding genetic and environmental factors influencing the severity of TED presentation. This review will describe the classic risk factors for TED, outline treatments for Graves' disease (GD) and TED, and describe newer evidence of socioeconomic disparities in TED presentation.

  7. Both interleukin-23A polymorphism and serum interlukin-23 expression are associated with Graves' disease risk.

    PubMed

    Jia, Huiying; Tao, Feng; Liu, Changqin; Guo, Ting; Zhu, Wei; Wang, Shu; Cui, Bin; Ning, Guang

    2015-03-01

    Two independent Chinese cohorts were used to study the genetic association between the interleukin-23A (IL-23A) gene polymorphism (rs11171806) and susceptibility to Graves' disease (GD). The initial Shanghai cohort consisted of 712 unrelated patients with GD and 705 healthy control subjects, and the replication cohort from Xiamen Island included 433 patients with GD and 410 healthy control subjects. The serum concentration of IL-23 in GD patients was measured significantly higher than in health controls. Moreover in the subgroup analysis, higher concentrations of IL-23 were identified in patients of older age (⩾40 years) and female gender. We also performed an association study with the IL-23 gene polymorphism rs11171806 in both cohorts, in Shanghai cohorts, the frequencies of rs11171806 alleles were strongly different between Graves' disease patients (G 95.7% and A 4.3%) and healthy controls (G 97.7% and A 2.3%) (P=2.6×10(-3), OR=1.93 (95% CI: 1.25-2.97)), and in Xiamen cohorts, the proportion of individuals carrying the A allele of rs11171806 was the same significantly higher in Graves' disease patients than in controls [Graves' disease vs. control, 4.8% vs. 4.3%, OR=2.15 (95% CI: 1.23-3.79), P(allele)=6.3×10(-3)]. The distribution of rs11171806 genotype was also investigated in subgroups according to the age and gender. All of these findings suggested that IL-23 may play an important role in the development of GD, and the IL-23A gene is a genetic risk marker for GD in Han Chinese population.

  8. Cradle-to-Grave Nuclear Fuel Supply Assurance Workshop: Industry’s Potential Role

    SciTech Connect

    Bengelsdorf, Harold; Hund, Gretchen; Kessler, Carol E.; Mahy, Heidi A.; McGoldrick, Fred; Seward, Amy M.

    2007-09-30

    The Pacific Northwest Center for Global Security hosted a workshop on June 6, 2007 in Washington D.C. to discuss the feasibility, merits and implications of the United States offering cradle-to-grave nuclear fuel cycle services to other countries. The workshop consisted of a small group of senior individuals from the private sector, government and the national laboratories. The workshop is summarized and recommendations given.

  9. The philosopher Socrates had exophthalmos (a term coined by Plato) and probably Graves' disease.

    PubMed

    Papapetrou, Peter D

    2015-01-01

    According to a previously published theory, Socrates was afflicted with temporal lobe epilepsy since his childhood. Plato, Xenophon, and Aristoxenus described Socrates as having exophthalmos, probably diplopia, and some symptoms compatible with hyperthyroidism. Using these data, we theorize that Socrates had Graves' disease. In order to determine a cause of his temporal lobe epilepsy, we speculate that the philosopher also had autoimmune thyroiditis and Hashimoto encephalopathy during his childhood and his epilepsy may have been a sequel to this hypothesized encephalopathy.

  10. Effect of Selenium Supplementation on Recurrent Hyperthyroidism Caused by Graves' Disease: A Prospective Pilot Study.

    PubMed

    Wang, L; Wang, B; Chen, S R; Hou, X; Wang, X F; Zhao, S H; Song, J Q; Wang, Y G

    2016-09-01

    The effect of selenium supplementation on recurrent hyperthyroidism caused by Graves' disease is unclear. Our study aimed to assess the efficacy of selenium supplementation therapy on recurrent Graves' disease. Forty-one patients with recurrent Graves' disease were enrolled in this study. All patients received the routine treatment using methimazole (MMI), while patients allocated to the selenium group received additional selenium therapy for 6 months. The influence of selenium supplementation on the concentrations of thyroid stimulating hormone (TSH), anti-TSH-receptor antibodies (TRAb), free thyroxine (FT4), and free triiodothyronine (FT3) were assessed. The remission rate was also compared between 2 groups. There was no obvious difference in the demographic data and the levels of serum FT4, FT3, TSH, and TRAb between the 2 groups at baseline. Both FT4 and FT3 decreased more at 2 months in the selenium group than the controls, while the TSH level increased more in patients receiving selenium supplementation (p<0.05). The TRAb level was significantly lower in patients receiving selenium supplementation (2.4 IU/l vs. 5.6 IU/l, p=0.04). The percentages of patients with normal TRAb level at 6 months was also significantly higher in the selenium group (19.0 vs. 0%, p=0.016). Kaplan-Meier survival curve showed patients receiving selenium supplementation had a significantly higher rate of remission than controls (Log-rank test p=0.008). In conclusion, selenium supplementation can enhance the effect of antithyroid drugs in patients with recurrent Graves' disease. Randomized trials with large number of participants are needed to validate the finding above.

  11. Randomized double-blind trial of prednisone versus radiotherapy in Graves' ophthalmopathy

    SciTech Connect

    Prummel, M.F.; Mourits, M.; Blank, L.; Berghout, A.; Koornneef, L.; Wiersinga, W.M. )

    1993-10-16

    Corticosteriods are usually given for management of Graves' ophthalmopathy, but they have many and serious side-effects. By comparison, retrobulbar irradiation is well tolerated, although its efficacy has been evaluated only in uncontrolled studies. Therefore, the authors did a double-blind randomized trial, in which 28 patients with moderately severe Graves' ophthalmopathy were treated with a 3-month course of oral prednisone and sham irradiation, and 28 received retrobulbar irradiation (20 Gy) and placebo capsules. Therapeutic outcome, assessed twenty-four weeks after the start of treatment, was determined by the change in the highest NOSPECS class. A successful outcome was observed in 14 prednisone-treated and in 13 irradiated patients. Responders to treatment (but not nonresponders) in both groups showed improvements in total and subjective eye score and a decrease in eye-muscle volume. Response to either treatment was due largely to changes in soft-tissue involvement and eye-muscle motility. Radiotherapy and oral prednisone appear to be equally effective as initial treatment in patients with moderately severe Graves' ophthalmopathy. In view of its better tolerability, radiotherapy should be considered the treatment of first choice.

  12. Preserved brains from the Spanish Civil War mass grave (1936) at La Pedraja1, Burgos, Spain.

    PubMed

    Serrulla, Fernando; Herrasti, Lourdes; Navarro, Carmen; Cascallana, Jose Luis; Bermejo, Ana Maria; Marquez-Grant, Nicholas; Etxeberria, Francisco

    2016-12-01

    During the excavation of the Spanish Civil War mass grave at La Pedraja (Burgos, Spain), 104 individuals were found interred within it, 45 of which displayed brains that were preserved but dehydrated and reduced in size. This exceptional finding has resulted in the formation of a multidisciplinary team, with the aim of obtaining as much information as possible and to primarily understand the taphonomic phenomena that has led to the preservation of these brains. The following types of analyses were undertaken on three of these brains: macroscopy, histology, radiology, chemical-toxicology, genetics, chemical analysis of the soil and 3D modelling for stereolithography. The historical context was considered, plus all archaeological and other forensic data provided by the investigation of the mass grave. The results of the analyses on these morphologically identifiable human brains confirmed the presence of nerve structures, fatty acids, and in one case ante-mortem evidence for an intracranial haemorrhage. The fatty acid profile corresponds to the process of saponification. Therefore, the interpretation is that the preservation of these brains at the mass grave of La Pedraja was due to the saponification process, which was influenced by the manner and cause of death, the chemical composition of the brain, the physicochemical properties of the soil and the meteorological conditions at the time.

  13. GRAVE: An Interactive Geometry Construction and Visualization Software System for the TORT Nuclear Radiation Transport Code

    SciTech Connect

    Blakeman, E.D.

    2000-05-07

    A software system, GRAVE (Geometry Rendering and Visual Editor), has been developed at the Oak Ridge National Laboratory (ORNL) to perform interactive visualization and development of models used as input to the TORT three-dimensional discrete ordinates radiation transport code. Three-dimensional and two-dimensional visualization displays are included. Display capabilities include image rotation, zoom, translation, wire-frame and translucent display, geometry cuts and slices, and display of individual component bodies and material zones. The geometry can be interactively edited and saved in TORT input file format. This system is an advancement over the current, non-interactive, two-dimensional display software. GRAVE is programmed in the Java programming language and can be implemented on a variety of computer platforms. Three- dimensional visualization is enabled through the Visualization Toolkit (VTK), a free-ware C++ software library developed for geometric and data visual display. Future plans include an extension of the system to read inputs using binary zone maps and combinatorial geometry models containing curved surfaces, such as those used for Monte Carlo code inputs. Also GRAVE will be extended to geometry visualization/editing for the DORT two-dimensional transport code and will be integrated into a single GUI-based system for all of the ORNL discrete ordinates transport codes.

  14. Excessive Cytosolic DNA Fragments as a Potential Trigger of Graves' Disease: An Encrypted Message Sent by Animal Models.

    PubMed

    Luo, Yuqian; Yoshihara, Aya; Oda, Kenzaburo; Ishido, Yuko; Suzuki, Koichi

    2016-01-01

    Graves' hyperthyroidism is caused by autoantibodies directed against the thyroid-stimulating hormone receptor (TSHR) that mimic the action of TSH. The establishment of Graves' hyperthyroidism in experimental animals has proven to be an important approach to dissect the mechanisms of self-tolerance breakdown that lead to the production of thyroid-stimulating TSHR autoantibodies (TSAbs). "Shimojo's model" was the first successful Graves' animal model, wherein immunization with fibroblasts cells expressing TSHR and a major histocompatibility complex (MHC) class II molecule, but not either alone, induced TSAb production in AKR/N (H-2(k)) mice. This model highlights the importance of coincident MHC class II expression on TSHR-expressing cells in the development of Graves' hyperthyroidism. These data are also in agreement with the observation that Graves' thyrocytes often aberrantly express MHC class II antigens via mechanisms that remain unclear. Our group demonstrated that cytosolic self-genomic DNA fragments derived from sterile injured cells can induce aberrant MHC class II expression and production of multiple inflammatory cytokines and chemokines in thyrocytes in vitro, suggesting that severe cell injury may initiate immune responses in a way that is relevant to thyroid autoimmunity mediated by cytosolic DNA signaling. Furthermore, more recent successful Graves' animal models were primarily established by immunizing mice with TSHR-expressing plasmids or adenovirus. In these models, double-stranded DNA vaccine contents presumably exert similar immune-activating effect in cells at inoculation sites and thus might pave the way toward successful Graves' animal models. This review focuses on evidence suggesting that cell injury-derived self-DNA fragments could act as Graves' disease triggers.

  15. A study of the effect of seasonal climatic factors on the electrical resistivity response of three experimental graves

    NASA Astrophysics Data System (ADS)

    Jervis, John R.; Pringle, Jamie K.

    2014-09-01

    Electrical resistivity surveys have proven useful for locating clandestine graves in a number of forensic searches. However, some aspects of grave detection with resistivity surveys remain imperfectly understood. One such aspect is the effect of seasonal changes in climate on the resistivity response of graves. In this study, resistivity survey data collected over three years over three simulated graves were analysed in order to assess how the graves' resistivity anomalies varied seasonally and when they could most easily be detected. Thresholds were used to identify anomalies, and the ‘residual volume' of grave-related anomalies was calculated as the area bounded by the relevant thresholds multiplied by the anomaly's average value above the threshold. The residual volume of a resistivity anomaly associated with a buried pig cadaver showed evidence of repeating annual patterns and was moderately correlated with the soil moisture budget. This anomaly was easiest to detect between January and April each year, after prolonged periods of high net gain in soil moisture. The resistivity response of a wrapped cadaver was more complex, although it also showed evidence of seasonal variation during the third year after burial. We suggest that the observed variation in the graves' resistivity anomalies was caused by seasonal change in survey data noise levels, which was in turn influenced by the soil moisture budget. It is possible that similar variations occur elsewhere for sites with seasonal climate variations and this could affect successful detection of other subsurface features. Further research to investigate how different climates and soil types affect seasonal variation in grave-related resistivity anomalies would be useful.

  16. Diagnosis and treatment of Graves' disease with particular emphasis on appropriate techniques in nuclear medicine. General state of knowledge.

    PubMed

    Prasek, Karolina; Płazińska, Maria Teresa; Królicki, Leszek

    2015-01-01

    Graves' disease is an autoimmune disease. It accounts for 50-80% of cases of hyperthyroidism. Antibodies against the TSH receptor (TRAb) are responsible for hyperthyroidism (TRAB). The key role in monitoring and diagnosis of Graves' disease plays the level of hormones of free thyroxine and triiodothyronine. Helpful is an ultrasound of the thyroid scintigraphy which due to its functional character is both a valuable addition to morphological studies as well as plays an important role in the diagnosis and therapy in patients with Graves' disease. There is no perfect treatment for Graves' disease. The reason for this is the lack of therapy directed against primary pathogenic mechanisms. Currently available treatments need to be thoroughly discussed during the first visit as the patient's understanding of the choice of a treatment constitutes a vital role in the success of therapy. Graves' disease treatment is based on three types of therapies that have been carried out for decades including: pharmacological treatment anti-thyroid drugs, I131 therapy and radical treatment - thyroidectomy. The purpose of the treatment is to control symptoms and patient to return to euthyreosis. Treatment of Graves' disease is of great importance because if left untreated, it can lead to long-term harmful effects on the heart, bone and mental well-being of patients.

  17. Graves' Disease

    MedlinePlus

    ... Versions PDF Version (198 KB) Additional Links Hyperthyroidism Pregnancy and Thyroid Disease Thyroid Tests This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. ...

  18. Graves' Disease

    MedlinePlus

    ... after radioiodine therapy as a supplemental treatment. Side effects of both drugs include rash, joint pain, liver failure or a decrease in disease-fighting white blood cells. Methimazole isn't used to treat pregnant women in the first trimester because of the slight ...

  19. Discordant hypothyroxinemia and hypertriiodothyroninemia in treated patients with hyperthyroid Graves' disease

    SciTech Connect

    Chen, J.J.; Ladenson, P.W.

    1986-07-01

    Hypothyroxinemia and hypertriiodothyroninemia may occur in the course of antithyroid drug or /sup 131/I treatment for hyperthyroid Graves' disease. To determine the frequency of combined high serum T3 and low serum T4 concentrations during such treatment and to assess the clinical significance of its recognition, we reviewed 60 patients treated for hyperthyroid Graves' disease with antithyroid drugs (n = 43) or radioactive iodine (n = 17). Six of these patients (10%) were found to have high serum T3 and low serum T4 concentrations during therapy. Four were receiving antithyroid drugs, and 2 had received radioactive iodine. At the time this abnormality occurred, 4 patients were euthyroid, 1 was hypothyroid, and 1 was hyperthyroid. The serum TSH concentration was increased in 2, at the upper limit of normal in 1, and undetectable in 3 patients. After discontinuation or reduction in the dose of antithyroid drug, clinical and chemical euthyroidism was restored in 2 additional patients with previously elevated TSH levels. In 2 patients, both of whom previously had undetectable serum TSH levels, clinical hyperthyroidism persisted or recurred, and additional therapy was required. No patient developed permanent hypothyroidism during the period of follow-up (1-22 months). An additional 19 of the 60 patients (32%) had an elevated serum T3 level with a normal serum T4 concentration during the course of follow-up. Among the 19 patients, the magnitude of serum T3 elevation was not different between clinically euthyroid (n = 13) and hyperthyroid (n = 6) patients. We conclude that discordance of serum T4 and T3 concentrations is frequently encountered in patients with hyperthyroid Graves' disease during or after therapy. The low serum T4 level does not predict hypothyroidism, nor does a high serum T3 level predict hyperthyroidism.

  20. Identification process of skeletal remains from mass graves: Our experience and proposal guidelines.

    PubMed

    Sutlovic, Davorka; Boric, Igor; Zulim, Tamara; Vucinovic, Ana

    2015-03-01

    Aim of this paper is to present our experience and proposal guidelines for reducing the number of samples for DNA analysis of skeletal remains from mass graves, whether for scientific purpose or for the identification of mass graves victims. Therefore, the analysis of 94 bone fragments included the following measurements: femur length and the femoral head diameter, the diameter of the upper, wider portion and lower wider portion of the bone fragment, densitometry of the fragments and measurement of mass and volume of fragments. Bone density was determined on the basis of measured values of mass and volume. The results of fragment matching by physical analyses were compared with the pairing results obtained by previously conducted DNA analysis. Deviation in measured values of matching bone fragments that made a pair was calculated for all successfully matched fragments. By the results of DNA analysis 36 femoral pairs were successfully formed. Measured values were added to the DNA analysis. Out of 36 pairs, positively ascertained by the DNA analysis, 29 pairs were formed after adding the results of physical measurements and removing the data where femur samples were damaged. Total correspondence in measurements of the femoral length was noted in 25.9% pairs, while the correspondence within the 5% error was 100%. Density of the tested femurs was significantly different for the same person (DNA match), both for the left and the right femoral fragment. It would be optimal to choose only the whole-length left or right femur and thus reduce the number of samples by 50%. With regard to the results of our research and the observations deriving from them, as well as to the guidelines we used in the study, we suggested these guidelines be used both for scientific researches and to identify mass graves victims.

  1. Réactions immunoallergiques graves aux antibacillaires: à propos de 10 cas

    PubMed Central

    Alami, Sabah El Machichi; Hammi, Sanae; Bourkadi, Jamal Eddine

    2014-01-01

    L'hypersensibilité aux antituberculeux est l'un des effets secondaires imprévisibles qui apparait chez 4 à 5 % de la population exposée et s’élève à 25% chez les sujets VIH positifs. Dans notre étude parmi 39 patients ayant présenté des réactions immunoallergiques, 10 avaient des formes graves. Le délai moyen d'apparition des signes était de 23 jours. Les réactions immunoallergiques observées étaient 5 cas de toxidermie généralisée fébrile, un cas de Dress syndrome, un cas de neutropénie, un cas de pancitopénie et 2 cas de thrombopénie. Tous nos patients avaient bien évolué cliniquement et bactériologiquement après l'adoption d'un régime thérapeutique excluant le ou les médicaments incriminés. En pratique, si l'effet indésirable imputé à un antituberculeux est grave, il est impératif de l'arrêter, de traiter l'incident et d'associer une autre molécule chez certains cas. Notre étude a montré une fréquence significative des complications graves probablement sous-estimée, surtout dans les pays fortement touchés par l'infection HIV.

  2. Current perspectives on the role of orbital fibroblasts in the pathogenesis of Graves' ophthalmopathy.

    PubMed

    Dik, Willem A; Virakul, Sita; van Steensel, Leendert

    2016-01-01

    Graves' ophthalmopathy (GO) is an extra-thyroidal complication of Graves' disease (GD; Graves' hyperthyroidism) characterized by orbital tissue inflammation, expansion, remodeling and fibrosis. Although the initiating trigger of GO is still indistinct, excessive orbital fibroblast activity is at the heart of its pathogenesis. Orbital fibroblasts are activated by cellular interactions with immune cells and the soluble factors they secrete. Orbital fibroblasts, especially from GO patients, express the thyrotropin receptor (TSH-receptor; TSHR), and activation of the orbital fibroblast population by stimulatory autoantibodies directed against the TSHR may provide an important link between GD and GO. Furthermore, stimulatory autoantibodies directed against the insulin-like growth factor-1 receptor have been proposed to contribute to orbital fibroblast activation in GO. Activated orbital fibroblasts produce inflammatory mediators thereby contributing to the orbital inflammatory process in GO. Moreover, orbital fibroblasts exhibit robust proliferative activity and extracellular matrix (especially hyaluronan) synthesizing capacity and can differentiate into adipocytes and myofibroblasts with disease progression, thereby contributing to tissue expansion/remodeling and fibrosis in GO. Orbital fibroblasts, especially those from GO patients, exhibit a hyper-responsive phenotype when compared to fibroblasts from other anatomical regions, which may further contribute to GO pathogenesis. Fibrocytes have been identified as additional source of orbital fibroblasts in GO, where they may contribute to orbital tissue inflammation, adipogenesis and remodeling/fibrosis. This review addresses our current view on the role that orbital fibroblasts fulfill in GO pathogenesis and both established as well as less established not fully crystallized concepts that need future studies will be discussed.

  3. Crystal structure of a TSH receptor monoclonal antibody: insight into Graves' disease pathogenesis.

    PubMed

    Chen, Chun-Rong; Hubbard, Paul A; Salazar, Larry M; McLachlan, Sandra M; Murali, Ramachandran; Rapoport, Basil

    2015-01-01

    The TSH receptor (TSHR) A-subunit is more effective than the holoreceptor in inducing thyroid-stimulating antibodies (TSAb) that cause Graves' disease. A puzzling phenomenon is that 2 recombinant, eukaryotic forms of A-subunits (residues 22-289), termed active and inactive, are recognized mutually exclusively by pathogenic TSAb and mouse monoclonal antibody 3BD10, respectively. Understanding the structural difference between these TSHR A-subunit forms could provide insight into Graves' disease pathogenesis. The 3-dimensional structure of the active A-subunit (in complex with a human TSAb Fab, M22) is known, but the structural difference with inactive A-subunits is unknown. We solved the 3BD10 Fab 3-dimensional crystal structure. Guided by prior knowledge of a portion of its epitope, 3BD10 docked in silico with the known active TSHR-289 monomeric structure. Because both TSAb and 3BD10 recognize the active TSHR A-subunit monomer, this form of the molecule can be excluded as the basis for the active-inactive dichotomy, suggesting, instead a role for A-subunit quaternary structure. Indeed, in silico analysis revealed that M22, but not 3BD10, bound to a TSHR-289 trimer. In contrast, 3BD10, but not M22, bound to a TSHR-289 dimer. The validity of these models is supported experimentally by the temperature-dependent balance between active and inactive TSHR-289. In summary, we provide evidence for a structural basis to explain the conformational heterogeneity of TSHR A-subunits (TSHR-289). The pathophysiologic importance of these findings is that affinity maturation of pathogenic TSAb in Graves' disease is likely to involve a trimer of the shed TSHR A-subunit.

  4. An extraordinary case: suicide with insulin in a grave dug by the victim himself.

    PubMed

    Hänsch, C F; De Roy, G

    1977-05-27

    The undressed body of a young man was discovered in a pit in a forest. The victim was a 27 year old depressed man, suffering from a severe diabetes. Besides personal objects, three empty insulin vials (400 I.U./vial) and empty ampules of distilled water, injection-needles and a syringe were also found in the pit. The investigation carried out at the scene, the questioning of his family and physicians, and the autopsy clarified this unusual case. In conclusion the hypothesis of "suicide" was maintained: the man administered himself a large dose of insulin; in hypoglycaemic coma he died from a bronchopneumonia in a "grave" dug by himself.

  5. Peritonitis secondary to ruptured splenic abscess: a grave complication of typhoid fever.

    PubMed

    George, Peter; Ahmed, Ashfaq; Maroli, Roshan; Tauro, Leo Francis

    2012-12-01

    Splenic abscesses are increasingly being identified, possibly due to widespread use of imaging modalities in clinical practice. The commonest clinical features are high grade fever and exclusively localised left upper quadrant abdominal pain. These symptoms are similar to most infectious diseases prevalent in the tropics, making imaging by ultrasonography or computer tomography a necessity in the diagnosis. There are reports from different geographic areas on splenic abscesses associated with typhoid fever. We reported ruptured splenic abscess presenting with peritonitis as a rare and grave complication of typhoid fever.

  6. Walter Miles, Pop Warner, B. C. Graves, and the psychology of football.

    PubMed

    Baugh, Frank G; Benjamin, Ludy T

    2006-01-01

    In 1926-1927, a graduate student, B. C. Graves, working with Stanford University psychologist Walter Miles and legendary football coach Pop Warner, conducted an investigation of variations in signal calling as they affected the charging times of football players. The study was one of two that involved Miles and the ingenious multiple chronograph that he had invented to time the reactions of seven players simultaneously. These studies represented a brief digression in the career of Miles, who certainly was no sport psychologist. They tell of an interesting collaboration between scientist and coaches that produced one of the richest studies in sport psychology in the first half of the twentieth century.

  7. Unusual locations of localized myxedema in Graves disease. Report of three cases

    SciTech Connect

    Noppakun, N.; Bancheun, K.; Chandraprasert, S.

    1986-01-01

    Three patients with Graves disease had very unusual locations of localized myxedema. One patient had localized myxedema on the pretibial and shoulder areas after sodium iodide I 131 therapy. The second patient had localized myxedema on his neck, shoulders, and upper part of the back as well as on the pretibial area. The third patient had localized myxedema on the pinnae, also following sodium iodide I 131 therapy. After surgical removal followed by intralesional triamcinolone acetonide injections, the first patient's lesions recurred. The lesions in the second case did not respond to topical steroid cream. The third patient had a partial response to intralesional steroid injections.

  8. Management of Graves' disease: an overview and comparison of clinical practice guidelines with actual practice trends.

    PubMed

    Muldoon, Becky T; Mai, Vinh Q; Burch, Henry B

    2014-06-01

    Over the last century, much has been learned about the pathogenesis, manifestations, and management of Graves' disease leading to the establishment of evidence-based clinical practice guidelines. The joint clinical practice guidelines from the American Thyroid Association and the American Association of Clinical Endocrinologists give recommendations on both the diagnosis and treatment of hyperthyroidism. A survey of clinicians performed that same year, however, revealed that current practices diverge from these recently published guidelines in multiple areas. These differences will need to be assessed serially to determine the impact of the guidelines on future clinical practice and perhaps vice versa.

  9. Hypothyroid Graves' disease complicated with elephantiasis nostras verrucosa (ENV): a case report and review of the literature.

    PubMed

    Ukinç, Kubilay; Bayraktar, Miyase; Gedik, Arzu

    2009-08-01

    Thyroid dermopathy is not a frequent feature of hyperthyroid Graves' disease, being present in less than 5% of the patients. Graves' disease has been shown to exist in euthyroid or hypothyroid forms in untreated patients. Here, we describe a case of hypothyroid Graves' disease with elephantiasis nostras verrucosa (ENV), which is an extreme form of thyroid dermopathy (TD). A 58-year-old female patient was admitted to the emergency department with somnolence, hypothermia, and bradycardia. Her mental status gradually worsened, resulting in a deep coma. She was intubated and followed in the intensive care unit, as she needed mechanical ventilatory assistance due to respiratory failure. She also had bilateral non-pitting edema, a cobblestone-like appearance, and hyperkeratotic greenish-brown-colored lesions in the pretibial and dorsal regions of the feet that were compatible with ENV. Hypothyroid Graves' disease is a very rare condition among autoimmune thyroid disorders, and ENV is an extremely rare form of TD. Here, we present a patient with hypothyroid Graves' disease and ENV.

  10. Serial analysis of the effects of methimazole or radical therapy on circulating CD16/56 subpopulations in Graves' disease.

    PubMed

    Rojano, J; Sasián, S; Gavilán, I; Aguilar, M; Escobar, L; Girón, J A

    1998-09-01

    The distribution of peripheral blood CD16/56 cytotoxic T and natural killer (NK) cells in Graves' disease patients is analyzed in order to correlate them with disease activity and with prognosis. Eighteen patients with Graves' disease, twenty-four patients with Hashimoto's thyroiditis and thirty-two sex- and age-matched healthy control subjects were studied. Peripheral blood CD16/56 (cytotoxic T and NK) cells were analyzed by cytofluorometry. A decreased proportion of CD16/56+ and CD16/ 56+CD3+ cells were detected in Graves' disease patients when compared with thyroiditis patients and healthy control groups. No correlation was detected with serum free thyroxine. On diagnosis, patients who would require a radical treatment for thyrotoxicosis control showed a significant decrease of cytotoxic CD56+ T (CD3+) and NK (CD3-) cells compared with those who would maintain the euthyroid state after methimazole. These results suggest that the cytotoxic compartment, both T and NK cells, of the immune system is altered in patients with Graves' disease, independently of the functional thyroid status. Changes in peripheral blood lymphocytes in Graves' disease patients could be useful as predictive markers of an unfavorable outcome.

  11. The gravimeter "B-grave" for the in-situ surface gravity measurements of an asteroid

    NASA Astrophysics Data System (ADS)

    van Ruymbeke, Michel; karatekin, ozgur; rasson, jean; wielant, françois; dumont, Phillipe; Ritter, Birgit; zhu, Ping

    2016-04-01

    In the context of the preliminary study phase for the CubeSats supporting ESA's Asteroid Impact Mission (AIM) to the Didymos, we investigate a miniaturized gravimeter as part of the geophysical instrument package for the Asteroid Geophysical Explorer (AGEX). AGEX intends to land a CubeSat on the secondary object in the Didymos system, Didymoon in order to characterize the asteroid surface and internal structure A 3D compact gravimeter is developed at the Royal Observatory of Belgium. Its design allows to meter a weak 50 μm/sec² gravity field corresponding to 5 ppm of Earth gravity in a harsh environment. A system with three components mounted in an orthogonal geometry allows obtaining the gravity field in amplitude and in angular position without any requirement of levelling. B-GRAVES will use a in-situ calibration and multi-parameter approach for validation of the measurements. A laboratory simulation is induced with centrifugal forces applied to the pendulum set-up in a vertical position to reject the Earth gravity field. Signal treatment and uncertainties are discussed keeping in mind questions of thermal and vibration influence. The B-GRAVES can serve as a novel and robust instrument for future lander and rover missions .

  12. [Particular evolution of the thyroid state in Grave's disease: two cases].

    PubMed

    Cherif, Lotfi; Ben Abdallah, Néjib; Khairi, Karima; Hadj Ali, Inçaf; Turki, Sami; Ben Maïz, Hédi

    2003-09-01

    We report two cases of Grave's disease (GD) caracterized by the succession of hypothyroid and hyperthyroid states. Case 1: A 32 years old woman, has presented initially a typical GD with hyperthyroidism. Grave's ophtalmopathy and homogenous goiter. Four months later, she presented a spontaneous hypothyroidism necessiting treatment with thyroxine and a severe myasthenia gravis. More later (6 months), she experienced symptoms of hyperthyroidism after thymectomy. The level of anti-thyrotropin-receptor antibodies (TSab) was very high (141 UI/I, NV < 10). Case 2: A 29 years old woman has been treated by thyroxine (150 microg/day) for a primary hypothyroidism. Ten months later, she presented symptoms of hyperthyroidism even after stoppage of thyroxine. TSH value was decreased (TSH < 0.05 microU/ml) and FT4 level was raised (FT4 = 25.5 pmol/l). The thyroid antibodies were positive. We discuss, after review of the litterature, the physiopathological mecanisms of these changes in the thyroid state, particularly the role of the blocking and stimulating anti-thyrotropin-receptor antibodies.

  13. STAT6 deficiency ameliorates Graves' disease severity by suppressing thyroid epithelial cell hyperplasia

    PubMed Central

    Jiang, Xuechao; Zha, Bingbing; Liu, Xiaoming; Liu, Ronghua; Liu, Jun; Huang, Enyu; Qian, Tingting; Liu, Jiajing; Wang, Zhiming; Zhang, Dan; Wang, Luman; Chu, Yiwei

    2016-01-01

    Signal transducer and activator of transcription 6 (STAT6) is involved in epithelial cell growth. However, little is known regarding the STAT6 phosphorylation status in Graves' disease (GD) and its role in thyroid epithelial cells (TECs). In this study, we found that STAT6 phosphorylation (p-STAT6) was significantly increased in TECs from both GD patients and experimental autoimmune Graves' disease mice and that STAT6 deficiency ameliorated GD symptoms. Autocrine IL-4 signalling in TECs activated the phosphorylation of STAT6 via IL-4 R engagement, and the downstream targets of STAT6 were Bcl-xL and cyclin D1. Thus, the IL-4-STAT6-Bcl-xL/cyclin D1 pathway is crucial for TEC hyperplasia, which aggravates GD. More importantly, in vitro and in vivo experiments demonstrated that STAT6 phosphorylation inhibited by AS1517499 decreased TEC hyperplasia, thereby reducing serum T3 and T4 and ameliorating GD. Thus, our study reveals that in addition to the traditional pathogenesis of GD, in which autoantibody TRAb stimulates thyroid-stimulating hormone receptors and consequently produces T3, T4, TRAb could also trigger TECs producing IL-4, and IL-4 then acts in an autocrine manner to activate p-STAT6 signalling and stimulate unrestricted cell growth, thus aggravating GD. These findings suggest that STAT6 inhibitors could be potent therapeutics for treating GD. PMID:27906181

  14. Association between Age at Diagnosis of Graves' Disease and Variants in Genes Involved in Immune Response

    PubMed Central

    Jurecka-Lubieniecka, Beata; Ploski, Rafal; Kula, Dorota; Krol, Aleksandra; Bednarczuk, Tomasz; Kolosza, Zofia; Tukiendorf, Andrzej; Szpak-Ulczok, Sylwia; Stanjek-Cichoracka, Anita; Polanska, Joanna; Jarzab, Barbara

    2013-01-01

    Background Graves' disease (GD) is a complex disease in which genetic predisposition is modified by environmental factors. The aim of the study was to examine the association between genetic variants in genes encoding proteins involved in immune response and the age at diagnosis of GD. Methods 735 GD patients and 1216 healthy controls from Poland were included into the study. Eight genetic variants in the HLA-DRB1, TNF, CTLA4, CD40, NFKb, PTPN22, IL4 and IL10 genes were genotyped. Patients were stratified by the age at diagnosis of GD and the association with genotype was analysed. Results Polymorphism in the HLA-DRB1, TNF and CTLA4 genes were associated with GD. The carriers of the HLA DRB1*03 allele were more frequent in patients with age at GD diagnosis ≤30 years than in patients with older age at GD diagnosis. Conclusions HLADRB1*03 allele is associated with young age at diagnosis of Graves' disease in polish population. PMID:23544060

  15. Protracted Hypofractionated Radiotherapy for Graves' Ophthalmopathy: A Pilot Study of Clinical and Radiologic Response

    SciTech Connect

    Casimiro de Deus Cardoso, Cejana; Giordani, Adelmo Jose; Borri Wolosker, Angela Maria; Souhami, Luis; Gois Manso, Paulo; Souza Dias, Rodrigo; Comodo Segreto, Helena Regina; Araujo Segreto, Roberto

    2012-03-01

    Purpose: To evaluate the clinical and radiologic response of patients with Graves' ophthalmopathy given low-dose orbital radiotherapy (RT) with a protracted fractionation. Methods and Materials: Eighteen patients (36 orbits) received orbital RT with a total dose of 10 Gy, fractionated in 1 Gy once a week over 10 weeks. Of these, 9 patients received steroid therapy as well. Patients were evaluated clinically and radiologically at 6 months after treatment. Clinical response assessment was carried out using three criteria: by physical examination, by a modified clinical activity score, and by a verbal questionnaire considering the 10 most common signs and symptoms of the disease. Radiologic response was assessed by magnetic resonance imaging. Results: Improvement in ocular pain, palpebral edema, visual acuity, and ocular motility was observed in all patients. Significant decrease in symptoms such as tearing (p < 0.001) diplopia (p = 0.008), conjunctival hyperemia (p = 0.002), and ocular grittiness (p = 0.031) also occurred. Magnetic resonance imaging showed decrease in ocular muscle thickness and in the intensity of the T2 sequence signal in the majority of patients. Treatments were well tolerated, and to date no complications from treatment have been observed. There was no statistical difference in clinical and radiologic response between patients receiving RT alone and those receiving RT plus steroid therapy. Conclusion: RT delivered in at a low dose and in a protracted scheme should be considered as a useful therapeutic option for patients with Graves' ophthalmopathy.

  16. Transient Hypothyroidism after Radioiodine for Graves' Disease: Challenges in Interpreting Thyroid Function Tests.

    PubMed

    Sheehan, Michael T; Doi, Suhail A R

    2016-03-01

    Graves' disease is the most common cause of hyperthyroidism and is often managed with radioactive iodine (RAI) therapy. With current dosing schemes, the vast majority of patients develop permanent post-RAI hypothyroidism and are placed on life-long levothyroxine therapy. This hypothyroidism typically occurs within the first 3 to 6 months after RAI therapy is administered. Indeed, patients are typically told to expect life-long thyroid hormone replacement therapy to be required within this timeframe and many providers expect this post-RAI hypothyroidism to be complete and permanent. There is, however, a small subset of patients in whom a transient post-RAI hypothyroidism develops which, initially, presents exactly as the typical permanent hypothyroidism. In some cases the transient hypothyroidism leads to a period of euthyroidism of variable duration eventually progressing to permanent hypothyroidism. In others, persistent hyperthyroidism requires a second dose of RAI. Failure to appreciate and recognize the possibility of transient post-RAI hypothyroidism can delay optimal and appropriate treatment of the patient. We herein describe five cases of transient post-RAI hypothyroidism which highlight this unusual sequence of events. Increased awareness of this possible outcome after RAI for Graves' disease will help in the timely management of patients.

  17. Clinical criteria for the assessment of disease activity in Graves' ophthalmopathy: a novel approach.

    PubMed Central

    Mourits, M P; Koornneef, L; Wiersinga, W M; Prummel, M F; Berghout, A; van der Gaag, R

    1989-01-01

    Patients with serious inflammatory Graves' ophthalmopathy should be treated with anti-inflammatory drugs or radiotherapy to prevent complications like fibrosis, while those with non-inflammatory ophthalmopathy may be treated by surgery immediately. It is often difficult, however, to distinguish inflammatory from non-inflammatory Graves' disease. We therefore present a simple clinical classification here to differentiate between these two conditions. This classification is based on the classical signs of inflammation--pain, redness, swelling, and impaired function. After two consecutive clinical examinations an 'activity score' can be determined, ranging from 0 to 10 points. In a retrospective study testing the efficacy of this classification we found that patients with an activity score of 3 or more at the beginning of therapy responded well to anti-inflammatory drugs, while those with a lower activity score mostly did not. Comparing the pretreatment activity score with the degree of enlargement of the extraocular muscles on the CT scan, we found a significant correlation between these two parameters: the higher the activity score, the more the enlargement of the muscles. We conclude that this classification facilitates the proper selection of patients for treatment. Images PMID:2765444

  18. DNA Identification of Skeletal Remains from World War II Mass Graves Uncovered in Slovenia

    PubMed Central

    Marjanović, Damir; Durmić-Pašić, Adaleta; Bakal, Narcisa; Haverić, Sanin; Kalamujić, Belma; Kovačević, Lejla; Ramić, Jasmin; Pojskić, Naris; Škaro, Vedrana; Projić, Petar; Bajrović, Kasim; Hadžiselimović, Rifat; Drobnič, Katja; Huffine, Ed; Davoren, Jon; Primorac, Dragan

    2007-01-01

    Aim To present the joint effort of three institutions in the identification of human remains from the World War II found in two mass graves in the area of Škofja Loka, Slovenia. Methods The remains of 27 individuals were found in two small and closely located mass graves. The DNA was isolated from bone and teeth samples using either standard phenol/chloroform alcohol extraction or optimized Qiagen DNA extraction procedure. Some recovered samples required the employment of additional DNA purification methods, such as N-buthanol treatment. QuantifilerTM Human DNA Quantification Kit was used for DNA quantification. PowerPlex 16 kit was used to simultaneously amplify 15 short tandem repeat (STR) loci. Matching probabilities were estimated using the DNA View program. Results Out of all processed samples, 15 remains were fully profiled at all 15 STR loci. The other 12 profiles were partial. The least successful profile included 13 loci. Also, 69 referent samples (buccal swabs) from potential living relatives were collected and profiled. Comparison of victims' profile against referent samples database resulted in 4 strong matches. In addition, 5 other profiles were matched to certain referent samples with lower probability. Conclusion Our results show that more than 6 decades after the end of the World War II, DNA analysis may significantly contribute to the identification of the remains from that period. Additional analysis of Y-STRs and mitochondrial DNA (mtDNA) markers will be performed in the second phase of the identification project. PMID:17696306

  19. Post-radioiodine De Novo Onset Graves' Ophthalmopathy: Case Reports and a Review of the Literature.

    PubMed

    Batra, Ruchika; Krishnasamy, Senthil Kumar; Buch, Harit; Sandramouli, Soupramanien

    2015-05-01

    New-onset Graves' ophthalmopathy (GO) following radioiodine treatment (RAI) and worsening of existing GO are well-described in the endocrinology literature. These phenomena are recognized by ophthalmologists, yet poorly documented in the ophthalmology literature. Two male patients, aged 43 and 62 years, respectively, with Graves' disease without GO, received RAI. Four months later, one patient developed acute GO with unilateral reduction in visual acuity, conjunctival chemosis, lagophthalmos, bilateral severely restricted ocular motility, and lid retraction. High-dose intravenous steroids, followed by oral steroids, led to a dramatic clinical improvement. The second patient received a second dose of RAI for persistent hyperthyroidism and subsequently developed acute GO-comprising restricted ocular motility, peri-orbital swelling, and conjunctival chemosis. Symptoms gradually resolved on continued carbimazole treatment. Neither patient received pre-RAI prophylactic glucocorticoids, as currently they are only recommended for patients with pre-existing GO or multiple risk factors. We discuss the limitations of using this risk-based approach in preventing new-onset GO following RAI therapy.

  20. Fetal and neonatal thyroid function in relation to maternal Graves' disease.

    PubMed

    Polak, Michel; Le Gac, Isabelle; Vuillard, Edith; Guibourdenche, J; Leger, J; Toubert, M-E; Madec, A-M; Oury, J-F; Czernichow, P; Luton, Dominique

    2004-06-01

    The abundance of published data on the neonatal effects of maternal Graves' disease (GD) contrasts with the paucity of information on fetal effects. In our yet unpublished study, we prospectively studied 72 pregnant women with a history of Graves' disease. Fetal ultrasonography was done at 22 and 32 weeks of gestational age. Fetal goiter was found at 32 weeks in 11 of the fetuses of the 41 mothers with positive TSH-receptor antibodies and/or antithyroid treatment and in none of the fetuses of the 31 other mothers. In the 11 fetuses with goiter, ultrasound findings (thyroid Doppler and bone maturation), fetal heart rate, and maternal antibody and antithyroid drug status effectively discriminated between hypothyroidism (n=7) and hyperthyroidism (n=4). One fetus with hyperthyroidism died in utero at 35 weeks from heart failure. Treatment was successful in the ten other fetuses. One fetus without goiter had moderate hypothyroidism at birth. This study showed that it is of the utmost importance to have the fetal thyroid scrutinized by an expert ultrasonographist and to have team work with obstetricians and paediatric endocrinologists in pregnant mothers with GD. This allowed us to accurately determine fetal thyroid status and to adapt the treatment in mothers successfully. Fetal hyperthyroidism does exist and needs an appropriate aggressive treatment.

  1. Radioiodine-induced hypothyroidism in Graves' disease: factors associated with the increasing incidence

    SciTech Connect

    Cunnien, A.J.; Hy, I.D.; Gorman, C.A.; Offord, K.P.; Scanlon, P.W.

    1982-11-01

    A retrospective analysis was done of the records of 454 patients who received their first I-131 treatment for Graves' disease during six periods covering 1951 to 1978. In the earliest group, 3% of patients were hypothyroid 3 mo after I-131 use, and 40% were hypothyroid at 1 yr. In the most recent group, 36% of patients were hypothyroid at 3 mo and 91% were myxedematous at 1 yr. Although no obvious trends were noted, whether in the number of patients pretreated with thionamide drugs, in the mean 24-hr I-131 uptake, or in the calculated dose of I-131 (..mu..Ci/estimated gram of thyroid tissue) during the years of the study, the initial mean dose of I-131 administered increased from 8.1 mCi in the earliest group to 13.8 mCi in the latest group. Concurrently, estimates of gland size increased from a mean of 26 g in the first group to 43 g in the last. If, in patients with Graves' disease, the thyroid gland size did not truly increase during the years of the study, the increasing occurrence of early hypothyroidism seen after I-131 use may reflect the conscious or unconscious decision to use larger doses of I-131 calculated on the basis of inflated estimates of thyroid gland weight.

  2. Clinical efficacy of combined rituximab treatment in a woman with severe Graves' ophthalmopathy

    PubMed Central

    Liu, Xiaomei; Guo, Hui; Liu, Juan; Shi, Bingyin

    2016-01-01

    The present study reports the case of a female Chinese patient with Graves' disease (GD) and severe Graves' ophthalmopathy (GO) in its active phase, who was treated with propylthiouracil and oral prednisolone for 2 months at a local hospital. However, a lack of improvement in symptoms meant that the patient was transferred to the First Affiliated Hospital of Xi'an Jiaotong University (Xi'an, China), whereupon the patient received high-dose intravenous methylprednisolone pulse therapy, although with limited efficacy. Subsequently, rituximab (RTX; anti-CD20 monoclonal antibody) combined with orbital irradiation treatment was initiated. The patient responded positively to the combined treatment; the clinical symptoms and enlargement of the extraocular muscles were ameliorated, and there were marked decreases in the clinical activity and NOSPECS grading scores. Furthermore, the serum levels of anti-thyrotropin receptor antibodies (TRAb) were markedly decreased at 2 months following RTX therapy. The patient was maintained in a euthyroid state by treatment with methimazole during and following RTX therapy. It was concluded that RTX treatment may attenuate severe GO by depleting lymphocytes, and may promote the recovery of GD by reducing the serum levels of TRAb. PMID:27446325

  3. Combined segregation and linkage analysis of Graves disease with a thyroid autoantibody diathesis

    SciTech Connect

    Shields, D.C.; Ratanachaiyavong, S.; McGregor, A.M.; Collins, A.; Morton, N.E.

    1994-09-01

    Combined segregation and linkage analysis is a powerful technique for modeling linkage to diseases whose etiology is more complex than the effect of a well-described single genetic locus and for investigating the influence of single genes on various aspects of the disease phenotype. Graves disease is familial and is associated with human leukocyte antigen (HLA) allele DR3. Probands with Graves disease, as well as close relatives, have raised levels of thyroid autoantibodies. This phenotypic information additional to affection status may be considered by the computer program COMDS for combined segregation and linkage analysis, when normals are classified into diathesis classes of increasing thyroid autoantibody titer. The ordinal model considers the cumulative odds of lying in successive classes, and a single additional parameter is introduced for each gene modeled. Distributional assumptions are avoided by providing estimates of the population frequencies of each class. Evidence for linkage was increased by considering the thyroid autoantibody diathesis and by testing two-locus models. The analysis revealed evidence for linkage to HLA-DR when the strong coupling of the linked locus to allele DR3 was considered (lod score of 6.6). Linkage analysis of the residual variation revealed no evidence of linkage to Gm, but a suggestion of linkage to Km. 32 refs., 10 tabs.

  4. Antiphospholipid Antibody Syndrome Associated with Graves' Disease Presenting As Inferior Vena Cava Thrombosis with Bilateral Lower Limb DVT.

    PubMed

    Jain, Ankur

    2014-01-01

    We report a case of a 60-year-old lady who presented with bilateral lower limb swelling and a thyroid swelling with clinical features consistent with thyrotoxicosis. Investigations revealed the presence of a thrombus in bilateral external, internal iliac veins, and inferior vena cava extending up to its infrahepatic part. Hormone profile and radioiodine uptake scan confirmed the diagnosis of Graves' disease. Further workup revealed the presence of antiphospholipid antibodies (confirmed after a repeat test at 12 weeks). The patient was treated with antithyroid drugs and anticoagulants. The patient improved with normalization of thyroid function and partial recanalization of the infrahepatic part of inferior vena cava. Hyperthyroidism has been implicated as a potential hypercoagulable state; however, the association of Graves' disease with antiphospholipid antibody syndrome is limited to isolated case reports. This case highlights a new mechanism underlying hypercoagulability associated with Graves' disease.

  5. A 33-Year-Old Man with Gynaecomastia and Galactorrhea as the First Symptoms of Graves Hyperthyroidism

    PubMed Central

    Khoohaphatthanakul, Somdul

    2016-01-01

    Graves' hyperthyroidism has a various number of well-recognized manifestations. Galactorrhea is a rare manifestation in this disease. We describe a 33-year-old man who presented with the symptoms of hyperthyroidism, gynaecomastia, and galactorrhea for 2 months. Physical examination revealed goitre, gynaecomastia, and galactorrhea, bilaterally. Laboratory investigations demonstrated high free thyroxine with suppressed thyroid-stimulating hormone level together with elevated anti-TSH receptor; therefore, the diagnosis of Graves' disease was confirmed. Other investigations to elucidate the etiology of galactorrhea were normal, so the galactorrhea was hypothesized to be caused by Graves' disease. The gynaecomastia and galactorrhea resolved with the successful treatment of hyperthyroidism. Although the galactorrhea is extremely rare in thyrotoxicosis male patients, to the best of our knowledge, this is the third case which reported gynaecomastia and galactorrhea in male patient who presented with thyrotoxicosis. PMID:28044109

  6. Diagnostic Utility of Contrast-enhanced 3D T1-weighted Imaging in Acute Cerebral Infarction Associated with Graves Disease.

    PubMed

    Gon, Yasufumi; Sakaguchi, Manabu; Oyama, Naoki; Mochizuki, Hideki

    2017-02-01

    Graves disease is rarely complicated with cerebrovascular steno-occlusive diseases. Previous studies have suggested several hypotheses for this occurrence, including excess thyroid hormone, which stimulates the sympathetic nervous system, which in turn causes an abnormal hemodynamic response with consequent atherosclerotic changes, and antithyroid antibodies cause local vascular inflammation in patients with Graves disease. However, radiological findings of vasculitis in patients with Graves disease and cerebral infarction remain less known. We report the case of a 30-year-old Japanese woman with acute cerebral infarction due to vasculitis associated with Graves disease. She was admitted to our hospital with a 4-day history of intermittent transient dysarthria and limb shaking of the left leg when standing. Three weeks before admission, she went to a local hospital because of general malaise and was diagnosed with Graves disease. Neurological examination revealed paralytic dysarthria, left central facial nerve palsy, and left hemiparesis (manual muscle testing, 4 of 5). Blood examinations showed hyperthyroidism (thyroid-stimulating hormone ≤.010 µU/mL; free T3 ≥25.0 pg/mL; free T4 ≥8.0 ng/dL) and elevation of antithyroid antibody levels (thyroid peroxidase antibody, 87 IU/mL). The vessel wall of the right internal carotid artery was markedly enhanced on contrast-enhanced three-dimensional T1-weighted magnetic resonance imaging, suggesting vasculitis. Magnetic resonance angiography revealed right internal carotid artery occlusion after the branching ophthalmic artery. Arterial stenosis due to vasculitis was considered the cause of hemodynamic ischemic stroke. Vessel wall imaging such as high-resolution contrast-enhanced T1-weighted imaging seems useful for assessing the underlying mechanism of stroke in patients with Graves disease.

  7. The cranial analysis of eight skulls from collective grave of the Early Bronze Age Vucedol site (East Slavonia, Croatia).

    PubMed

    Hincak, Zdravka; Cavalli, Fabio; Durman, Aleksandar

    2013-03-01

    The collective grave of the Vucedol culture signed as "grave 3/1985" with skeletons of eight persons, represents the most important burial of this culture on the eponimic site in East Croatia, with several indications of human sacrifice. Anthropological and radiological analysis were performed on crania remains of the individuals, specifically on the skulls of one male and seven females. Nondestructive methods embraced craniometrical analysis, analysis of cranial non-metric traits and multivariate distance analysis, with a help of radiological methods, to detect every distinct anatomical characteristic of the skulls. All methods used in this work tried to present similarities and a possible homogeneity of the analysed individuals.

  8. Intercellular adhesion molecule-1 (ICAM-1) in Graves' disease: contrast between in vivo and in vitro results.

    PubMed Central

    Ciampolillo, A; Napolitano, G; Mirakian, R; Miyasaki, A; Giorgino, R; Bottazzo, G F

    1993-01-01

    We have reassessed the possible role of the adhesion molecule ICAM-1 in the pathogenesis of thyroid autoimmunity. In order to do that, we have investigated its expression in eight Graves' thyroids both in vivo (i.e. on cryostat sections and on cell suspensions), and in vitro (i.e. on cells cultured in monolayers for 3 days), and the results were compared with those obtained with similar preparations from four normal glands. On cryostat sections, the expression of ICAM-1, and for comparison that of HLA Class I and Class II molecules, was studied by immunofluorescence (IFL), but the former were also assessed by a distinct immunohistochemical technique. ICAM-1 was not detected in thyrocytes in vivo of both normal and Graves' glands, but solely in endothelial cells and antigen-presenting cells (APC). This selective reaction was confirmed by a four-layer technique using specific markers which identify endothelial cells and thyrocytes. HLA Class II molecules were confirmed to be inappropriately expressed in thyrocytes of Graves' glands, but there was no co-expression of these products and ICAM-1 in the same cells. In contrast, ICAM-1 appeared de novo in a proportion of Graves' and normal thyrocytes soon after the attachment and spreading of these cells in monolayer cultures (36-48 h). Graves' thyrocytes showed a quantitatively higher degree of expression compared with that detected on normal thyroid cells (40-70% versus 12-20%). Under these experimental conditions, the four-layer staining with thyroid microsomal antibodies confirmed that thyrocytes were indeed the positive cells which expressed ICAM-1. Blocking experiments with cultured thyrocytes from two Graves' glands and MoAbs to tumour necrosis factor-alpha (TNF-alpha) and interferon-gamma (IFN-gamma) did not prevent the occurrence of ICAM-1 expression. As a result of our study, we failed to demonstrate that Graves' thyrocytes express ICAM-1 in vivo. The unexpected case of inducing ICAM-1 on thyroid cells under

  9. Les cellulites cervico-faciales graves, facteurs et critères de gravité

    PubMed Central

    Lakouichmi, Mohammed; Tourabi, Khalid; Abir, Bader-eddine; Zouhair, Said; Lahmiti, Saad; Hattab, Nadia Mansouri

    2014-01-01

    La cellulite cervico-faciale grave est une infection polymicrobienne extensive et redoutable du tissu cellulo-adipeux de la face et du cou. L'objectif de cette étude est d'analyser certains facteurs favorisants et d’évaluer les critères de gravité en fonction des formes anatomo-cliniques. Il s'agit d'une étude rétrospective réalisée, entre janvier 2007 et décembre 2012, au service de chirurgie maxillo faciale de l'hôpital militaire Avicenne de Marrakech. Sur 147 cas de cellulites cervico-faciales pris en charge au niveau du service, 13 dossiers de cellulites graves ont été retenus. Neuf hommes (69%) et quatre femmes (31%) ont fait l'objet de cette étude, avec un âge moyen de 35 ans. Tous les patients ont été adressés pour prise en charge secondaire après avoir pris des anti-inflammatoires (AI). Sept cas (54%) étaient immunocompétents. La cause dentaire était soulevée chez neufs cas (69%). Cinq cas (38%) ont présenté une forme pseudo phlegmoneuse avec des signes compressifs des voies aéro-digestives. L'extension médiastinale a été observée chez quatre patients (31%). La forme nécrosante extensive a été retrouvée dans trois cas (23%). L’étude bactériologique, réalisée chez tous les patients, avait mis en évidence une flore microbienne mixte et polymorphe. Les cellulites cervico-faciales graves posent un réel problème de prise en charge thérapeutique. L'analyse des facteurs favorisants et l’évaluation des critères de gravité dans cette série ont permis de limiter une évolution défavorable. PMID:26113891

  10. 3D GPR in forensics: Finding a clandestine grave in a mountainous environment.

    PubMed

    Novo, Alexandre; Lorenzo, Henrique; Rial, Fernando I; Solla, Mercedes

    2011-01-30

    In the present work we show a forensic case study carried out in a mountainous environment. Main objective was to locate a clandestine grave which is around 10-20 years old and contains human remains of one individual and a metallic tool, probably a pick. Survey design started with an experimental burial of a pick at the expected depth (1m) as well as the calculation of synthetic radargrams in order to know if the 250MHz antenna was suitable for its detection and to have a record of the reflection of the pick. Conclusions extracted from the experiments together with rough terrain conditions suggested the use of the 250MHz antenna which allowed a good compromise between target detection and dense grid acquisition of an extensive survey area.

  11. Graves' Disease Mechanisms: The Role of Stimulating, Blocking, and Cleavage Region TSH Receptor Antibodies

    PubMed Central

    Morshed, S. A.; Davies, T. F.

    2016-01-01

    The immunologic processes involved in Graves' disease (GD) have one unique characteristic – the autoantibodies to the TSH receptor (TSHR) – which have both linear and conformational epitopes. Three types of TSHR antibodies (stimulating, blocking, and cleavage) with different functional capabilities have been described in GD patients, which induce different signaling effects varying from thyroid cell proliferation to thyroid cell death. The establishment of animal models of GD by TSHR antibody transfer or by immunization with TSHR antigen has confirmed its pathogenic role and, therefore, GD is the result of a breakdown in TSHR tolerance. Here we review some of the characteristics of TSHR antibodies with a special emphasis on new developments in our understanding of what were previously called “neutral” antibodies and which we now characterize as autoantibodies to the “cleavage” region of the TSHR ectodomain. PMID:26361259

  12. Outpatient 131I Treatment for a Patient with Graves' Disease Receiving Hemodialysis

    PubMed Central

    Suzuki, Miho; Yoshimura Noh, Jaeduk; Sugino, Kiminori; Ito, Koichi

    2016-01-01

    A patient presented with hyperthyroidism and end-stage renal disease requiring hemodialysis that was difficult to control despite increased dosages of anti-thyroid drugs. The condition could finally be controlled by 131I radioactive iodine therapy (RIT) and hemodialysis provided under a hospital-linkage system. During three hemodialysis sessions after the oral administration of 131I, we measured the radioactivity released from the patient and the radioactivity of the devices/tools used. The radioactivity of the devices/tools was managed by allowing the isotope to decay into non-radioactive elements. Our experience suggests that outpatient RIT may provide a safe and convenient means of treating Graves' disease, even in patients receiving hemodialysis. PMID:27853074

  13. [Serum concentration of calcium and calcitonin in hyperthyroidism caused by Graves' disease].

    PubMed

    Fereira-Valbuena, H; Fernández de Argüello, E; Campos, G; Ryder, E; Avellaneda, A

    1991-01-01

    Serum calcium and calcitonin were determined in 13 patients (12 women and 1 man), ages ranging from 30 to 40 years, with clinical diagnosis of hyperthyroidism due to Graves' Disease, confirmed by serum determinations of T3 and T4, with the purpose of establishing the relationship that these two substances may have in this pathology. The results obtained showed a decrease in seric calcium concentration in relation to a control group (10.02 +/-) 0.48 vs 11.49 +/- 0.28 mg/dl; p less than 0.005) and an increase in calcitonin concentration (193.6 +/- 8.62 vs 116.7 +/- 7.61 pg/ml; p less than 0.0001). We also found a significative negative association (r = -0.69; p less than 0.01) between these two compounds in the group of patients with hyperthyroidism, not being found in the control group.

  14. 99Tc-MDP treatment for the therapy of rheumatoid arthritis, choroidal neovascularisation and Graves' ophthalmopathy

    PubMed Central

    WU, QIAN; NI, YANG; YANG, QINGRUI; SUN, HONGSHENG

    2016-01-01

    Technetium 99 conjugated with methylene diphosphonate, which is an anti-inflammatory drug, can inhibit macrophage infiltration and downregulate a number of proinflammatory cytokines, such as tumor necrosis factor-α and interleukin-1β. Recently, numerous studies have indicated that it could improve rheumatoid arthritis (RA) activity by upregulating the frequency of peripheral γδ T cells and cluster of differentiation CD4+CD25+Foxp3+ Tregs, affecting the serum cytokine environment, inhibiting osteoclast formation and reducing the concentrations of rheumatoid factor-immunoglobulin M (IgM)/IgG/IgA. As well, it may have a therapeutic role for choroidal neovascularisation (CNV) and Graves' ophthalmopathy (GO). Therefore, it will be a valuable choice in the treatment of RA, CNV and GO. PMID:27073620

  15. TL, OSL and C-14 dating results of the sediments and bricks from mummified nuns' grave.

    PubMed

    Tudela, Diego R G; Tatumi, Sonia H; Yee, Márcio; Brito, Silvio L M; Morais, José L; Morais, Daisy de; Piedade, Silvia C; Munita, Casimiro S P; Hazenfratz, Roberto

    2012-06-01

    This paper presents the results of TL and OSL dating of soil and fragments of bricks from a grave, which was occupied by two mummified nuns, found at "Luz" Monastery, located in the state of São Paulo, Brazil. The TL and OSL ages were compared to C-14 dating ones obtained from bone collagens of the mummies. The majority of the ages is related to the eighteenth century. The gamma-ray spectroscopy was used to evaluate natural radioisotope concentrations in the samples, and by using these concentrations the annual dose rates, from 3.0 to 5.3 Gy/kyr, were obtained. Neutron activation analysis was performed and the radioisotope contents results are in agreement with those obtained by gamma-ray spectroscopy. The contents of U, Th and Ce elements were higher than those found in usual sediments.

  16. Fieldpath Lunar Meteorite Graves Nunataks 06157, a Magnesian Piece of the Lunar Highlands Crust

    NASA Technical Reports Server (NTRS)

    Zeigler, Ryan A.; Korotev, R. L.; Korotev, R. L.

    2012-01-01

    To date, 49 feldspathic lunar meteorites (FLMs) have been recovered, likely representing a minimum of 35 different sample locations in the lunar highlands. The compositional variability among FLMs far exceeds the variability observed among highland samples in the Apollo and Luna sample suites. Here we will discuss in detail one of the compositional end members of the FLM suite, Graves Nunataks (GRA) 06157, which was collected by the 2006-2007 ANSMET field team. At 0.79 g, GRA 06157 is the smallest lunar meteorite so far recovered. Despite its small size, its highly feldspathic and highly magnesian composition are intriguing. Although preliminary bulk compositions have been reported, thus far no petrographic descriptions are in the literature. Here we expand upon the bulk compositional data, including major-element compositions, and provide a detailed petrographic description of GRA 06157.

  17. Insulin autoimmune syndrome induced by methimazole in a Korean girl with Graves' disease

    PubMed Central

    Lee, Sun Hee; Oh, Seung Hwan

    2013-01-01

    Hypoglycemia was detected in a 15-year-old girl due to loss of consciousness. She was diagnosed with Graves' disease and was being treated with methimazole for the past 4 months. A paradoxically increased insulin levels was found when she suffered from the hypoglycemic episode. An imaging study showed no mass lesion in the pancreas, and insulin antibodies were found in the serum. She was diagnosed with insulin autoimmune syndrome. Her HLA typing was performed, and it revealed HLA-DRB1 *04:06. The patient was treated with a corticosteroid for 2 months. After discontinuing the steroid, the insulin antibody titer decreased dramatically, and she did not have any episode of hypoglycemia since. This is the first report of insulin autoimmune syndrome in a Korean girl, and we have revealed the connection between HLA type and insulin autoimmune syndrome in Korea. PMID:24904848

  18. Repatriation in the United States: The Current State of the Native American Graves Protection and Repatriation Act

    ERIC Educational Resources Information Center

    Daehnke, Jon; Lonetree, Amy

    2011-01-01

    Repatriation in the United States today is synonymous with the passage of the Native American Graves Protection and Repatriation Act (NAGPRA). Although repatriations of Native American ancestral remains and cultural objects certainly occurred--and continue to occur--outside of the purview of NAGPRA, this law remains the centerpiece of repatriation…

  19. Funerary practices of the Iberomaurusian population of Taforalt (Tafoughalt, Morocco, 11-12,000 BP): the case of Grave XII.

    PubMed

    Belcastro, Maria Giovanna; Condemi, Silvana; Mariotti, Valentina

    2010-06-01

    The Iberomaurusian necropolis of Taforalt (Morocco, 11-12000 BP), excavated by Roche in the 1950s, contains 28 multiple graves. The funerary practices of the Taforalt population have been the focus of a previous work (Mariotti et al., 2009). In the absence of the excavation records of the necropolis, these funerary practices were investigated through the analysis of the contents of each grave and the distribution of intentionally modified specimens (ochre-dyeing, cut marks). Previous research has drawn particular attention to Grave XII (containing three male adults and two juveniles), where many intentionally modified specimens were identified. The present study focused specifically on the human remains recovered from Grave XII. Analysis of these remains has provided evidence of interventions, such as dismemberment and defleshing of the cadaver, and the use of ochre to colour the bones. Furthermore, the presence of lesions on two skulls suggests the possibility of intentional killing and cannibalism among the Taforalt population. This study further supports our previous impression of the complex and diversified funerary practices, characterising the social life of the Iberomaurusian population of Taforalt.

  20. L'Attitude Chirurgicale dans les Brulures Electriques Graves par Haut Voltage: À Propos de Deux Cas

    PubMed Central

    Moussaoui, A.; Fejjal, N.; Achbouk, A.; Tourabi, K.; Ribag, Y.; Bakkali, H.; Ababou, K.; Ihrai, H.

    2008-01-01

    Summary Devant une brûlure électrique grave, deux attitudes chirurgicales se distinguent: 1. une attitude conservatrice; 2. une attitude d'amputation. A la lumière de deux observations, les Auteurs discutent les avantages et les difficultés de la mise en oeuvre de chaque attitude. PMID:21991118

  1. Possibility of using space radar GRAVES signals for uninterrupted monitoring of orbital parameters of space objects in low orbits

    NASA Astrophysics Data System (ADS)

    Bushuev, F. I.; Vorsin, G. V.; Grinchenko, A. A.; Kalyuzhny, N. A.; Shulga, A. V.

    2013-12-01

    The paper shows the possibility to monitor the orbital parameters of space objects using an experimental radio hardware and software complex that receives signals of the space radar GRAVES (France) which are reflected by the monitored objects. The results of comparing the calculated and the measured values of Doppler frequency shift are shown for selected objects and the Moon.

  2. Interferon-alpha-induced destructive thyroiditis followed by Graves' disease in a patient with chronic hepatitis C: a case report.

    PubMed

    Kim, Bu Kyung; Choi, Young Sik; Park, Yo Han; Lee, Sang Uk

    2011-12-01

    Interferon-induced thyroiditis (IIT) is a major clinical problem for patients receiving interferon-alpha (IFN-α) therapy. But, destructive thyroiditis followed by Graves' disease associated with IFN-α therapy is very rarely reported. Herein, we report a rare case of pegylated IFN-α (pegIFN-α) induced destructive thyroiditis followed by Graves' disease in a patient with HCV infection. A 31-yr-old woman suffered from chronic active hepatitis C and was treated with pegIFN-α and ribavirin for 12 months. Results of a thyroid function test and autoantibody levels were normal before IFN-α therapy was initiated. Destructive thyrotoxicosis appeared seven months after the initiation of IFN-α therapy, followed by Graves' thyrotoxicosis two months after the cessation of therapy. The diagnoses of destructive thyroiditis and Graves' disease were confirmed by the presence of TSH receptor antibodies in addition to Tc-99m scintigraphy findings. The patient's antithyroglobulin antibody titer increased gradually during IFN-α therapy and remained weakly positive after IFN-α therapy was discontinued.

  3. Lack of Association between Selenium Status and Disease Severity and Activity in Patients with Graves' Ophthalmopathy

    PubMed Central

    Dehina, Nora; Hofmann, Peter Josef; Behrends, Thomas; Eckstein, Anja; Schomburg, Lutz

    2016-01-01

    Background Selenium (Se) is of importance for regular functioning of the immune system and thyroid gland, and may have a health effect in mild Graves' ophthalmopathy (GO). Objective As the Se status declines in inflammation, we analyzed whether GO activity or severity affects the Se status of patients. Methods Serum Se and selenoprotein P (SePP) concentrations were retrospectively determined in 84 consecutive GO patients before treatment and compared to their clinical activity score (CAS) and severity of eye changes (NOSPECS) status, and to the concentrations of autoantibodies targeting the TSH receptor (TRAK) or the IGF1 receptor (IGF1R-aAB). Results Serum Se and SePP were linearly associated, indicating a suboptimal Se status of our patients. In comparison to data from other European cohorts, the majority of GO patients had a relatively poor Se status ([Se] ± SD; 70.0 ± 23.8 µg/l), below the threshold needed for full expression of selenoproteins. TRAK were inversely associated with Se concentrations, while IGF1R-aAB titers were not associated with Se. Neither Se nor SePP concentrations differed between GO patients with severe versus mild or active versus inactive disease, or showed significant associations with the CAS or NOSPECS values. Conclusion GO patients are at risk of a low Se status, yet disease severity or activity does not seem to affect Se or SePP concentrations directly. However, as the retrospective nature of the analysis does not allow conclusions on a potential causative role of Se on Graves' disease or GO risk, these results neither support nor discourage adjuvant Se supplementation attempts. PMID:27099840

  4. A predictive mathematical model for the calculation of the final mass of Graves' disease thyroids treated with 131I

    NASA Astrophysics Data System (ADS)

    Traino, Antonio C.; Di Martino, Fabio; Grosso, Mariano; Monzani, Fabio; Dardano, Angela; Caraccio, Nadia; Mariani, Giuliano; Lazzeri, Mauro

    2005-05-01

    Substantial reductions in thyroid volume (up to 70-80%) after radioiodine therapy of Graves' hyperthyroidism are common and have been reported in the literature. A relationship between thyroid volume reduction and outcome of 131I therapy of Graves' disease has been reported by some authors. This important result could be used to decide individually the optimal radioiodine activity A0 (MBq) to administer to the patient, but a predictive model relating the change in gland volume to A0 is required. Recently, a mathematical model of thyroid mass reduction during the clearance phase (30-35 days) after 131I administration to patients with Graves' disease has been published and used as the basis for prescribing the therapeutic thyroid absorbed dose. It is well known that the thyroid volume reduction goes on until 1 year after therapy. In this paper, a mathematical model to predict the final mass of Graves' diseased thyroids submitted to 131I therapy is presented. This model represents a tentative explanation of what occurs macroscopically after the end of the clearance phase of radioiodine in the gland (the so-called second-order effects). It is shown that the final thyroid mass depends on its basal mass, on the radiation dose absorbed by the gland and on a constant value α typical of thyroid tissue. α has been evaluated based on a set of measurements made in 15 reference patients affected by Graves' disease and submitted to 131I therapy. A predictive equation for the calculation of the final mass of thyroid is presented. It is based on macroscopic parameters measurable after a diagnostic 131I capsule administration (0.37-1.85 MBq), before giving the therapy. The final mass calculated using this equation is compared to the final mass of thyroid measured 1 year after therapy administration in 22 Graves' diseased patients. The final masses calculated and measured 1 year after therapy are in fairly good agreement (R = 0.81). The possibility, for the physician, to decide a

  5. Risk factors of hepatic dysfunction in patients with Graves' hyperthyroidism and the efficacy of 131iodine treatment.

    PubMed

    Wang, Renfei; Tan, Jian; Zhang, Guizhi; Zheng, Wei; Li, Chengxia

    2017-02-01

    Hepatic dysfunction is often observed in patients with Graves' hyperthyroidism. The aims of this study were to investigate the risk factors for hepatic dysfunction and to analyze the efficacy of I (radioactive iodine-131) treatment. In total, 2385 patients with Graves' hyperthyroidism (478 males, 1907 females; age 42.8 ± 13.5 years) were involved in our study. Of these, 1552 cases with hepatic dysfunction received I treatment. All clinical data were retrospectively reviewed to explore the risk factors associated with hepatic dysfunction using logistic regression analysis. Furthermore, we observed thyroid and liver function indices for the 1552 subjects at 3, 6 and 12 months after I treatment, in order to evaluate efficacy. Overall, 65% patients were affected by hepatic dysfunction. The most common abnormality was elevated alkaline phosphatase (ALP), of which the prevalence was 52.3%. The percentages of hepatocellular injury type, bile stasis, and mixed type were 45.8%, 32.4%, and 21.8%, respectively. Both univariate and multivariate analyses demonstrated that age, duration of Graves hyperthyroidism, free triiodothyronine (FT3)level, and thyrotrophin receptor antibody (TRAb) concentration were the most significant risk factors predicting hepatic dysfunction. Additionally, the patients with mild hepatic dysfunction, or hepatocellular injury type were more likely to attain normal liver function after I treatment. Furthermore, after I treatment, liver function was more likely to return to normal in the cured group of patients compared with the uncured group. Older patients and cases with a longer history of Graves' hyperthyroidism, higher FT3 or TRAb concentration were more likely to be associated with hepatic dysfunction, and the prognosis of hepatic dysfunction was closely associated with the outcomes of Graves' hyperthyroidism after I treatment.

  6. Therapeutic effectiveness of potassium iodine in drug-naïve patients with Graves' disease: a single-center experience.

    PubMed

    Uchida, Toyoyoshi; Goto, Hiromasa; Kasai, Takatoshi; Komiya, Koji; Takeno, Kageumi; Abe, Hiroko; Shigihara, Nayumi; Sato, Junko; Honda, Akira; Mita, Tomoya; Kanazawa, Akio; Fujitani, Yoshio; Watada, Hirotaka

    2014-11-01

    Iodine is beneficial against Graves' thyrotoxicosis, though its effects are short-lived. However, its long-term effectiveness as an initial therapy has not been fully elucidated. Here, we compared the effects of potassium iodine (KI) and methimazole (MMI) in Graves' thyrotoxicosis and on thyrotropin receptor antibody (TRAb) levels. Between 2008 and 2011, 293 patients with untreated Graves' disease visited the outpatient clinic of Juntendo University. Of these, 227 patients were treated with MMI and 30 treated with KI as the initial therapy. To compare the effects of KI and MMI, we identified patients with similar probabilities of receiving MMI or KI using propensity score (PS) analysis based on the observed clinical features. PS matching created 20 matched pairs of patients with Graves' disease treated with MMI and KI. The baseline characteristics of post-matched patients treated with MMI were comparable to those treated with KI (FT3; 7.16 ± 2.30, 6.56 ± 1.85 pg/ml, FT4; 2.57 ± 0.79, 2.49 ± 0.70 ng/dl, respectively). The initial dose of MMI was 14.0 ± 8.2 mg/day and that of KI was 53.6 ± 11.7 mg/day. Three patients of the KI group did not respond to the monotherapy, requiring the inclusion of antithyroid drugs. One patient on MMI developed moderate skin eruption, but continued the treatment. Patients who continued the initial treatment showed significant and comparable reductions in FT4, FT3 and TRAb by MMI as well as by KI at the end of 12-month treatment. Although patients were limited to mild untreated Graves' disease thyrotoxicosis, KI offers a possible alternative initial treatment for this condition.

  7. Earliest floral grave lining from 13,700-11,700-y-old Natufian burials at Raqefet Cave, Mt. Carmel, Israel.

    PubMed

    Nadel, Dani; Danin, Avinoam; Power, Robert C; Rosen, Arlene M; Bocquentin, Fanny; Tsatskin, Alexander; Rosenberg, Danny; Yeshurun, Reuven; Weissbrod, Lior; Rebollo, Noemi R; Barzilai, Omry; Boaretto, Elisabetta

    2013-07-16

    Flowering plants possess mechanisms that stimulate positive emotional and social responses in humans. It is difficult to establish when people started to use flowers in public and ceremonial events because of the scarcity of relevant evidence in the archaeological record. We report on uniquely preserved 13,700-11,700-y-old grave linings made of flowers, suggesting that such use began much earlier than previously thought. The only potentially older instance is the questionable use of flowers in the Shanidar IV Neanderthal grave. The earliest cemeteries (ca. 15,000-11,500 y ago) in the Levant are known from Natufian sites in northern Israel, where dozens of burials reflect a wide range of inhumation practices. The newly discovered flower linings were found in four Natufian graves at the burial site of Raqefet Cave, Mt. Carmel, Israel. Large identified plant impressions in the graves include stems of sage and other Lamiaceae (Labiatae; mint family) or Scrophulariaceae (figwort family) species; accompanied by a plethora of phytoliths, they provide the earliest direct evidence now known for such preparation and decoration of graves. Some of the plant species attest to spring burials with a strong emphasis on colorful and aromatic flowers. Cave floor chiseling to accommodate the desired grave location and depth is also evident at the site. Thus, grave preparation was a sophisticated planned process, embedded with social and spiritual meanings reflecting a complex preagricultural society undergoing profound changes at the end of the Pleistocene.

  8. Earliest floral grave lining from 13,700–11,700-y-old Natufian burials at Raqefet Cave, Mt. Carmel, Israel

    PubMed Central

    Nadel, Dani; Danin, Avinoam; Power, Robert C.; Rosen, Arlene M.; Bocquentin, Fanny; Tsatskin, Alexander; Rosenberg, Danny; Yeshurun, Reuven; Weissbrod, Lior; Rebollo, Noemi R.; Barzilai, Omry; Boaretto, Elisabetta

    2013-01-01

    Flowering plants possess mechanisms that stimulate positive emotional and social responses in humans. It is difficult to establish when people started to use flowers in public and ceremonial events because of the scarcity of relevant evidence in the archaeological record. We report on uniquely preserved 13,700–11,700-y-old grave linings made of flowers, suggesting that such use began much earlier than previously thought. The only potentially older instance is the questionable use of flowers in the Shanidar IV Neanderthal grave. The earliest cemeteries (ca. 15,000–11,500 y ago) in the Levant are known from Natufian sites in northern Israel, where dozens of burials reflect a wide range of inhumation practices. The newly discovered flower linings were found in four Natufian graves at the burial site of Raqefet Cave, Mt. Carmel, Israel. Large identified plant impressions in the graves include stems of sage and other Lamiaceae (Labiatae; mint family) or Scrophulariaceae (figwort family) species; accompanied by a plethora of phytoliths, they provide the earliest direct evidence now known for such preparation and decoration of graves. Some of the plant species attest to spring burials with a strong emphasis on colorful and aromatic flowers. Cave floor chiseling to accommodate the desired grave location and depth is also evident at the site. Thus, grave preparation was a sophisticated planned process, embedded with social and spiritual meanings reflecting a complex preagricultural society undergoing profound changes at the end of the Pleistocene. PMID:23818584

  9. Ratio of serum free triiodothyronine to free thyroxine in Graves' hyperthyroidism and thyrotoxicosis caused by painless thyroiditis.

    PubMed

    Yoshimura Noh, Jaeduk; Momotani, Naoko; Fukada, Shuji; Ito, Koichi; Miyauchi, Akira; Amino, Nobuyuki

    2005-10-01

    The serum T3 to T4 ratio is a useful indicator for differentiating destruction-induced thyrotoxicosis from Graves' thyrotoxicosis. However, the usefulness of the serum free T3 (FT3) to free T4 (FT4) ratio is controversial. We therefore systematically evaluated the usefulness of this ratio, based on measurements made using two widely available commercial kits in two hospitals. Eighty-two untreated patients with thyrotoxicosis (48 patients with Graves' disease and 34 patients with painless thyroiditis) were examined in Kuma Hospital, and 218 patients (126 with Graves' disease and 92 with painless thyroiditis) and 66 normal controls were examined in Ito Hospital. The FT3 and FT4 values, as well as the FT3/FT4 ratios, were significantly higher in the patients with Graves' disease than in those with painless thyroiditis in both hospitals, but considerable overlap between the two disorders was observed. Receiver operating characteristic (ROC) curves for the FT3 and FT4 values and the FT3/FT4 ratios of patients with Graves' disease and those with painless thyroiditis seen in both hospitals were prepared, and the area under the curves (AUC), the cut-off points for discriminating Graves' disease from painless thyroiditis, the sensitivity, and the specificity were calculated. AUC and sensitivity of the FT(3)/FT(4) ratio were smaller than those of FT(3) and FT(4) in both hospitals. The patients treated at Ito hospital were then divided into 4 groups according to their FT4 levels (A: < or =2.3, B: >2.3 approximately < or =3.9, C: 3.9 approximately < or =5.4, D: >5.4 ng/dl), and the AUC, cut-off points, sensitivity, and specificity of the FT(3)/FT(4) ratios were calculated. The AUC and sensitivity of each group increased with the FT4 levels (AUC: 57.8%, 72.1%, 91.1%, and 93.4%, respectively; sensitivity: 62.6%, 50.0%, 77.8%, and 97.0%, respectively). The means +/- SE of the FT3/FT4 ratio in the Graves' disease groups were 3.1 +/- 0.22, 3.1 +/- 0.09, 3.2 +/- 0.06, and 3.1 +/- 0

  10. Geophysical Investigation of an Abandoned Cemetery: Teachers Discover Evidence of Unmarked Graves in Prairie View, TX

    NASA Astrophysics Data System (ADS)

    Henning, A. T.; Sawyer, D. S.; Baldwin, R.; Kahera, A.; Thoms, A.

    2007-12-01

    In July 2007, a group of nineteen K-12 teachers investigated an abandoned cemetery in Prairie View, Texas, utilizing ground-penetrating radar (GPR) to image the subsurface. In a period of two weeks, the group acquired and interpreted 59 GPR profiles in Wyatt Chapel Cemetery and surrounding areas in order to determine the local stratigraphy and try to locate unmarked graves. The sandy soil in this area is ideally suited for GPR investigations and numerous geophysical anomalies were identified. Wyatt Chapel Cemetery is located adjacent to the campus of Prairie View A&M University in Prairie View, TX, and is thought to have originated as a slave burial ground in the 1850's. Participants in a summer course at Rice University conducted a geophysical investigation of the site. Participants were in-service K-12 teachers from urban Houston school districts where the majority of students are members of historically underrepresented minority groups. Recruitment efforts targeted educators who are currently teaching science without a science degree. Participants included elementary, middle and high school teachers. This summer experience is followed by a content-intensive academic year course in Physical Geology. GPR is an excellent tool for investigating the sandy soil encountered at Wyatt Chapel Cemetery. The stratigraphy in the area consists of 3-6 feet of reddish-brown, medium-grained sand overlying a light gray, highly compacted clay. The sand-clay boundary appears as a strong reflector on the GPR profiles. Participants identified numerous anomalies in the GPR data and two were excavated. One consisted of a pair of bright hyperbolae, suggesting two edges of a metal object. This excavation resulted in the discovery of a metal plank thought to be a burial cover. The second anomaly consisted of a break in the horizon representing the top of the clay layer, and subsequent excavation revealed a grave shaft. Participants experienced the process of science first-hand and used

  11. Determining thyroid {sup 131}I effective half-life for the treatment planning of Graves' disease

    SciTech Connect

    Willegaignon, Jose; Sapienza, Marcelo T.; Barberio Coura Filho, George; Buchpiguel, Carlos A.; Traino, Antonio C.

    2013-02-15

    Purpose: Thyroid {sup 131}I effective half-life (T{sub eff}) is an essential parameter in patient therapy when accurate radiation dose is desirable for producing an intended therapeutic outcome. Multiple {sup 131}I uptake measurements and resources from patients themselves and from nuclear medicine facilities are requisites for determining T{sub eff}, these being limiting factors when implementing the treatment planning of Graves' disease (GD) in radionuclide therapy. With the aim of optimizing this process, this study presents a practical, propitious, and accurate method of determining T{sub eff} for dosimetric purposes. Methods: A total of 50 patients with GD were included in this prospective study. Thyroidal {sup 131}I uptake was measured at 2-h, 6-h, 24-h, 48-h, 96-h, and 220-h postradioiodine administration. T{sub eff} was calculated by considering sets of two measured points (24-48-h, 24-96-h, and 24-220-h), sets of three (24-48-96-h, 24-48-220-h, and 24-96-220-h), and sets of four (24-48-96-220-h). Results: When considering all the measured points, the representative T{sub eff} for all the patients was 6.95 ({+-}0.81) days, whereas when using such sets of points as (24-220-h), (24-96-220-h), and (24-48-220-h), this was 6.85 ({+-}0.81), 6.90 ({+-}0.81), and 6.95 ({+-}0.81) days, respectively. According to the mean deviations 2.2 ({+-}2.4)%, 2.1 ({+-}2.0)%, and 0.04 ({+-}0.09)% found in T{sub eff}, calculated based on all the measured points in time, and with methods using the (24-220-h), (24-48-220-h), and (24-96-220-h) sets, respectively, no meaningful statistical difference was noted among the three methods (p > 0.500, t test). Conclusions: T{sub eff} obtained from only two thyroid {sup 131}I uptakes measured at 24-h and 220-h, besides proving to be sufficient, accurate enough, and easily applicable, attributes additional major cost-benefits for patients, and facilitates the application of the method for dosimetric purposes in the treatment planning of

  12. Transconjunctival orbital decompression in Graves' ophthalmopathy: lateral wall approach ab interno

    PubMed Central

    Paridaens, D.; Verhoeff, K.; Bouwens, D.; van den Bosch, W. A

    2000-01-01

    AIMS—A modified surgical technique is described to perform a one, two, or three wall orbital decompression in patients with Graves' ophthalmopathy.
METHODS—The lateral wall was approached ab interno through a "swinging eyelid" approach (lateral canthotomy and lower fornix incision) and an extended periosteum incision along the inferior and lateral orbital margin. In addition, the orbital floor and medial wall were removed when indicated. To minimise the incidence of iatrogenic diplopia, the lateral and medial walls were used as the first surfaces of decompression, leaving the "medial orbital strut" intact. During 1998, this technique was used in a consecutive series of 19 patients (35 orbits) with compressive optic neuropathy (six patients), severe exposure keratopathy (one patient), or disfiguring/congestive Graves' ophthalmopathy (12 patients).
RESULTS—The preoperative Hertel value (35 eyes) was on average 25 mm (range 19-31 mm). The mean proptosis reduction at 2 months after surgery was 5.5 mm (range 3-7 mm). Of the total group of 19 patients, iatrogenic diplopia occurred in two (12.5%) of 16 patients who had no preoperative diplopia or only when tired. The three other patients with continuous preoperative diplopia showed no improvement of double vision after orbital decompression, even when the ocular motility (ductions) had improved. In the total group, there was no significant change of ductions in any direction at 2 months after surgery. All six patients with recent onset compressive optic neuropathy showed improvement of visual acuity after surgery. No visual deterioration related to surgery was observed in this study. A high satisfaction score (mean 8.2 on a scale of 1 to 10) was noted following the operation.
CONCLUSION—This versatile procedure is safe and efficacious, patient and cost friendly. Advantages are the low incidence of induced diplopia and periorbital hypaesthesia, the hidden and small incision, the minimal surgical

  13. Funerary practices of the Iberomaurusian population of Taforalt (Tafoughalt; Morocco, 11-12,000BP): new hypotheses based on a grave by grave skeletal inventory and evidence of deliberate human modification of the remains.

    PubMed

    Mariotti, Valentina; Bonfiglioli, Benedetta; Facchini, Fiiorenzo; Condemi, Silvana; Belcastro, Maria Giovanna

    2009-04-01

    The Iberomaurusian necropolis of Taforalt (Morocco, 11-12,000BP), excavated by Roche in the 1950s, contains 28 multiple graves. The osteological collection has been the focus of many anthropological studies and has been used as a comparative sample for other paleoanthropological investigations. The presence of particular sepulchral structures and the use of ochre testify to complex funerary practices, which have not been adequately investigated thus far. Unfortunately, neither the excavation records nor detailed descriptions of the graves are available today. The aim of this study is to investigate the funerary practices of the population based on examination of the human osteological collection (Institut de Paléontologie Humaine, Paris). The bones of adolescents and adults were inventoried to analyse the contents of each grave and the distribution of intentionally modified specimens (ochre-dyeing, cutmarks). The minimum number of individuals was also calculated. The results suggest that the necropolis is a group of primary and secondary burials, even within the same "grave," of about 40 adolescents and adults. The previous estimate of 86 individuals by Ferembach in 1962 appears to be an overestimation. The presence of red ochre and cutmarks on some bones suggests various rituals, which denote a certain profundity of thinking about life and death. It is possible that the Taforalt cave was a special, perhaps sacred, place where particular rituals were celebrated or where more occasional social or religious events took place. Comparison with other Iberomaurusian and Capsian sites provides evidence of cultural continuity in North Africa for a long period of time. The present study demonstrates that re-examination of human osteological collections deriving from ancient excavations, for which a lack of adequate documentation of the context of the specimens is fairly common, can also provide information about aspects like funerary practices, which are usually

  14. An unusual suicide inside a grave with two gunshot wounds to the head--the psychological approach.

    PubMed

    Kastanaki, Anastasia E; Kranioti, Elena F; Theodorakis, Pavlos N; Michalodimitrakis, Manolis

    2009-03-01

    In this report, the authors present a case of suicide committed by a 66-year-old man, inside a grave at the local cemetery, with two gunshot wounds to the head. A multiple-paged, handwritten suicide note was found in an army type bag inside the victim's car, while a second one was found in his house. Medicolegal examination of the body revealed two typical contact gunshot entrance wounds and one exit wound to the head. Toxicological analysis of the femoral blood was negative for alcohol and drugs. The history, scene and autopsy findings, along with further police investigation, indicated an obvious case of suicide. The literature is reviewed and discussed. We report this case as the place of suicide is extremely uncommon and as there is no mention of a gunshot suicide inside a grave in the current literature.

  15. [Thyroid abscess revealing Graves-Basedow disease: about a case and review of the literature].

    PubMed

    Chenguir, Meriem; Souldi, Hajar; Loufad, Fatima Zahra; Rouadi, Sami; Abada, Reda; Roubal, Mohamed; Mahtar, Mohamed

    2016-01-01

    Thyroid abscess is a very rare clinical entity. It accounts for 0.1% of the surgical pathologies of the thyroid gland. The anatomical and physiological characteristics of the gland give it resistance to pathogens. Streptococcal and Staphylococcal are the most common. Tuberculosis is rarely reported in the literature. The occurrence of infection associated with toxic goiter is exceptional. The authors report a rare case of a 22-year-old young patient with thyroid abscess revealing a toxic goitre. He presented to our otorhinolaryngology emergency unit with anterior cervical swelling, slightly lateralized to the left, moving on swallowing, associated with hemoptysis, signs of thyroid dysfunction, fever, night sweats. Cervical CT scan showed a mass occupying the left lobe of the thyroid gland, with fluid content, measuring 2 cm and with purulent fluid collected via fine needle aspiration biopsy. Cytobacteriological examination showed Staphylococcus with positive BK test. Patient underwent chest radiograph showing right apical pulmonary alveolar. Cytobacteriological examination of sputum isolated Koch bacillus. Thyroid biological assessment was in favor of Graves-Basedow disease. The management was medical and included parenteral triple antibiotic, anti-bacillary and anti-thyroid synthesis therapy with good evolution. The diagnosis of tuberculosis should be suspected in patients with thyroid abscess formation associated with an unclear clinical picture. This is most often caused by hematogenous spread from another primary infection, particularly a pulmonary infection. The treatment is based on antibacillary drugs sometimes associated with surgery.

  16. Synthetic gene network restoring endogenous pituitary-thyroid feedback control in experimental Graves' disease.

    PubMed

    Saxena, Pratik; Charpin-El Hamri, Ghislaine; Folcher, Marc; Zulewski, Henryk; Fussenegger, Martin

    2016-02-02

    Graves' disease is an autoimmune disorder that causes hyperthyroidism because of autoantibodies that bind to the thyroid-stimulating hormone receptor (TSHR) on the thyroid gland, triggering thyroid hormone release. The physiological control of thyroid hormone homeostasis by the feedback loops involving the hypothalamus-pituitary-thyroid axis is disrupted by these stimulating autoantibodies. To reset the endogenous thyrotrophic feedback control, we designed a synthetic mammalian gene circuit that maintains thyroid hormone homeostasis by monitoring thyroid hormone levels and coordinating the expression of a thyroid-stimulating hormone receptor antagonist (TSHAntag), which competitively inhibits the binding of thyroid-stimulating hormone or the human autoantibody to TSHR. This synthetic control device consists of a synthetic thyroid-sensing receptor (TSR), a yeast Gal4 protein/human thyroid receptor-α fusion, which reversibly triggers expression of the TSHAntag gene from TSR-dependent promoters. In hyperthyroid mice, this synthetic circuit sensed pathological thyroid hormone levels and restored the thyrotrophic feedback control of the hypothalamus-pituitary-thyroid axis to euthyroid hormone levels. Therapeutic plug and play gene circuits that restore physiological feedback control in metabolic disorders foster advanced gene- and cell-based therapies.

  17. Le Point sur la Pharmacologie des Agents Anesthesiques Chez le Brule Grave

    PubMed Central

    Siah, S.; Ababou, K.; Benziane, H.; El Jaoudi; Bensghir, M.; Bakali, H.; El Wali, A.; Ihrai, I.; Drissi, N.K.

    2008-01-01

    Summary La pharmacologie des agents anesthésiques chez le brûlé est variable et imprévisible. Dans les premières 48 h, il y a une hypovolémie avec chute du débit cardiaque et des fuites plasmatiques. Après 48 h, il y a une hypervolémie avec augmentation du débit cardiaque, hypermétabolisme et la clearance des médicaments est augmentée. Parmi les facteurs de déséquilibre, on retrouve les variations des protéines plasmatiques. Deux protéines sont importantes chez le brûlé grave : l'albumine et l'alpha 1- glycoprotéine. Leur taux varie beaucoup au cours de l'évolution de la brûlure. Les agents anesthésiques dont la liaison avec ces deux protéines est prédominante verront leur pharmacocinétique modifiée. L'anesthésiste-réanimateur du service des brûlés va maîtriser ces notions pharmacologiques pour utiliser à bon escient les agents anesthésiques. PMID:21991108

  18. Geophysical and botanical monitoring of simulated graves in a tropical rainforest, Colombia, South America

    NASA Astrophysics Data System (ADS)

    Molina, Carlos Martin; Pringle, Jamie K.; Saumett, Miguel; Evans, Gethin T.

    2016-12-01

    In most Latin American countries there are significant numbers of missing people and forced disappearances, currently 80,000 only in Colombia. Successful detection of shallow buried human remains by forensic search teams is currently difficult in varying terrain and climates. Within this research we built four simulated clandestine burial styles in tropical rainforests, as this is a common scenario and depositional environment encountered in Latin America, to gain knowledge of optimum forensic geophysics detection techniques. The results of geophysically monitoring these burials using ground penetrating radar, magnetic susceptibility, bulk ground conductivity and electrical resistivity are presented from one to forty three weeks post-burial. Radar survey results with both the 250 MHz and 500 MHz frequency antennae showed good detection of modern simulated burials on 2D profiles and horizontal time slices but poor detection on the other simulated graves. Magnetic susceptibility, bulk ground conductivity and electrical resistivity results were generally poor at detecting the simulated targets. Observations of botanical variations on the test site show rapid regrowth of Malvaceae and Petiveria alliacea vegetation over all burials that are common in these forests, which can make detection more difficult.

  19. Early Medieval Muslim Graves in France: First Archaeological, Anthropological and Palaeogenomic Evidence.

    PubMed

    Gleize, Yves; Mendisco, Fanny; Pemonge, Marie-Hélène; Hubert, Christophe; Groppi, Alexis; Houix, Bertrand; Deguilloux, Marie-France; Breuil, Jean-Yves

    2016-01-01

    The rapid Arab-Islamic conquest during the early Middle Ages led to major political and cultural changes in the Mediterranean world. Although the early medieval Muslim presence in the Iberian Peninsula is now well documented, based in the evaluation of archeological and historical sources, the Muslim expansion in the area north of the Pyrenees has only been documented so far through textual sources or rare archaeological data. Our study provides the first archaeo-anthropological testimony of the Muslim establishment in South of France through the multidisciplinary analysis of three graves excavated at Nimes. First, we argue in favor of burials that followed Islamic rites and then note the presence of a community practicing Muslim traditions in Nimes. Second, the radiometric dates obtained from all three human skeletons (between the 7th and the 9th centuries AD) echo historical sources documenting an early Muslim presence in southern Gaul (i.e., the first half of 8th century AD). Finally, palaeogenomic analyses conducted on the human remains provide arguments in favor of a North African ancestry of the three individuals, at least considering the paternal lineages. Given all of these data, we propose that the skeletons from the Nimes burials belonged to Berbers integrated into the Umayyad army during the Arab expansion in North Africa. Our discovery not only discusses the first anthropological and genetic data concerning the Muslim occupation of the Visigothic territory of Septimania but also highlights the complexity of the relationship between the two communities during this period.

  20. Geophysical monitoring of simulated graves with resistivity, magnetic susceptibility, conductivity and GPR in Colombia, South America.

    PubMed

    Molina, Carlos Martin; Pringle, Jamie K; Saumett, Miguel; Evans, Gethin T

    2016-04-01

    In most Latin American countries there are significant numbers of both missing people and forced disappearances, ∼71,000 Colombia alone. Successful detection of buried human remains by forensic search teams can be difficult in varying terrain and climates. Three clandestine burials were simulated at two different depths commonly encountered in Latin America. In order to gain critical knowledge of optimum geophysical detection techniques, burials were monitored using: ground penetrating radar, magnetic susceptibility, bulk ground conductivity and electrical resistivity up to twenty-two months post-burial. Radar survey results showed good detection of modern 1/2 clothed pig cadavers throughout the survey period on 2D profiles, with the 250MHz antennae judged optimal. Both skeletonised and decapitated and burnt human remains were poorly imaged on 2D profiles with loss in signal continuity observed throughout the survey period. Horizontal radar time slices showed good anomalies observed over targets, but these decreased in amplitude over the post-burial time. These were judged due to detecting disturbed grave soil rather than just the buried targets. Magnetic susceptibility and electrical resistivity were successful at target detection in contrast to bulk ground conductivity surveys which were unsuccessful. Deeper burials were all harder to image than shallower ones. Forensic geophysical surveys should be undertaken at suspected burial sites.

  1. Disease activity in Graves' ophthalmopathy: diagnosis with orbital MR imaging and correlation with clinical score.

    PubMed

    Tortora, Fabio; Cirillo, Mario; Ferrara, Marco; Belfiore, Maria Paola; Carella, Carlo; Caranci, Ferdinando; Cirillo, Sossio

    2013-10-01

    In Graves' ophthalmopathy (GO) it is important to distinguish acute inflammation at an early stage, responsive to immunosuppressive treatment, from inactive fibrotic end stage disease, unresponsive to the same treatment. The purpose of this study was to identify the most relevant signal intensities on orbital MR imaging with contrast administration both to classify patients according to their clinical activity score (defined by a cut-off value of 3) and to make a prediction of patient's CAS. Such threshold was considered as widely used in literature. Sixteen consecutive patients with a diagnosis of GO in different phases of thyroid disease based on clinical and orbital MR imaging signs, and six normal volunteers were examined. Orbital MR imaging was performed on a 1.5 Tesla MR Unit. MR scans were assessed by an experienced neuroradiologist, blinded to the clinical examinations. We found a statistical correlation between CAS and both STIR and contrast enhanced T1-weighted sequences. There was also a statistically significant correlation between STIR and contrast-enhanced T1 images disclosing the possibility of avoiding the injection of contrast medium. Our study proved that signal intensity values on STIR sequence increase in the inflammatory oedematous phase of disease. We confirmed the correlation between signal intensities on this sequence and CAS, showing an increase in signal intensity proportional to the CAS value. So we validated MRI use to establish the activity phase of disease more sensitively than CAS alone.

  2. White goddess--the unspeakable name. An inquiry into Robert Graves' King Jesus.

    PubMed

    Nakano, N

    1984-03-01

    Robert Graves is a poet-mythographer, well-known in the U. K. and the U. S. A., but not in Japan despite his huge amount of poetic, mythographical, prose and critical works. Furthermore, even in the U. S. A. and the U. K., some people have been shunning him politely as a versatile iconoclast possessed of the White Goddess. In fact, it is not difficult to imagine that when King Jesus, a life story of Christ, was published, people were shocked at his extraordinary mythographical Christology derived from his enthusiasm towards the White Goddess Cult. In Christ he discovered the fragments of maternal doctrine as a new concept in opposition to the Apollonian theory of Judaism, but they seemed to be quite incomplete in the author's eyes lacking in something most essential in life, recognition of love and hatred discipline. This paper is an inquiry into how the author developed his own hermaneutics of Christ through his wide and thorough scholarship on mythology, history, the Bible and Celtic poetry.

  3. Common phenotype and different non-HLA genes in Graves' disease and alopecia areata.

    PubMed

    Taketomo, Yasunori; Noso, Shinsuke; Babaya, Naru; Hiromine, Yoshihisa; Ito, Hiroyuki; Kanto, Kousei; Niwano, Fumimaru; Oiso, Naoki; Kawada, Akira; Kawabata, Yumiko; Ikegami, Hiroshi

    2017-02-01

    Our previous observations clarified that Graves' disease (GD) is the most frequent autoimmune disease in patients with alopecia areata (AA), and 42.7% of patients with AA were positive for thyrotropin receptor antibody (TRAb). A class II HLA haplotype DRB1(∗)15:01-DQB1(∗)06:02 was suggested to contribute to autoimmunity against the thyroid gland in AA. To further clarify the genetic factors contributing to organ specificity in autoimmune diseases, we studied the contribution of non-HLA genes to organ specificity in GD and AA. A high frequency of AA (13.4%) was observed in patients with GD, indicating strong phenotypic association between GD and AA. CTLA4 and TSHR were significantly associated with GD (Pc=0.007 and Pc<0.002, respectively), but not with AA, even in TRAb-positive patients. The difference in the association between GD and AA suggests that the CTLA4 and TSHR are not main factors contributing to determining common genetic basis among GD and AA.

  4. Variable regions of Ig heavy chain genes encoding antithyrotropin receptor antibodies of patients with Graves' disease

    SciTech Connect

    Shin, Euy Kyun; Akamizu, Takashi; Matsuda, Fumihiko; Sugawa, Hideo; Fujikura, Junji; Mori, Toru; Honjo, Tasuku )

    1994-02-01

    The authors have established EBV-transformed human B cell clones producing monoclonal antithyrotropin receptor antibodies from two patients with Graves' disease. They then isolated and characterized Ig H chain genes of 5 B cell clones with thyrotropin-binding inhibitor Ig (TBII) activity and 4 B cell clones with thyroid-stimulating antibody (TSAb) activity. They found that V[sub H] gene families used in the 5 TBII clones were diverse, including V[sub H-II, -III, -IV,] and [sub -V]. Most of V[sub H] segments used in TBII and TSAb are commonly used in other autoantibodies and fetal liver repertoire. The frequency of somatic mutations in TBII was higher than that in TSAb. In as much as the same germline V[sub H] segment (V3-23) was used for both TBII and TSAb, the frequency and position of somatic mutations may be important for generation of TBII and TSAb. 56 refs., 2 figs., 2 tabs.

  5. Early Medieval Muslim Graves in France: First Archaeological, Anthropological and Palaeogenomic Evidence

    PubMed Central

    Pemonge, Marie-Hélène; Hubert, Christophe; Groppi, Alexis; Houix, Bertrand; Deguilloux, Marie-France; Breuil, Jean-Yves

    2016-01-01

    The rapid Arab-Islamic conquest during the early Middle Ages led to major political and cultural changes in the Mediterranean world. Although the early medieval Muslim presence in the Iberian Peninsula is now well documented, based in the evaluation of archeological and historical sources, the Muslim expansion in the area north of the Pyrenees has only been documented so far through textual sources or rare archaeological data. Our study provides the first archaeo-anthropological testimony of the Muslim establishment in South of France through the multidisciplinary analysis of three graves excavated at Nimes. First, we argue in favor of burials that followed Islamic rites and then note the presence of a community practicing Muslim traditions in Nimes. Second, the radiometric dates obtained from all three human skeletons (between the 7th and the 9th centuries AD) echo historical sources documenting an early Muslim presence in southern Gaul (i.e., the first half of 8th century AD). Finally, palaeogenomic analyses conducted on the human remains provide arguments in favor of a North African ancestry of the three individuals, at least considering the paternal lineages. Given all of these data, we propose that the skeletons from the Nimes burials belonged to Berbers integrated into the Umayyad army during the Arab expansion in North Africa. Our discovery not only discusses the first anthropological and genetic data concerning the Muslim occupation of the Visigothic territory of Septimania but also highlights the complexity of the relationship between the two communities during this period. PMID:26910855

  6. Choroidal changes observed with enhanced depth imaging optical coherence tomography in patients with mild Graves orbitopathy.

    PubMed

    Özkan, B; Koçer, Ç A; Altintaş, Ö; Karabaş, L; Acar, A Z; Yüksel, N

    2016-07-01

    PurposeTo evaluate the choroidal thickness in patients with Graves orbitopathy (GO) using enhanced depth imaging-optical coherence tomography (EDI-OCT).MethodsThirty-one patients with GO were evaluated prospectively. All subjects underwent ophthalmologic examination including best-corrected visual acuity, intraocular pressure measurement, biomicroscopic, and fundus examination. Choroidal thickness was measured at the central fovea. In addition, visual evoked potential measurement and visual field evaluation were performed.ResultsThe mean choroidal thickness was 377.8±7.4 μ in the GO group, and 334±13.7 μ in the control group. (P=0.004). There was a strong correlation between the choridal thickness and the clinical activity scores (CAS) of the patients (r=0.281, P=0.027). Additionally, there was a correlation between the choroidal thickness and the visual-evoked potential (VEP) P100 latency measurements of the patients (r=0.439, P=0.001).ConclusionsThe results of this study demonstrate that choroid is thicker in patients with GO. The choroidal thickness is also correlated with the CAS and VEP P100 latency measurements in these patients.

  7. Late onset of atypical paroxysmal non-kinesigenic dyskinesia with remote history of Graves' disease.

    PubMed

    Rana, Abdul Qayyum; Nadeem, Ambreen; Yousuf, Muhammad Saad; Kachhvi, Zakerabibi M

    2013-10-01

    Paroxysmal non-kinesigenic dyskinesia (PNKD) is a rare hyperkinetic movement disorder and falls under the category of paroxysmal movement disorders. In this condition, episodes are spontaneous, involuntary, and involve dystonic posturing with choreic and ballistic movements. Attacks last for minutes to hours and rarely occur more than once per day. Attacks are not typically triggered by sudden movement, but may be brought on by alcohol, caffeine, stress, fatigue, or chocolate. We report a patient with multiple atypical features of PNKD. She had a 7-year history of this condition with onset at the age of 59, and a remote history of Graves' disease requiring total thyroidectomy. The frequency of attacks in our case ranged from five to six times a day to a minimum of twice per week, and the duration of episode was short, lasting not more than 2 min. Typically, PNKDs occur at a much younger age and have longer attack durations with low frequency. Administering clonazepam worked to reduce her symptoms, although majority of previous research suggests that pharmacological interventions have poor outcomes.

  8. Educational interventions targeted at minors in situations of grave social vulnerability and their families

    NASA Astrophysics Data System (ADS)

    de La Caba Collado, Mariangeles; Bartau Rojas, Isabel

    2010-10-01

    The aim of this article is to outline and assess an educational intervention programme targeted at improving the skills of families and the personal and social development of children living in situations of grave social vulnerability. The sample comprised 10 families during the first phase of the intervention and six during the second. The design, intervention and assessment process of this study was carried out in two phases over a period of a year and a half. For both phases, three different groups—of men/fathers, women/mothers and children—were established. Study variables (parenting skills and children's personal and social development) were evaluated before and after the intervention in every group, as well as during the entire process. The results, taking into account the improvements reported by all the participants (social workers, group monitors, fathers, mothers, children) show that inter-professional involvement and coordination at all phases of the intervention is vital in order to achieve small but significant improvements.

  9. Autoantibody against diiodinated tyrosine-gastrin in a patient with Graves' disease

    SciTech Connect

    Noguchi, M.; Adachi, H.; Aoki, E.; Iida, Y.; Kasagi, K.; Endo, K.; Konishi, J.; Torizuka, K.

    1987-01-01

    We describe autoantibodies against iodinated gastrin in a patient with Graves' disease. Values for serum gastrin differed in this case, depending on which of two different radioimmunoassay (RIA) kits was used. RIA with the dextran-coated charcoal method for separation of free tracer gastrin gave a value less than 9.5 pmol/L, whereas the value by a RIA kit by the double-antibody method was 318 pmol/L. The patient's serum contained a binding protein for /sup 125/I-labeled gastrin, as detected by Sephadex G-200 column chromatography. The IgG fraction was responsible for the ability of serum to bind /sup 125/I-labeled gastrin. Interestingly, of the two possible forms of iodinated gastrins, monoiodinated (MIT) and diiodinated (DIT) tyrosine-/sup 125/I-labeled gastrin, only the latter bound to patient's IgG. Furthermore, DIT-gastrin, but not gastrin or MIT-gastrin, inhibited the binding of DIT-/sup 125/I-labeled gastrin. The patient's serum evidently contains autoantibodies against DIT-gastrin that interfere with RIA of gastrin.

  10. The effect of preoperative Lugol's iodine on thyroid blood flow in patients with Graves' hyperthyroidism.

    PubMed

    Chang, D C; Wheeler, M H; Woodcock, J P; Curley, I; Lazarus, J R; Fung, H; John, R; Hall, R; McGregor, A M

    1987-12-01

    A study was conducted to investigate the effect of Lugol's iodine on the superior thyroid artery (STA) blood flow with use of a Duplex ultrasound scanner for 12 patients with Graves' disease. All patients were treated with antithyroid drugs until they were euthyroid and then, with randomization, the patients received either Lugol's iodine, 0.3 ml thrice daily, or placebo for 9 days in a double-blind fashion. Antithyroid drugs were continued throughout the study. Reduction in the diameter, time-averaged velocity (TAV), and volume flow (VF) of the STAs was demonstrated in all patients in the treatment group, whereas there were no consistent trends in the placebo group. The changes in TAV and VF were significantly different between the placebo and treatment groups (p less than 0.01 for TAV and p less than 0.005 for VF). These changes were more marked in patients with high initial VF and minimal in patients with low initial VF. On the basis of these results, we recommend that patients with high thyroid blood flow before thyroidectomy should receive Lugol's iodine preoperatively.

  11. High Prevalence of Infertility among Women with Graves' Disease and Hashimoto's Thyroiditis.

    PubMed

    Quintino-Moro, Alessandra; Zantut-Wittmann, Denise E; Tambascia, Marcos; Machado, Helymar da Costa; Fernandes, Arlete

    2014-01-01

    Objectives. To evaluate the prevalence of infertility in women with Graves' disease (GD) or Hashimoto's thyroiditis (HT) and associated factors. Material and Methods. This cross-sectional study was conducted at the Endocrinology Clinic for Thyroid Autoimmune Diseases, with 193 women aged 18-50 years with GD and 66 women aged 18-60 years with HT. The women were interviewed to obtain data on their gynecological and obstetric history and family history of autoimmune diseases. Their medical records were reviewed to determine the characteristics of the disease and to confirm association with other autoimmune diseases. Infertility was defined as 12 months of unprotected sexual intercourse without conception. Results. The prevalence of infertility was 52.3% in GD and 47.0% in HT. Mean age at diagnosis was 36.5 years and 39.2 years, in GD and HT, respectively. The mean number of pregnancies was lower in women who were 35 years old or younger at diagnosis and was always lower following diagnosis of the disease, irrespective of age. The only variable associated with infertility was a shorter time of the disease in HT. Conclusions. The prevalence of infertility was high in women with GD and HT and affected the number of pregnancies in young women.

  12. Iatrogenic myxoedema madness following radioactive iodine ablation for Graves' disease, with a concurrent diagnosis of primary hyperaldosteronism

    PubMed Central

    Snell, L; Morris, D V

    2015-01-01

    Summary Myxoedema madness was first described as a consequence of severe hypothyroidism in 1949. Most cases were secondary to long-standing untreated primary hypothyroidism. We present the first reported case of iatrogenic myxoedema madness following radioactive iodine ablation for Graves' disease, with a second concurrent diagnosis of primary hyperaldosteronism. A 29-year-old woman presented with severe hypothyroidism, a 1-week history of psychotic behaviour and paranoid delusions 3 months after treatment with radioactive iodine ablation for Graves' disease. Her psychiatric symptoms abated with levothyroxine replacement. She was concurrently found to be hypertensive and hypokalemic. Primary hyperaldosteronism from bilateral adrenal hyperplasia was diagnosed. This case report serves as a reminder that myxoedema madness can be a complication of acute hypothyroidism following radioactive iodine ablation of Graves' disease and that primary hyperaldosteronism may be associated with autoimmune hyperthyroidism. Learning points Psychosis (myxoedema madness) can present as a neuropsychiatric manifestation of acute hypothyroidism following radioactive iodine ablation of Graves' disease.Primary hyperaldosteronism may be caused by idiopathic bilateral adrenal hyperplasia even in the presence of an adrenal adenoma seen on imaging.Adrenal vein sampling is a useful tool for differentiating between a unilateral aldosterone-producing adenoma, which is managed surgically, and an idiopathic bilateral adrenal hyperplasia, which is managed medically.The management of autoimmune hyperthyroidism, iatrogenic hypothyroidism and primary hyperaldosteronism from bilateral idiopathic adrenal hyperplasia in patients planning pregnancy includes delaying pregnancy 6 months following radioactive iodine treatment and until patient is euthyroid for 3 months, using amiloride as opposed to spironolactone, controlling blood pressure with agents safe in pregnancy such as nifedipine and avoiding

  13. The Accuracy of the Osteological Sexing of Cremated Human Remains: A Test Based on Grave Goods from East Lithuanian Barrows.

    PubMed

    Kurila, Laurynas

    2015-12-01

    The accuracy of the sex determination of cremated human remains is one of the vital parameters for archaeologists and skeletal anthropologists dealing with cremations. Few studies have so far aimed at testing it. In the present paper, the accuracy of the sexing techniques was assessed by paralleling biological sex (identified morphologically) to gender (presumed on the basis of the grave goods which accompanied the deceased). A collection of cremated bones from East Lithuanian barrows (c. fourth/fifth--eleventh/twelfth centuries AD) was employed. The fragmentary nature and poor state of the bones generally represents cremains from similar archaeological contexts. The database inevitably underwent several stages of filtration. Out of 364 cremations with a minimum of 445 individuals, only 157 were sexed single adult burials, of which only 81 had "gender-related" grave goods. The relationship of artefact type to gender was defined statistically, revising the results in line with the chronological and typological differences and the probable symbolism of the grave goods. Sex and gender coincided in 56 cases (69.14%), but a considerable distance between the results for both sexes was observed. Biological females displayed a fairly high match level, i.e. 35 out of the 41 (85.37%) individuals osteologically identified as females had been given "feminine" items. The burials of biological males, on the other hand, yielded a surprisingly low match rate, i.e. only 21 out of 40 (52.50%). This disparity suggests a possible misinterpretation of grave goods as gender markers, rather than (only?) erroneous sexing. It is thus argued that for females, the mean value for the accuracy of sexing is 85.5%. In most cases, such precision is entirely satisfactory for the analysis of a poorly-preserved osteological material. For males, however, the accuracy is likely to fall somewhere in the range between 52.5 and 85.5%, with the applied methodology so far failing to contribute to higher

  14. A Cultural Resources Literature Search of the Bayou Du Chien Drainage Project Area in Fulton, Graves, and Hickman Counties, Kentucky

    DTIC Science & Technology

    1985-10-10

    Mary E., and Roger W. Barbour 1971 A Guide to the Wildflowers and Ferns of Kentucky . The University Press of Kentucky , Lexington. I. 59 I Wharton, Mary...DRAINAGE PROJECT AREA IN FULTON, GRAVES, AND HICKMAN COUNTIES, KENTUCKY I by ?amela A. Schenian October 10, 1985 - DTIC S APRL 9 19933 I E i Cultural... KENTUCKY by Pamela A. Schenian Pamela A.’ Schenia Principal Investigator and Project Archaeologist October 10, 1985 Prepared for: The Memphis

  15. Semblance analysis to assess GPR data from a five-year forensic study of simulated clandestine graves

    NASA Astrophysics Data System (ADS)

    Booth, Adam D.; Pringle, Jamie K.

    2016-02-01

    Ground penetrating radar (GPR) surveys have proven useful for locating clandestine graves in a number of forensic searches. There has been extensive research into the geophysical monitoring of simulated clandestine graves in different burial scenarios and ground conditions. Whilst these studies have been used to suggest optimum dominant radar frequencies, the data themselves have not been quantitatively analysed to-date. This study uses a common-offset configuration of semblance analysis, both to characterise velocity trends from GPR diffraction hyperbolae and, since the magnitude of a semblance response is proportional to signal-to-noise ratio, to quantify the strength of a forensic GPR response. 2D GPR profiles were acquired over a simulated clandestine burial, with a wrapped-pig cadaver monitored at three-month intervals between 2008 and 2013 with GPR antennas of three different centre-frequencies (110, 225 and 450 MHz). The GPR response to the cadaver was a strong diffraction hyperbola. Results show, in contrast to resistivity surveys, that semblance analysis have little sensitivity to changes attributable to decomposition, and only a subtle influence from seasonality: velocity increases (0.01-0.02 m/ns) were observed in summer, associated with a decrease (5-10%) in peak semblance magnitude, SM, and potentially in the reflectivity of the cadaver. The lowest-frequency antennas consistently gave the highest signal-to-noise ratio although the grave was nonetheless detectable by all frequencies trialled. These observations suggest that forensic GPR surveys could be undertaken with little seasonal hindrance. Whilst GPR analysis cannot currently provide a quantitative diagnostic proxy for time-since-burial, the consistency of responses suggests that graves will remain detectable beyond the five years shown here.

  16. Cigarette Smoke Extract-Induced Oxidative Stress and Fibrosis-Related Genes Expression in Orbital Fibroblasts from Patients with Graves' Ophthalmopathy.

    PubMed

    Kau, Hui-Chuan; Wu, Shi-Bei; Tsai, Chieh-Chih; Liu, Catherine Jui-Ling; Wei, Yau-Huei

    2016-01-01

    Cigarette smoking is the most important risk factor for the development or deterioration of Graves' ophthalmopathy. Smoke-induced increased generation of reactive oxygen species may be involved. However, it remains to be clarified how orbital fibroblasts are affected by cigarette smoking. Our study demonstrated that Graves' orbital fibroblasts have exaggerated response to cigarette smoke extract challenge along with increased oxidative stress, fibrosis-related genes expression, especially connective tissue growth factor, and intracellular levels of transforming growth factor-β1 and interleukin-1β. The findings obtained in this study provide some clues for the impact of cigarette smoking on Graves' ophthalmopathy and offer a theoretical basis for the potential and rational use of antioxidants in treating Graves' ophthalmopathy.

  17. Upper eyelid retraction in Graves' ophthalmopathy: a new surgical technique and a study of the abnormal levator muscle.

    PubMed Central

    Small, R G

    1988-01-01

    A new surgical procedure, the proximal levator technique, achieves recession of the retracted upper eyelid in Graves' ophthalmopathy by sectioning the levator muscle proximal to Whitnall's ligament and fixing eyelid position with sutures that permit postoperative adjustment. This technique deserves further study. Enlargement of the proximal levator muscle in Graves' eye disease is shown on orbital CT scans and is found at surgery when the proximal levator technique is employed. Histologic and morphometric studies demonstrate increased levator muscle fiber size as well as increased extracellular volume. These findings suggest that levator muscle hypertrophy is important in the pathogenesis of upper eyelid retraction in Graves' ophthalmopathy. Images FIGURE 2 A FIGURE 3 A FIGURE 3 B FIGURE 3 C FIGURE 3 D FIGURE 4 A,B FIGURE 4 C,D,E FIGURE 4 F,G FIGURE 6 A FIGURE 6 B FIGURE 7 A FIGURE 7 B FIGURE 8 A FIGURE 8 B FIGURE 9 A FIGURE 9 B FIGURE 10 A FIGURE 10 B FIGURE 11 A FIGURE 11 B FIGURE 12 A FIGURE 12 B FIGURE 13 A FIGURE 13 B FIGURE 14 A FIGURE 14 B FIGURE 15 A FIGURE 15 B FIGURE 16 A FIGURE 16 B FIGURE 17 A FIGURE 17 B FIGURE 18 A FIGURE 18 B FIGURE 19 A FIGURE 19 B FIGURE 20 FIGURE 21 FIGURE 22 FIGURE 23 FIGURE 24 FIGURE 25 FIGURE 26 FIGURE 27 FIGURE 28 FIGURE 29 FIGURE 30 FIGURE 31 FIGURE 32 PMID:2979032

  18. A modified ELISA accurately measures secretion of high molecular weight hyaluronan (HA) by Graves' disease orbital cells.

    PubMed

    Krieger, Christine C; Gershengorn, Marvin C

    2014-02-01

    Excess production of hyaluronan (hyaluronic acid [HA]) in the retro-orbital space is a major component of Graves' ophthalmopathy, and regulation of HA production by orbital cells is a major research area. In most previous studies, HA was measured by ELISAs that used HA-binding proteins for detection and rooster comb HA as standards. We show that the binding efficiency of HA-binding protein in the ELISA is a function of HA polymer size. Using gel electrophoresis, we show that HA secreted from orbital cells is primarily comprised of polymers more than 500 000. We modified a commercially available ELISA by using 1 million molecular weight HA as standard to accurately measure HA of this size. We demonstrated that IL-1β-stimulated HA secretion is at least 2-fold greater than previously reported, and activation of the TSH receptor by an activating antibody M22 from a patient with Graves' disease led to more than 3-fold increase in HA production in both fibroblasts/preadipocytes and adipocytes. These effects were not consistently detected with the commercial ELISA using rooster comb HA as standard and suggest that fibroblasts/preadipocytes may play a more prominent role in HA remodeling in Graves' ophthalmopathy than previously appreciated.

  19. Preliminary results of sequential monitoring of simulated clandestine graves in Colombia, South America, using ground penetrating radar and botany.

    PubMed

    Molina, Carlos Martin; Pringle, Jamie K; Saumett, Miguel; Hernández, Orlando

    2015-03-01

    In most Latin American countries there are significant numbers of missing people and forced disappearances, 68,000 alone currently in Colombia. Successful detection of shallow buried human remains by forensic search teams is difficult in varying terrain and climates. This research has created three simulated clandestine burial styles at two different depths commonly encountered in Latin America to gain knowledge of optimum forensic geophysics detection techniques. Repeated monitoring of the graves post-burial was undertaken by ground penetrating radar. Radar survey 2D profile results show reasonable detection of ½ clothed pig cadavers up to 19 weeks of burial, with decreasing confidence after this time. Simulated burials using skeletonized human remains were not able to be imaged after 19 weeks of burial, with beheaded and burnt human remains not being able to be detected throughout the survey period. Horizontal radar time slices showed good early results up to 19 weeks of burial as more area was covered and bi-directional surveys were collected, but these decreased in amplitude over time. Deeper burials were all harder to image than shallower ones. Analysis of excavated soil found soil moisture content almost double compared to those reported from temperate climate studies. Vegetation variations over the simulated graves were also noted which would provide promising indicators for grave detection.

  20. Human thyroid peroxidase (TPO) isoforms, TPO-1 and TPO-2: analysis of protein expression in Graves' thyroid tissue.

    PubMed

    Gardas, A; Lewartowska, A; Sutton, B J; Pasieka, Z; McGregor, A M; Banga, J P

    1997-11-01

    Thyroid peroxidase (TPO) is the key enzyme involved in the biosynthesis of thyroid hormones and is an important autoantigen in autoimmune thyroid disease. Different messenger RNA species coding for TPO are present in thyroid tissue, including the species coding for a 933-amino acid protein (termed TPO-1) and a second in which exon 10 is deleted and which is 57 residues shorter (termed TPO-2). However, it is not known whether the smaller, TPO-2 isoform is expressed as a protein in thyroid cells. In SDS-PAGE under reducing conditions, TPO appears in the thyroid microsome and purified protein preparations as a closely migrating double band of approximately 105 (larger form) and 100 kilodaltons (smaller form). We investigated the presence of the isoform TPO-2 polypeptide in Graves' thyroid tissue using rabbit antisera to three different synthetic peptides from exon 10 (specific for TPO-1) and a polyclonal rabbit and monoclonal anti-TPO antibody (both of which are specific for the two forms of TPO). The larger and smaller forms of TPO were purified by electroelution after gel electrophoresis of highly purified natural TPO from Graves' thyroid microsomes. Both of the purified forms of TPO react with all three anti-exon 10 peptide antibodies, the polyclonal anti-TPO and the monoclonal antibody anti-TPO. This shows that both forms of TPO contain exon 10-encoded polypeptide of TPO-1. Interestingly, the proportion of the larger and smaller forms of TPO varied in different Graves' thyroid microsome preparations. To investigate the presence of the smaller TPO-2 isoform in the purified natural TPO preparation, affinity depletion of TPO-1 using the anti-exon 10 peptide antibodies was carried out. The binding of anti-exon 10 peptide antibodies to the immunodepleted TPO-1 fraction was considerably diminished in comparison to binding of polyclonal anti-TPO, suggesting the presence of small amounts (< 10%) of TPO-2 expressed as a protein in thyroid cells. Our results extend previous

  1. Alteration of Connective Tissue Growth Factor (CTGF) Expression in Orbital Fibroblasts from Patients with Graves' Ophthalmopathy.

    PubMed

    Tsai, Chieh-Chih; Wu, Shi-Bei; Chang, Pei-Chen; Wei, Yau-Huei

    2015-01-01

    Graves' ophthalmopathy (GO) is a disfiguring and sometimes blinding disease, which is characterized by inflammation and swelling of orbital tissues, with fibrosis and adipogenesis being predominant features. The aim of this study is to investigate whether the expression levels of fibrosis-related genes, especially that of connective tissue growth factor (CTGF), are altered in orbital fibroblasts of patients with GO. The role of oxidative stress in the regulation of CTGF expression in GO orbital fibroblasts is also examined. By a SYBR Green-based real time quantitative PCR (RT-QPCR), we demonstrated that the mRNA expression levels of fibronectin, apolipoprotein J, and CTGF in cultured orbital fibroblasts from patients with GO were significantly higher than those of age-matched normal controls (p = 0.007, 0.037, and 0.002, respectively). In addition, the protein expression levels of fibronectin, apolipoprotein J, and CTGF analyzed by Western blot were also significantly higher in GO orbital fibroblasts (p = 0.046, 0.032, and 0.008, respectively) as compared with the control. Furthermore, after treatment of orbital fibroblasts with a sub-lethal dose of hydrogen peroxide (200 μM H2O2), we found that the H2O2-induced increase of CTGF expression was more pronounced in the GO orbital fibroblasts as compared with those in normal controls (20% vs. 7%, p = 0.007). Importantly, pre-incubation with antioxidants including N-acetylcysteine (NAC) and vitamin C, respectively, resulted in significant attenuation of the induction of CTGF in GO orbital fibroblasts in response to H2O2 (p = 0.004 and 0.015, respectively). Taken together, we suggest that oxidative stress plays a role in the alteration of the expression of CTGF in GO orbital fibroblasts that may contribute to the pathogenesis and progression of GO. Antioxidants may be used in combination with the therapeutic agents for effective treatment of GO.

  2. Down-regulated resistin level in consequence of decreased neutrophil counts in untreated Grave's disease

    PubMed Central

    Huang, Fengjiao; Chen, Xinxin; Zhou, Yulin; Ye, Lei; Wang, Weiqing; Ning, Guang; Wang, Shu

    2016-01-01

    Resistin, belongs to cysteine-rich secretory protein, is mainly produced by circulating leukocytes, such as neutrophils monocytes and macrophages in humans. To date, few but controversial studies have reported about resistin concentrations in hyperthyroid patients, especially in Graves' disease (GD). We undertaked a controlled, prospective study to explore the serum resistin concentration in GD patients before and after -MMI treatment. In addition, we also investigated the main influencing factor on serum resistin level and discuessed the potential role of serum resistin plays in GD patients. 39 untreated GD (uGD) patients, including 8 males and 31 females, were enrolled in our investigation. All of these patients were prescribed with MMI treatment, in addition to 25 healthy controls. Anthropometric parameters and hormone assessment were measured. Enzyme-linked immunosorbent assay was used to detect serum resistin concentration in different stages of GD patients. Furthermore, neutrophil cell line NB4 with or without T3 treatment to detect the effect of thyroid hormones on resistin expression. The serum resistin level and neutrophil counts in untreated GD patients were significantly declined. And all of these parameters were recovered to normal after MMI treatment in ethyroid GD (eGD) and TRAb-negative conversion (nGD) patients. Resistin concentration exhibited a negative correlation with FT3 and FT4, but a positive correlation with absolute number of neutrophiles in uGD patients, whereas did not correlate with thyroid autoimmune antibodies and BMI. Neutrophile cell line, NB4, produced decreased expression of resistin when stimulated with T3. Our study showed a decrease of serum resistin level in GD patients and we suggested that the serum resistin might primarily secreted from circulating neutrophils and down-regulated by excessive thyroid hormones in GD patients. PMID:27637079

  3. Atypical Complications of Graves' Disease: A Case Report and Literature Review

    PubMed Central

    Siddique, Mashhood Ahmed; Arroub, Shaimaa Ahmed; Ebrahim, Ahmed Hamdi; Jayyousi, Amin Ahmed

    2017-01-01

    Graves' disease (GD) may display uncommon manifestations. We report a patient with rare complications of GD and present a comprehensive literature review. A 35-year-old woman presented with a two-week history of dyspnea, palpitations, and edema. She had a raised jugular venous pressure, goiter, and exophthalmos. Laboratory tests showed pancytopenia, a raised alkaline phosphatase level, hyperbilirubinemia (mainly direct bilirubin), and hyperthyroidism [TSH: <0.01 mIU/L (reference values: 0.45–4.5), fT4: 54.69 pmol/L (reference values: 9.0–20.0), and fT3: >46.08 pmol/L (reference values: 2.6–5.7)]. Her thyroid uptake scan indicated GD. Echocardiography showed a high right ventricular systolic pressure: 60.16 mmHg. Lugol's iodine, propranolol, cholestyramine, and dexamethasone were initiated. Hematologic investigations uncovered no reason for the pancytopenia; therefore, carbimazole was started. Workup for hepatic impairment and pulmonary hypertension (PH) was negative. The patient became euthyroid after 3 months. Leukocyte and platelet counts and bilirubin levels normalized, and her hemoglobin and alkaline phosphatase levels and right ventricular systolic pressure (52.64 mmHg) improved. This is the first reported single case of GD with the following three rare manifestations: pancytopenia, cholestatic liver injury, and PH with right-sided heart failure. With antithyroid drugs treatment, pancytopenia should resolve with euthyroidism, but PH and liver injury may take several months to resolve. PMID:28348902

  4. The Efficacy of Radiation Therapy in the Treatment of Graves' Orbitopathy

    SciTech Connect

    Matthiesen, Chance; Thompson, J. Spencer; Thompson, David; Farris, Bradley; Wilkes, Byron; Ahmad, Salahuddin; Herman, Terence; Bogardus, Carl

    2012-01-01

    Purpose: To review our institutional outcomes of patients treated with radiation therapy (RT) for Graves' orbitopathy (GO), assess the role of orbital reirradiation, and identify prognostic factors of complete response (CR). Methods and Materials: This is a retrospective review of 211 patients who presented with a diagnosis of GO and received RT between January 2000-2010. RT dose was 20 Gy in 10 fractions. Patient median age was 51 years (range, 15-84 years), median follow-up was 11 months (range, 1-88 months). Patient symptoms included any combination of proptosis (90.9%), extraocular muscle dysfunction (78.9%), soft tissue signs (68.4%), and diplopia (58.4%). Corticosteroids were used as first-line therapy in 20.6% of patients. Among those who achieved either CR or partial response (PR), prognostic factors were evaluated. Results: Stabilization of disease without recurrence was clinically achieved overall in 202 patients (96.7%). At the completion of RT, 176 patients (84.2%) reported a symptomatic improvement of pretreatment symptoms. CR of GO symptoms was achieved using multiple treatment modalities, including RT by 93 patients (44.5%), of which 32 patients received RT only. Corticosteroids were discontinued in 97.8% of patients who received them as initial therapy. Surgical intervention following radiotherapy was required for 144 (68.9%) of all patients. Fourteen patients received orbital reirradiation for persistent or recurrent symptoms. Five of these achieved a CR, and the other nine achieved disease stabilization but retained persistent ocular symptoms. Long-term side effects of RT included dry eyes (12%). Of the prognostic factors we investigated, only gender predicted CR, which was less common in men (33.9%) than in women (49.7%) p = 0.0471. Conclusions: Orbital radiation for GO is an established treatment modality for patients. Orbital reirradiation is beneficial for patients who do not respond to initial RT or experience symptom recurrence without an

  5. Thyroid stimulating antibody: an index of thyroid stimulation in Graves' disease?

    PubMed

    Baldet, L; Madec, A M; Papachristou, C; Stefanutti, A; Orgiazzi, J; Jaffiol, C

    1987-09-01

    Early (20 min) thyroid radio-iodine uptake (ERU) and thyroid-stimulating antibodies (TSab) were determined in 27 untreated unselected patients with Graves' disease at the time of diagnosis. In 21 subjects the same tests were further performed in parallel during combined carbimazole-L-T3 therapy (mean duration of follow-up: 10.8 +/- 5.8 months; mean +/- SD). TSab was determined by a cAMP-human thyrocyte culture stimulation assay and expressed in microliter-equivalent of a TSab standard/ml (microliter-eq/ml). Before treatment, ERU, ranging from 15 to 54% of the injected dose (normal less than or equal to 8% dose) correlated with serum T3 (r: 0.54; P less than 0.01); TSab, ranging from 6 to 85 microliter-eq/ml was detected in 21/27 patients. There was a significant correlation between ERU and TSab (Spearman rank test: r: 0.57; P less than 0.01). During the first months of treatment, 5 of the 21 patients sequentially studied had undetectable TSab levels throughout the study and in these patients ERU decreased by 57% of its initial value; the remaining 16 subjects were divided into two groups according to ERU changes: in group A (9 patients), initial ERU decreased by 50% or more or the absolute value became less than 20% of the dose and TSab decreased from 10.9 +/- 4.8 microliter-eq/ml to 5.3 +/- 1.6 microliter-eq/ml (P less than 0.01); in group B (7 patients), the fall of ERU was less than 50% or the absolute value remained greater than 20% of the dose and TSab values remained unchanged.(ABSTRACT TRUNCATED AT 250 WORDS)

  6. Impaired immune regulation after radioiodine therapy for Graves' disease and the protective effect of Methimazole.

    PubMed

    Côté-Bigras, Sarah; Tran, Viet; Turcotte, Sylvie; Rola-Pleszczynski, Marek; Verreault, Jean; Rottembourg, Diane

    2016-06-01

    Both therapies for Graves' disease (GD), radioactive iodine (RAI) and antithyroid drugs (ATD), were reported to have specific immune effects. We aimed at investigating the effects of RAI therapy on cellular subsets involved in immune regulation. We conducted a thirty day follow-up prospective cohort study of adult patients. Patients eligible for RAI therapy at our centre were approached. Twenty seven patients with GD were recruited, among whom 11 were treated with ATD. Twenty-two healthy subjects (HS) were also studied. Over time, frequency of regulatory T cells (Treg) and of invariant natural killer T cells (iNKT), along with Treg cell-mediated suppression and underlying mechanisms, were monitored in the peripheral blood. Variance in frequency of Treg and iNKT after RAI therapy was higher in GD patients than in HS over time (p < 0.0001). Reduced Treg suppressive function was observed after RAI therapy in GD patients (p = 0.002). ATD medication prior to RAI dampened these outcomes: less variation of Treg frequency (p = 0.0394), a trend toward less impaired Treg function, and prevention of reduced levels of suppressive cytokines (p < 0.05). Shortly after RAI therapy, alterations in immunoregulatory cells in patients with GD were observed and partially prevented by an ATD pretreatment. Worsening of autoimmunity after RAI was explained in previous studies by enhanced immune activity. This study adds new highlights on immune regulation deficiencies after therapeutic interventions in thyroid autoimmunity.

  7. Dissecting the Genetic Susceptibility to Graves' Disease in a Cohort of Patients of Italian Origin.

    PubMed

    Lombardi, Angela; Menconi, Francesca; Greenberg, David; Concepcion, Erlinda; Leo, Marenza; Rocchi, Roberto; Marinó, Michele; Keddache, Mehdi; Tomer, Yaron

    2016-01-01

    Graves' disease (GD) is an autoimmune oligogenic disorder with a strong hereditary component. Several GD susceptibility genes have been identified and confirmed during the last two decades. However, there are very few studies that evaluated susceptibility genes for GD in specific geographic subsets. Previously, we mapped a new locus on chromosome 3q that was unique to GD families of Italian origin. In the present study, we used association analysis of single-nucleotide polymorphism (SNPs) at the 3q locus in a cohort of GD patients of Italian origin in order to prioritize the best candidates among the known genes in this locus to choose the one(s) best supported by the association. DNA samples were genotyped using the Illumina GoldenGate genotyping assay analyzing 690 SNP in the linked 3q locus covering all 124 linkage disequilibrium blocks in this locus. Candidate non-HLA (human-leukocyte-antigen) genes previously reported to be associated with GD and/or other autoimmune disorders were analyzed separately. Three SNPs in the 3q locus showed a nominal association (p < 0.05): rs13097181, rs763313, and rs6792646. Albeit these could not be further validated by multiple comparison correction, we were prioritizing candidate genes at a locus already known to harbor a GD-related gene, not hypothesis testing. Moreover, we found significant associations with the thyroid-stimulating hormone receptor (TSHR) gene, the cytotoxic T-lymphocyte antigen-4 (CTLA-4) gene, and the thyroglobulin (TG) gene. In conclusion, we identified three SNPs on chromosome 3q that may map a new GD susceptibility gene in this region which is unique to the Italian population. Furthermore, we confirmed that the TSHR, the CTLA-4, and the TG genes are associated with GD in Italians. Our findings highlight the influence of ethnicity and geographic variations on the genetic susceptibility to GD.

  8. [Variability in the clinical presentation of Pompe disease: development following enzyme replacement therapy].

    PubMed

    Ley-Martos, Myriam; Salado-Reyes, María J; Espinosa-Rosso, Raúl; Solera-García, Jesús; Jiménez-Jiménez, Luis

    2015-11-01

    Introduccion. La enfermedad de Pompe es un trastorno generalizado progresivo producido por el deficit de la enzima alfa-glucosidasa acida (AGA) de los lisosomas. Se presentan tres casos manifestados de forma muy diferente y tratados con terapia enzimatica sustitutiva (TES), con evolucion favorable. Casos clinicos. Caso 1: varon de 3 meses, con debilidad y rechazo de la alimentacion, hepatomegalia leve, ligera macroglosia e hipotonia, y aumento de las enzimas musculares. Caso 2: varon de 5 meses, con retraso del desarrollo motor, sordera neurosensorial grave, trastornos respiratorios de repeticion de evolucion torpida, hipotonia y leve elevacion de la creatincinasa. Caso 3: varon de 22 años con disnea progresiva, con antecedentes de elevacion de la creatincinasa y las transaminasas, e hipercolesterolemia. Sufrio insuficiencia respiratoria grave que preciso intubacion endotraqueal. La biopsia muscular presento depositos de glucogeno sugestivos de la enfermedad. En los tres casos, el estudio electromiografico dio un patron caracteristico, con descargas pseudomiotonicas, y se confirmo el deficit de AGA en los linfocitos. Se encontro una mutacion en un caso y dos mutaciones en los otros dos. Todos recibieron TES con evolucion favorable: desaparicion de las alteraciones cardiacas en el caso 1, mejoria en los hitos motores en los dos casos infantiles y retirada del respirador en el caso 3. Conclusion. La enfermedad de Pompe tiene una amplia variabilidad en la expresion clinica. La TES consigue una buena respuesta, especialmente en las formas infantiles. La supervivencia a largo plazo de las formas infantiles tratadas permitira conocer mas aspectos del curso de la enfermedad.

  9. Immunohistochemical studies using immunized Guinea pig sera with features of anti-human thyroid, eye and skeletal antibody and Graves' sera.

    PubMed

    Molnár, Ildikó; Szombathy, Zita; Kovács, Ilona; Szentmiklósi, A József

    2007-03-01

    Type 2 5' deiodinase enzyme was observed in both thyroid and eye muscle tissues, highlighting its possible role as a common antigen in thyroid-associated ophthalmopathy. Sera of 105 Graves' patients and 40 controls, and immunized guinea pig sera against TCSS peptide, showing homology to the amino acid sequence from 132 to 152 of type 2 5' deiodinase, were investigated to demonstrate the binding effects to human thyroid, eye and skeletal muscle tissues. Twenty-two Graves' patients were positive for anti-TCSS peptide antibodies, of whom 18 cases had ophthalmopathy. The levels of anti-TCSS peptide antibodies were higher not only in Graves' patients with (P<0.0001) and without (P<0.036) eye symptoms compared to controls but also the difference was significant between patients with and without ophthalmopathy (P<0.049). In Western blot, immunized sera showed binding reactions to the supernatant fractions of human thyroid, eye and skeletal muscle tissues at the range of 29 kDa. Patient sera with Graves' ophthalmopathy resulted in positive reactions directed to membrane areas in thyroid follicular cells, and to fibers in eye and skeletal muscles using immunohistochemical method, while no positive staining was present after adding control sera. The binding features of immunized guinea pig sera exhibited similar staining in all human tissues but could be blocked with Graves' sera. Our results suggest that type 2 5' deiodinase enzyme protein could play a role as an antigen in Graves' disease. Immunized guinea pig sera against TCSS peptide exhibited similar binding reactions and stainings to human thyroid, eye and skeletal muscle tissues as patient sera with Graves' ophthalmopathy.

  10. Transient polyuria related to central diabetes insipidus caused by lymphocytic infundibulo-neurohypophysitis in a patient treated for Graves' disease.

    PubMed

    Yamazaki, Masanori; Sato, Ai; Nishio, Shin-ichi; Uehara, Takeshi; Komatsu, Mitsuhisa

    2010-01-01

    A 45-year-old man was hospitalized because of weight loss, finger tremor, thirst, polydipsia and increased urinary frequency. He was diagnosed with Graves' disease (GD) and central diabetes insipidus (CDI). Magnetic resonance imaging revealed the enlarged posterior pituitary with thickened stalk. Histological examination obtained from biopsy of the pituitary revealed lymphocytic infundibulo-neurohypophysitis. He received treatment with thiamazole (MMI) for GD and desmopressin acetate (DDAVP) for CDI. However, DDAVP administration could be discontinued as GD was gradually improved. This course indicates that not only the recovered renal response to arginine-vasopressin but also the immunomodulative effects of MMI might attribute to the improvement of polyuria.

  11. Origin of primary PGM assemblage in сhromitite from a mantle tectonite at Harold's Grave (Shetland Ophiolite Complex, Scotland)

    NASA Astrophysics Data System (ADS)

    Badanina, Inna Yu.; Malitch, Kreshimir N.; Lord, Richard A.; Meisel, Thomas C.

    2013-12-01

    In this paper we present textural and mineral chemistry data for a PGM inclusion assemblage and whole-rock platinum-group element (PGE) concentrations of chromitite from Harold's Grave, which occurrs in a dunite pod in a mantle tectonite at Unst in the Shetland Ophiolite Complex (SOC), Scotland. The study utilized a number of analytical techniques, including acid digestion and isotope dilution (ID) ICP-MS, hydroseparation and electron microprobe analysis. The chromitite contains a pronounced enrichment of refractory PGE (IPGE: Os, Ir and Ru) over less refractory PGE (PPGE: Rh, Pt and Pd), typical of mantle hosted `ophiolitic' chromitites. A `primary' magmatic PGM assemblage is represented by euhedrally shaped (up to 60 μm in size) single and composite inclusions in chromite. Polyphase PGM grains are dominated by laurite and osmian iridium, with subordinate laurite + osmian iridium + iridian osmium and rare laurite + Ir-Rh alloy + Rh-rich sulphide (possibly prassoite). The compositional variability of associated laurite and Os-rich alloys at Harold's Grave fit the predicted compositions of experiment W-1200-0.37 of Andrews and Brenan (Can Mineral 40: 1705-1716, 2002) providing unequivocal information on conditions of their genesis, with the upper thermal stability of laurite in equilibrium with Os-rich alloys estimated at 1200-1250 °C and f(S2) of 10-0.39-10-0.07.

  12. Isotopic composition and identification of the origins of individuals buried in a Neolithic collective grave at Bronocice (southern Poland).

    PubMed

    Szostek, K; Haduch, E; Stepańczak, B; Kruk, J; Szczepanek, A; Pawlyta, J; Głąb, H; Milisauskas, S

    2014-04-01

    The oxygen present in a human organism comes from numerous sources, but the major factor that causes variation in the isotopic composition of this element in a tissue is available drinking water. The isotopic ratio of oxygen in an organism's tissue, including that found in bones and teeth, reflects the isotopic oxygen composition typical for the area where a given individual developed and lived. Of particular interest with regard to this issue were a series of skeletons from the multiple grave discovered at the Funnel Beaker-Baden settlement at Bronocice (southern Poland). The question therefore arose whether the specimens buried in this grave were part of the local community. The oxygen isotope level was established using apatite isolated from bones or teeth. A femur and root dentine samples taken from permanent teeth were subjected to oxygen isotope analysis. The oxygen isotope level of the site was established on the basis of local water precipitation and measurements taken from the oxygen isotope concentration in apatite samples isolated from the bones of animals co-occurring with the studied human group. It has been found that the oxygen isotope levels in the bones and dentine of almost all the analysed specimens from the excavated site at Bronocice were within the established range for the area's environment, providing evidence for their local origin. Thus, it can be assumed that the analysed group inhabiting the macrosettlement at Bronocice during the Funnel Beaker phase of the Baden culture was most probably of local origin.

  13. Geophysical monitoring of simulated clandestine graves using electrical and ground-penetrating radar methods: 0-3 years after burial.

    PubMed

    Pringle, Jamie K; Jervis, John R; Hansen, James D; Jones, Glenda M; Cassidy, Nigel J; Cassella, John P

    2012-11-01

    This study provides forensic search teams with systematic geophysical monitoring data over simulated clandestine graves for comparison to active cases. Simulated "wrapped" and "naked" burials were created. Multigeophysical surveys were collected over a 3-year monitoring period. Bulk ground resistivity, electrical resistivity imaging, multifrequency ground-penetrating radar (GPR), and grave and background "soil-water" conductivity data were collected. Resistivity surveys revealed the naked burial had consistently low-resistivity anomalies, whereas the wrapped burial had small, varying high-resistivity anomalies. GPR 110- to 900-MHz frequency surveys showed the wrapped burial could be detected throughout, with the "naked" burial mostly resolved. Two hundred and twenty-five megahertz frequency GPR data were optimal. "Soil-water" analyses showed rapidly increasing (year 1), slowly increasing (year 2), and decreasing (year 3) conductivity values. Results suggest resistivity and GPR surveys should be collected if target "wrapping" is unknown, with winter to spring surveys optimal. Resistivity surveys should be collected in clay-rich soils.

  14. Noble gases and halogens in Graves Nunataks 06129: The complex thermal history of a felsic asteroid crust

    NASA Astrophysics Data System (ADS)

    Claydon, Jennifer L.; Crowther, Sarah A.; Fernandes, Vera A.; Gilmour, Jamie D.

    2015-06-01

    The meteorite Graves Nunataks 06128/06129 is a rare example of felsic asteroidal crust. Knowledge of its history can help shed light on the evolution processes of planetesimals. The noble gases can be used to constrain both the chronology of meteorites and the processes that result in movements of volatile elements on asteroidal bodies. We have examined the I-Xe and Ar-Ar systems of the plagioclase-rich achondrite, Graves Nunataks 06129 by high-resolution laser step-heating of irradiated samples. Iodine and 129Xe∗ are both present but are released at different temperatures and do not show a correlation, therefore the I-Xe system in GRA 06129 has no chronological significance. We propose that radiogenic 129Xe∗ was lost from primary phases and parentless 129Xe∗ was later introduced into the rock by interaction with a fluid sourced from a reservoir that evolved with a high I/Xe ratio. This could have been the same halogen-rich fluid that induced the conversion of merrillite and pyroxene into chlorapatite. Inherited 40Ar (i.e. not generated by in situ decay of 40K) is also present in one of three fragments studied here and may have been introduced at the same time as parentless 129Xe∗.

  15. Methimazole, but not betamethasone, prevents 131I treatment-induced rises in thyrotropin receptor autoantibodies in hyperthyroid Graves' disease

    SciTech Connect

    Gamstedt, A.; Wadman, B.; Karlsson, A.

    1986-04-01

    The effects of methimazole or betamethasone therapy on the TSH receptor antibody response to radioiodine therapy were compared in a prospective randomized study of 60 patients with hyperthyroidism due to Graves' disease. The patients were followed for 1 yr after treatment with 131I. Twenty-three patients received 131I alone, 17 were treated with methimazole for 2 months before and 3 months after 131I therapy, and 20 patients were treated with betamethasone for 3 weeks before and 4 weeks after 131I therapy. 131I induced a transient rise in the mean serum level of TSH receptor autoantibodies, measured as TSH binding inhibitory immunoglobulin (TBII), but in patients receiving methimazole treatment, no such rise occurred. In the betamethasone-treated patients, TBII increased similarly to that in patients treated with 131I alone. In addition, in patients given betamethasone, there was an early decrease in total serum immunoglobulin G, which persisted throughout the follow-up period. In the other 2 groups, no changes in total immunoglobulin G were found. The results demonstrate that in hyperthyroid Graves' disease, TBII production is influenced by therapy. Methimazole abolished the 131I-induced increase in TBII, whereas betamethasone did not have such an inhibitory effect.

  16. The Sonographic Features of the Thyroid Gland After Treatment with Radioiodine Therapy in Patients with Graves' Disease.

    PubMed

    English, Collette; Casey, Ruth; Bell, Marcia; Bergin, Diane; Murphy, Joseph

    2016-01-01

    The aim of the study was to describe the typical sonographic features of the thyroid gland in patients with Graves' hyperthyroidism after radioiodine therapy (RIT). Thirty patients (21 female and 9 male) with a mean age of 53 y (standard deviation [SD] ± 11.3) and with previous Graves' disease who had been successfully treated with RIT were enrolled in the study. All were hypothyroid or euthyroid after treatment. The thyroid ultrasound was carried out by a single experienced operator with an 8-MHz linear transducer. Volume, vascularity, echogenicity and echotexture of the glands were noted. The presence of nodules and lymph nodes was also documented. The mean volumes of the right lobe were 2.4 mL ± 2.9 SD (0.6-14) and the left lobe were 1.8 mL ± 1.9 SD (0.4-9.1), with a mean total volume of 4.2 mL ± 4.7 SD (1.3-19.1). Of those who had a pre-treatment ultrasound (23%), the percentage reduction in volume was 87% (p < 0.05); 93% of the glands were hypovascular, with the remaining 7% showing normal vascularity. The glands were hyperechoic and of coarse echotexture. Overall, the sonographic features of the post-RIT gland included a significantly reduced mean total volume of 4.2 mL, hypovascularity, coarse echotexture and hyperechogenicity.

  17. Molecular cloning and characterization of genes for antibodies generated by orbital tissue-infiltrating B-cells in Graves` ophthalmopathy

    SciTech Connect

    Jaume, J.C.; Portolano, S.; Prummel, M.F.; McLachlan, S.M.; Rapoport, B.

    1994-02-01

    Graves` ophthalmopathy is a distressing autoimmune disease of unknown etiology. Analysis of the genes for antibodies secreted by orbital tissue-infiltrating plasma cells might provide insight into the pathogenesis of this disease. The authors, therefore, constructed an immunoglobulin heavy (H) chain and an immunoglobulin k light (L) chain cDNA library from the orbital tissue of a patient with active Graves` ophthalmopathy. Analysis of 15 H (IgG1) and 15 L (k) chains revealed a restricted spectrum of variable region genes. Fourteen of 15 variable k genes were about 94% homologous to the closest known germline gene, KL012. Thirteen of 15 H chain genes were 91% and 90% homologous to the closest germline genes, DP10 and hv1263, respectively. Remarkably, these germline genes also code for other autoantibodies to striated muscle (KL012) and thyroid peridase (KL012 and hv1263). These studies raise the possibility that particular germline genes may be associated with autoimmunity in humans. Further, the present study opens the way to identifying ocular autoantigens that may be the target of an humoral immune response. 29 refs., 4 figs., 1 tab.

  18. The Use of Complementary GPR Surveys with Different Grid Spacing to Locate Unmarked Graves in a 19th Century Cemetery in Selinsgrove PA

    NASA Astrophysics Data System (ADS)

    Lachhab, A.; Zawacki, A.

    2014-12-01

    Ground-penetrating radar (GPR) is a geophysical survey tool with many archaeological applications, including the search for graves. A 400 megahertz GPR was employed to locate unmarked graves and buried headstones in a neglected Pennsylvania cemetery dating from the 19th century. The site was initially scanned using a grid pattern with 50cm transect spacings. A smaller site within the cemetery was then selected and scanned at a higher 'resolution,' using smaller transect spacings, to determine whether this improved the accuracy of the findings. Supplementary perpendicular transects were also added. A number of potential sources of error were identified and their consequences were outlined. Short transects with small spacings were found to significantly improve the quality of the obtained data, as was the addition of perpendicular transects. The results are applicable to the search for graves and, more broadly, the use of GPR to identify and locate other subsurface features.

  19. Could the eucrite Graves Nunataks 98098 be Vesta's equivalent to Lunar KREEP?

    NASA Astrophysics Data System (ADS)

    Sarafian, A. R.; Marschall, H.; Nielsen, S.

    2013-12-01

    Basaltic eucrites, members of the HED achondrite clan, are thought to derive from the asteroid 4-Vesta [1]. Most eucrites show little compositional and petrographic variability, thus anomalous eucrite could provide key insights into differentiation processes that operated on Vesta. The eucrite Graves Nunataks (GRA) 98098 is an unbrecciated eucrite with cross cutting white tabular veins consisting of mainly equigranular tridymite and euhedral plagioclase with some pyroxene [2]. In addition, GRA has the second highest modal (volume) abundance of apatite in a eucrite studied thus far. The apatite is associated with the veins [2]. The GRA bulk rock composition is enriched in incompatible elements with concentrations ca. 3-5 times higher than in most basaltic eucrites [3]. Additionally, GRA has 10-20 times more Cl than any other analyzed eucritic apatite [2]. Here we measured the trace-element concentrations of plagioclase and pyroxene by laser ablation ICP-MS and the D/H ratio of the apatites by SIMS. In the domains of GRA cut by veins, the trace elements in plagioclase and pyroxene show an up to 15x enrichment in incompatible elements compared to other basaltic eucrites [4]. Here we report the first D/H measurement of any magmatic material from Vesta. The D/H of apatite in GRA is relatively light compared to vSMOW. Based on the high abundance of incompatible elements in GRA and the high Cl content found in apatites, Sarafian et al. [2] suggested that GRA could be akin to Lunar KREEP (lunar rocks enriched in K, REEs and P). With the additional evidence of enriched incompatible elements in plagioclase and pyroxene and the similarity in D/H compared to KREEP, it is likely that GRA was infiltrated by a late-stage melt enriched in incompatible elements, similar to Lunar KREEP. Further study is needed to determine if this late-stage melt formed in a similar manner as KREEP. 1. Consolmango, G.J. and M.J. Drake, Composition and evolution of the eucrite parent body: Evidence

  20. Increased microRNA-155 and decreased microRNA-146a may promote ocular inflammation and proliferation in Graves' ophthalmopathy.

    PubMed

    Li, Kaijun; Du, Yi; Jiang, Ben-Li; He, Jian-Feng

    2014-04-18

    Graves' ophthalmopathy is an inflammatory autoimmune disease of the orbit, characterized by inflammation and proliferation of the orbital tissue caused by CD4+T cells and orbital fibroblasts. Despite recent substantial findings regarding its cellular and molecular foundations, the pathogenesis of Graves' ophthalmopathy remains unclear. Accumulating data suggest that microRNAs play important roles in the pathophysiology of autoimmunity and proliferation. Specifically, microRNA-155 (miR-155) can promote autoimmune inflammation by enhancing inflammatory T cell development. In contrast to miR-155, microRNA-146a (miR-146a) can inhibit the immune response by suppressing T cell activation. Furthermore, miR-155 and miR-146a are involved in cell proliferation, differentiation, and many other life processes. Thus, miR-155 and miR-146a, with opposite impacts on inflammatory responses carried out by T lymphocytes, appear to have multiple targets in the pathogenesis of Graves' ophthalmopathy. Our previous work showed that the expression of miR-146a was significantly decreased in peripheral blood mononuclear cells from Graves' ophthalmopathy patients compared with normal subjects. Accordingly, we proposed that the expression of miR-155 increased and the expression of miR-146a decreased in the target cells (CD4+T cells and orbital fibroblasts), thus promoting ocular inflammation and proliferation in Graves' ophthalmopathy. The proposed hypothesis warrants further investigation of the function of the differentially expressed microRNAs, which may shed new light on the pathogenesis of Graves' ophthalmopathy and lead to new strategies for its management.

  1. [Epidemiological, clinical, therapeutic and evolutive aspects of Basedow-Graves disease in the Depatment of Internal Medicine at CHU Aristide Le Dantec, Dakar (Senegal)].

    PubMed

    Diagne, Nafissatou; Faye, Atoumane; Ndao, Awa Cheikh; Djiba, Boundia; Kane, Baidy Sy; Ndongo, Souhaibou; Pouye, Abdoulaye

    2016-01-01

    Basedow-Graves disease is an autoimmune affection characterized by the association of thyrotoxicosis with variable frequency events such as goiter, ophthalmopathy and pretibial myxedema. Its diagnosis is often easy, while its management remains difficult. A simple medical treatment exposes patient to recurrence risk. In Senegal and Sub-Saharan Africa few studies have focused on Basedow-Graves disease. This study aims to describe the epidemiological, clinical, therapeutic and evolutionary aspects of Basedow-Graves disease at a Hospital in Dakar. This was a retrospective study conducted from 1 January 2010 to 31 December 2013 in the Department of Internal Medicine at the Aristide Le Dantec University Hospital. During this period, 108 patients receiving outpatient treatment for Basedow-Graves disease were included out of a total of 834 patients receiving outpatient treatment. The diagnosis was made on the basis of clinical, biological and immunological signs. One hundred and eight patients suffering from Basedow-Graves disease were included out of a total of 834 consultations. Sex ratio was 7.3 and the average age was 34.6 years. The main reasons for consultation were: palpitations and weight loss in 46.3% and 39.8% of cases respectively. Thyrotoxicosis syndrome was found in 93.5% of patients, goiter was found in 87% of patients and exophthalmos in 78.7% of patients. The main complication was cardiothyreosis found in 11.1% of patients. All patients underwent antithyroid synthetic drugs treatment. The evolution was favorable in 19,4% of cases. Disease recurrence was observed in 57% of cases and in 23.1% of patients were lost to follow-up. Basedow-Graves disease is the most common cause of hyperthyroidism, The patient's clinical picture is dominated by manifestations related to hypermetabolism. This study highlights that thyroidectomy isn't the first-line of treatment if we consider the high number of recurrences after medical treatment.

  2. Presence of Epstein-Barr virus-infected B lymphocytes with thyrotropin receptor antibodies on their surface in Graves' disease patients and in healthy individuals.

    PubMed

    Nagata, Keiko; Higaki, Katsumi; Nakayama, Yuji; Miyauchi, Hiromi; Kiritani, Yui; Kanai, Kyosuke; Matsushita, Michiko; Iwasaki, Takeshi; Sugihara, Hirotsugu; Kuwamoto, Satoshi; Kato, Masako; Murakami, Ichiro; Nanba, Eiji; Kimura, Hiroshi; Hayashi, Kazuhiko

    2014-05-01

    Graves' disease is an autoimmune hyperthyroidism caused by thyrotropin receptor antibodies (TRAbs). Because Epstein-Barr virus (EBV) persists in B cells and is occasionally reactivated, we hypothesized that EBV contributes to TRAbs production in Graves' disease patients by stimulating the TRAbs-producing B cells. In order for EBV to stimulate antibody-producing cells, EBV must be present in those cells but that have not yet been observed. We examined whether EBV-infected (EBV(+)) B cells with TRAbs on their surface (TRAbs(+)) as membrane immunoglobulin were present in peripheral blood of Graves' disease patients. We analyzed cultured or non-cultured peripheral blood mononuclear cells (PBMCs) from 13 patients and 11 healthy controls by flow-cytometry and confocal laser microscopy, and confirmed all cultured PBMCs from 8 patients really had TRAbs(+) EBV(+) double positive cells. We unexpectedly detected TRAbs(+) cells in all healthy controls, and TRAbs(+) EBV(+) double positive cells in all cultured PBMC from eight healthy controls. The frequency of TRAbs(+) cells in cultured PBMCs was significantly higher in patients than in controls (p = 0.021). In this study, we indicated the presence of EBV-infected B lymphocytes with TRAbs on their surface, a possible player of the production of excessive TRAbs, the causative autoantibody for Graves' disease. This is a basic evidence for our hypothesis that EBV contributes to TRAbs production in Graves' disease patients. Our results further suggest that healthy controls have the potential for TRAbs production. This gives us an important insight into the pathogenesis of Graves' disease.

  3. Performance of Irikura Recipe Rupture Model Generator in Earthquake Ground Motion Simulations with Graves and Pitarka Hybrid Approach

    NASA Astrophysics Data System (ADS)

    Pitarka, Arben; Graves, Robert; Irikura, Kojiro; Miyake, Hiroe; Rodgers, Arthur

    2017-02-01

    We analyzed the performance of the Irikura and Miyake (Pure and Applied Geophysics 168(2011):85-104, 2011) (IM2011) asperity-based kinematic rupture model generator, as implemented in the hybrid broadband ground motion simulation methodology of Graves and Pitarka (Bulletin of the Seismological Society of America 100(5A):2095-2123, 2010), for simulating ground motion from crustal earthquakes of intermediate size. The primary objective of our study is to investigate the transportability of IM2011 into the framework used by the Southern California Earthquake Center broadband simulation platform. In our analysis, we performed broadband (0-20 Hz) ground motion simulations for a suite of M6.7 crustal scenario earthquakes in a hard rock seismic velocity structure using rupture models produced with both IM2011 and the rupture generation method of Graves and Pitarka (Bulletin of the Seismological Society of America, 2016) (GP2016). The level of simulated ground motions for the two approaches compare favorably with median estimates obtained from the 2014 Next Generation Attenuation-West2 Project (NGA-West2) ground motion prediction equations (GMPEs) over the frequency band 0.1-10 Hz and for distances out to 22 km from the fault. We also found that, compared to GP2016, IM2011 generates ground motion with larger variability, particularly at near-fault distances (<12 km) and at long periods (>1 s). For this specific scenario, the largest systematic difference in ground motion level for the two approaches occurs in the period band 1-3 s where the IM2011 motions are about 20-30% lower than those for GP2016. We found that increasing the rupture speed by 20% on the asperities in IM2011 produced ground motions in the 1-3 s bandwidth that are in much closer agreement with the GMPE medians and similar to those obtained with GP2016. The potential implications of this modification for other rupture mechanisms and magnitudes are not yet fully understood, and this topic is the subject of

  4. Decreased Frequencies of Peripheral Blood CD4+CD25+CD127-Foxp3+ in Patients with Graves' Disease and Graves' Orbitopathy: Enhancing Effect of Insulin Growth Factor-1 on Treg Cells.

    PubMed

    Pawlowski, Przemyslaw; Grubczak, Kamil; Kostecki, Jerzy; Ilendo-Poskrobko, Elzbieta; Moniuszko, Marcin; Pawlowska, Malgorzata; Rejdak, Robert; Reszec, Joanna; Mysliwiec, Janusz

    2017-02-21

    Graves' orbitopathy (GO) is characterized by orbital T cell infiltration. We evaluated the regulatory T (Treg) cell fractions induced with IGF-1 in Graves' disease (GD) with and without GO. Peripheral blood mononuclear cells (PBMCs) were obtained from 13 patients with GD without eye manifestations; 10 patients with active GO; and 12 patients with nodular goiter (NG). All the patients from GD, GO, and NG were subclinical hyperthyroid. We analyzed the expression of Treg cell markers (CD4, CD25, CD127(-), Foxp3) on T cells and their ability to respond to IGF-1 stimulation. In patients with GD without GO, we found lowered percentages of CD4(+) Foxp3(+) cells, as compared to nodular goiter 1.77 vs. 5.42% (p=0.0276). Similarly, significantly reduced frequencies of CD4(+)CD25(+)CD127(-)Foxp3(+) and CD4(+)CD25(+)CD127(-) cells were observed in GD patients as compared to nodular goiter patients with hyperthyreosis, (0.7 vs. 1.48%) (p=0.0071) and (14.5 vs. 37.2%) (p=0.0051), respectively. In GO with active GO, only the percentage of CD4(+)CD25(+)CD127(-) cells was found to be decreased versus nodular goiter (9.35 vs. 37.2) (p=0.0275). Stimulation of PBMC derived from GO patients with IGF-1 resulted in significant increase of frequency of both CD4(+) Foxp3(+) and CD4(+)CD25(+)CD127(-) Foxp3 cells. Decreased frequencies of peripheral blood CD4(+)CD25(+)CD127(-)Foxp3(+) in patients with GD and GO could be an useful marker of autoimmune process and perhaps a possible target for future therapies. This is the first study demonstrating Treg-enhancing effects of IGF-1. Thus IGF-1 can be accounted for modulating Treg cell-related action in GO.

  5. Discovery of a mass grave from the Spanish Civil War using Ground Penetrating Radar and forensic archaeology.

    PubMed

    Fernández-Álvarez, José-Paulino; Rubio-Melendi, David; Martínez-Velasco, Antxoka; Pringle, Jamie K; Aguilera, Hector-David

    2016-10-01

    An estimated 500,000 people died from all causes during the Spanish Civil War between 1936 and 1939, with a further 135,000 killed after the war ended. There are currently over 2000 known mass burial locations throughout Spain but many more are unknown. This study details the successful search for an unmarked mass grave in mountainous terrain in the Asturias region of Northern Spain. Two approximate locations were known due to eyewitness accounts. A phased site investigation approach was undertaken, which included Ground Penetrating Radar. Results showed a clear geophysical anomaly on 2D GPR profiles. The identified area was subsequently intrusively investigated by forensic archaeologists and human remains were successfully discovered. Careful and sensitive investigations are essential in these approaches where living relatives are involved.

  6. Mössbauer study of the warrior figures of pottery in the grave site of the first Chinese emperor (221 B.C.)

    NASA Astrophysics Data System (ADS)

    Zhongtian, Sun; Xianjia, Pan; Guangyong, Qin; Guoqiao, Jin; Zhongyi, Yuan

    1988-12-01

    Mossbauer spectroscopy measurements at both room and liquid nitrogen temperature of potsherd samples of terracotta figures of warriors and horses excavated from within the pit at the grave site of the First Emperor (221 B.C.), lead us to conclude that the No. 4 potsherd sample was fired at a temperature of 980±50°C in a reducing atmosphere.

  7. Dual onset of type 1 diabetes mellitus and Graves' disease during treatment with pegylated interferon alpha-2b and ribavirin for chronic hepatitis C.

    PubMed

    Hayashi, Masayuki; Kataoka, Yuko; Tachikawa, Kazushige; Koguchi, Hiroki; Tanaka, Hiroshi

    2009-11-01

    Currently, a combination therapy of pegylated (PEG) interferon (IFN) alpha-2b and ribavirin are being widely used for the treatment of chronic hepatitis C (CHC). We describe here a case of dual onset of type 1 DM accompanied by ketoacidosis, and Graves' disease during the combination therapy via the autoimmune process.

  8. Association of BTG2, CYR61, ZFP36, and SCD Gene Polymorphisms with Graves' Disease and Ophthalmopathy

    PubMed Central

    Shahida, Bushra; Sjögren, Marketa; Groop, Leif; Hallengren, Bengt; Lantz, Mikael

    2014-01-01

    Background: Environmental and genetic factors predispose an individual to the development of Graves' disease (GD). In an expression study of intraorbital tissue, adipocyte-related immediate early genes (IEGs) and immunomodulatory genes were found to be overexpressed in patients with Graves' ophthalmopathy (GO). We hypothesized that genetic variations in these genes could be associated with GD and/or GO. Methods: A total of 98 single nucleotide polymorphisms (SNPs) in 12 genes were genotyped in 594 GD patients with (n=267) or without (n=327) GO and 1147 sex- and ethnicity-matched controls from Malmö, Sweden. Results: Ten SNPs in four genes (BTG family, member 2 [BTG2], cysteine-rich, angiogenic inducer 61 [CYR61], zinc finger protein 36, C3H type, homolog mouse [ZFP36], and stearoyl-coenzyme A desaturase [SCD]) showed an association with GD and/or GO. SNPs rs12136280 (odds ratio [OR] 1.29, p=0.002), rs6663606 (OR 1.26, p=0.004), and rs17534202 (OR 1.21, p=0.02) in BTG2 and rs3753793 (OR 1.21, p=0.03) in CYR61 were associated with GD. An association with GO was shown for SNPs rs3753793 (OR 1.45, p=0.008), rs6682848 (OR 1.55, p=0.03), rs12756618 (OR 1.77, p=0.049), and rs1378228 (OR 1.29, p=0.049) in CYR61, rs1057745 (OR 1.56, p=0.03) and rs11083522 (OR 1.32, p=0.04) in ZFP36, and rs1393491 (OR 1.38, p=0,048) in SCD. Smoking and CYR61 rs12756618 interacted to increase the risk of GO. Conclusions: We found associations of SNPs in IEGs and SCD with GD and/or GO; however, confirmation in a different population is required. PMID:24780075

  9. Evaluation of quality of life in patients with Graves´ ophthalmopathy, before and after orbital decompression.

    PubMed

    Iacobæus, Lykke; Sahlin, Sven

    2016-06-01

    Graves' ophthalmopathy (GO) is a potentially sight threatening orbital disease that can have a large negative impact on the quality of life of the patient. Studies on long-term effects of GO on the quality of life are few. The aim of this study is to evaluate the health-related quality of life in patients with GO, before and after orbital decompression surgery. This is a prospective, longitudinal, interventional study in which patients who had orbital decompression were given the Graves´ ophthalmopathy quality of life questionnaire (GO-QOL) before and after surgery. The GO-QOL is a disease specific instrument to measure health-related quality of life. The answers are transformed into scores from 0-100 on 2 subscales. Higher score indicates better health. An additional patient satisfaction questionnaire was also given post-surgery. A significant, long-term, improvement in quality of life after orbital decompression was noted (p < 0.001, paired t-test). 50 patients were included and follow-up time was 5.3 ± 1.2 years (mean ± SD). The QOL-scores increased 28 ± 35 and 26 ± 31 points, respectively, on the two subscales, "visual functioning" and "appearance" (mean ± SD). The patient satisfaction questionnaire showed that 88% of the patients would recommend orbital decompression to a fellow patient. Persistent disturbing oscillopsia was seen in 2% and persistent disturbing infraorbital nerve hypoesthesia in 8% of the patients. Orbital decompression surgery has a positive effect on quality of life for patients with severe GO. The GO-QOL questionnaire showed significant improvement in QOL-scores even many years after surgery.

  10. The incidence of ophthalmopathy after radioiodine therapy for Graves` disease: Prognostic factors and the role of methimazole

    SciTech Connect

    Kung, A.W.C.; Cheng, A.

    1994-08-01

    Radioactive iodine-131 (RAI) has been reported to be associated with a high incidence of development or exacerbation of Graves` ophthalmopathy (GO). This is thought to be associated with a surge of autoantibodies after RAI therapy. The role of methimazole (MMI), which possesses immunomodulatory action, in the prevention of GO was explored by studying 114 patients with Graves` disease. They were assigned randomly to receive either RAI alone or adjunctive antithyroid drugs, which consisted of MMI and L-T{sub 4} as a block-replacement therapy for 12 months and were followed for 2 yr. Thirty-five patients (30.7%) had GO at presentation. Twenty-one (18%) patients developed new GO, and six had worsening of preexisting GO. The development of hypothyroidism (P < 0.01) and an elevation of TSH (P < 0.05) were associated with increased risk of development or exacerbation of GO. The chance of development or exacerbation of GO is higher in those with no ophthalmopathy than in those with preexisting GO at presentation (P = 0.002). The incidence of development or exacerbation of GO was similar in the two treatment groups (RAI, 22.8%; adjunctive antithyroid drugs, 23.7%; P = NS). MMI was able to suppress the surge of TSH receptor antibody (TRAB) after RAI, but a surge in TRAB was not of prognostic significance for the development of GO after RAI. Patients who developed or had exacerbation of GO actually had lower TRAB at presentation (P = 0.02). The authors conclude that hypothyroidism with elevated TSH is an important adverse factor for the development or exacerbation of GO, and MMI was unable to prevent the development or exacerbation of GO after RAI. 35 refs., 4 tabs.

  11. Pretreatment with betamethasone of patients with Graves' disease given radioiodine therapy: thyroid autoantibody responses and outcome of therapy

    SciTech Connect

    Gamstedt, A.; Karlsson, A. )

    1991-07-01

    The effects of betamethasone on thyroid autoantibody responses and outcome of radioiodine therapy were determined over a period of 1 yr in a prospective randomized study of 40 patients with Graves' disease. Twenty patients were given placebo tablets, and 20 patients were treated with betamethasone from 3 weeks before until 4 weeks after {sup 131}I therapy. At the time of inclusion in the study, the mean serum concentrations of TSH receptor antibodies, thyroid peroxidase antibodies, and thyroglobulin antibodies (TgAb) were increased in both groups. Three weeks of treatment with betamethasone reduced the thyroid peroxidase antibody and TgAb titers as well as the serum concentrations of thyroid hormones. A decrease in the TSH receptor antibody level was not statistically significant. After radioiodine therapy, transient increases in thyroid autoantibody levels were observed. The titers of the different antibodies generally changed in parallel. In some patients a detectable level of a given antibody was found only after the radioiodine treatment, and in two cases, TgAb did not appear at all, although the two other antibodies increased temporarily. Betamethasone delayed, but did not abolish, the {sup 131}I-induced antibody peaks. Betamethasone also caused a reduction in the total serum immunoglobulin G, a reduction which persisted throughout the study period. When the study ended, 17 patients given placebo and 9 patients given betamethasone were receiving replacement therapy due to the development of hypothyroidism. These patients at this point in time had lower antibody levels than those not requiring T4. The results of this study demonstrate that betamethasone reduces and modifies the thyroid autoantibody responses as well as the outcome of radioiodine therapy in patients with Graves' disease.

  12. Thyrotropin receptor antibodies and Graves' disease, a side-effect of 131I treatment in patients with nontoxic goiter.

    PubMed

    Nygaard, B; Knudsen, J H; Hegedüs, L; Scient, A V; Hansen, J E

    1997-09-01

    The use of 131I treatment in patients with benign nontoxic goiter is increasing, and the described side-effects are few. In this paper we describe appearance of TSH receptor antibodies (TRAb) and concomitant development of hyperthyroidism as a side-effect of 131I treatment in patients with nontoxic goiter. In this retrospective study, 191 consecutive patients with 131I-treated nontoxic goiter are described. Nine patients (5%) developed hyperthyroidism 3 months after 131I treatment, and 5 patients (3%) developed radiation thyroiditis within the first month. Frozen sera were analyzed for thyroid peroxidase antibodies (anti-TPO) in 130 patients before 131I treatment. In 21% of these, serum levels of anti-TPO were over 200 U/mL. The complication frequency of Graves'-like hyperthyroidism and hypothyroidism was 51% in patients with elevated anti-TPO (n = 27) and 15% in patients with normal serum anti-TPO levels (P < 0.00005). TRAb, anti-TPO, and thyroglobulin were followed in patients developing hyperthyroidism or radiation thyroiditis and in 10 control patients remaining euthyroid. At the time of 131I treatment, all patients had serum TRAb values within the normal range. Three months after administration of 131I, the patients developing hyperthyroidism had a transient extensive rise in serum TRAb and anti-TPO levels parallel to a rise in the serum free T4 index. In patients developing radiation thyroiditis, serum TRAb values were normal. In control patients, serum TRAb and anti-TPO values were both within the normal range throughout the observation period. In conclusion, hyperthyroidism can be triggered by 131I in patients with nontoxic goiter, not only related to radiation thyroiditis but also as a Graves'-like hyperthyroidism induced by TRAb. Elevated anti-TPO pretreatment is a marker of an increased risk of side-effects to 131I treatment in nontoxic goiter.

  13. Comparison of Early Total Thyroidectomy with Antithyroid Treatment in Patients with Moderate-Severe Graves' Orbitopathy: A Randomized Prospective Trial

    PubMed Central

    Erdoğan, Murat Faik; Demir, Özgür; Ersoy, Reyhan Ünlü; Gül, Kamile; Aydoğan, Berna İmge; Üç, Ziynet Alphan; Mete, Türkan; Ertek, Sibel; Ünlütürk, Uğur; Çakır, Bekir; Aral, Yalçın; Güler, Serdar; Güllü, Sevim; Çorapçıoğlu, Demet; Dağdelen, Selçuk; Erdoğan, Gürbüz

    2016-01-01

    Background The optimal therapeutic choice for Graves' hyperthyroidism in the presence of moderate-severe Graves' orbitopathy (GO) remains controversial. Objectives We aimed to compare GO course in patients with moderate-severe GO treated with early total thyroidectomy (TTx) versus antithyroid drug (ATD) regimens, in a prospective, randomized manner. Methods Forty-two patients with moderate-severe GO were enrolled. A total of 4.5 g of pulse corticosteroids were given intravenously to all patients before randomization. Patients in the first group were given TTx, whereas patients in the second group were treated with ATDs. TSH was kept between 0.4 and 1 mIU/l. The clinical course of GO was evaluated with proptosis, lid aperture, clinical activity score (CAS), and diplopia. Results Eighteen and 24 patients were randomized to the TTx and ATD groups, respectively. Thyroid autoantibodies decreased significantly, and there were significant improvements in proptosis, lid aperture, and CAS in the TTx group. While in the ATD group the decrement in thyroid autoantibodies was not significant, there were significant improvements in proptosis and CAS. When the TTx group was compared with the ATD group, anti-TPO, anti-Tg, and TSH-receptor antibodies were significantly decreased in the TTx group (p < 0.01), but there was no significant difference with respect to proptosis, lid aperture, CAS, and diplopia between the two groups during a median (min.-max.) follow-up period of 60 months (36-72). Conclusion Although no definitive conclusions could be drawn from the study, mainly due to limited power, early TTx and the ATD treatment regimens, followed by intravenous pulse corticosteroid therapy, seemed to be equally effective on the course of GO in this relatively small group of patients with moderate-severe GO during a median (min.-max.) follow-up period of 60 months (36-72). PMID:27493884

  14. Accuracy and optimal timing of activity measurements in estimating the absorbed dose of radioiodine in the treatment of Graves' disease

    NASA Astrophysics Data System (ADS)

    Merrill, S.; Horowitz, J.; Traino, A. C.; Chipkin, S. R.; Hollot, C. V.; Chait, Y.

    2011-02-01

    Calculation of the therapeutic activity of radioiodine 131I for individualized dosimetry in the treatment of Graves' disease requires an accurate estimate of the thyroid absorbed radiation dose based on a tracer activity administration of 131I. Common approaches (Marinelli-Quimby formula, MIRD algorithm) use, respectively, the effective half-life of radioiodine in the thyroid and the time-integrated activity. Many physicians perform one, two, or at most three tracer dose activity measurements at various times and calculate the required therapeutic activity by ad hoc methods. In this paper, we study the accuracy of estimates of four 'target variables': time-integrated activity coefficient, time of maximum activity, maximum activity, and effective half-life in the gland. Clinical data from 41 patients who underwent 131I therapy for Graves' disease at the University Hospital in Pisa, Italy, are used for analysis. The radioiodine kinetics are described using a nonlinear mixed-effects model. The distributions of the target variables in the patient population are characterized. Using minimum root mean squared error as the criterion, optimal 1-, 2-, and 3-point sampling schedules are determined for estimation of the target variables, and probabilistic bounds are given for the errors under the optimal times. An algorithm is developed for computing the optimal 1-, 2-, and 3-point sampling schedules for the target variables. This algorithm is implemented in a freely available software tool. Taking into consideration 131I effective half-life in the thyroid and measurement noise, the optimal 1-point time for time-integrated activity coefficient is a measurement 1 week following the tracer dose. Additional measurements give only a slight improvement in accuracy.

  15. A genomic point mutation in the extracellular domain of the thyrotropin receptor in patients with Graves` ophthalmopathy

    SciTech Connect

    Bahn, R.S.; Dutton, C.M.; Heufelder, A.E.; Sarkar, G. |

    1994-02-01

    Orbital and pretibial fibroblasts are targets of autoimmune attack in Graves` ophthalmopathy (GO) and pretibial dermopathy (PTD). The fibroblast autoantigen involved in these peripheral manifestations of Graves` disease and the reason for the association of GO and PTD with hyperthyroidism are unknown. RNA encoding the full-length extracellular domain of the TSH receptor has been demonstrated in orbital and dermal fibroblasts from patients with GO and normal subjects, suggesting a possible antigenic link between fibroblasts and thyrocytes. RNA was isolated from cultured orbital, pretibial, and abdominal fibroblasts obtained from patients with severe GO (n = 22) and normal subjects (n = 5). RNA was reverse transcribed, and the resulting cDNA was amplified by the polymerase chain reaction, using primers spanning overlapping regions of the entire extracellular domain of the TSH receptor. Nucleotide sequence analysis showed an A for C substitution in the first position of codon 52 in 2 of the patients, both of whom had GO, PTD, and acropachy. Genomic DNA isolated from the 2 affected patients, and not from an additional 12 normal subjects, revealed the codon 52 mutation by direct sequencing and AciI restriction enzyme digestions. In conclusion, the authors have demonstrated the presence of a genomic point mutation, leading to a threonine for proline amino acid shift in the predicted peptide, in the extracellular domain of the TSH receptor in two patients with severe GO, PTD, acropachy, and high thyroid-stimulating immunoglobulin levels. RNA encoding this mutant product was demonstrated in the fibroblasts of these patients. They suggest that the TSH receptor may be an important fibroblast autoantigen in GO and PTD, and that this mutant form of the receptor may have unique immunogenic properties. 28 refs., 3 figs., 2 tabs.

  16. Cutoff value of thyroid uptake of (99m)Tc-pertechnetate to discriminate between Graves' disease and painless thyroiditis: a single center retrospective study.

    PubMed

    Uchida, Toyoyoshi; Suzuki, Ruriko; Kasai, Takatoshi; Onose, Hiroyuki; Komiya, Koji; Goto, Hiromasa; Takeno, Kageumi; Ishii, Shinya; Sato, Junko; Honda, Akira; Kawano, Yui; Himuro, Miwa; Yamada, Emiko; Yamada, Tetsu; Watada, Hirotaka

    2016-01-01

    Thyroid uptake of (99m)Tc-pertechnetate is a useful way to determine the cause of thyrotoxicosis. In daily clinical practice, (99m)Tc-pertechnetate uptake is used to discriminate between Graves' disease and painless thyroiditis when clinical information is not enough to make the distinction. However, since the optimal cutoff value of (99m)Tc-pertechnetate uptake has not yet been elucidated, our aim was to determine this value. We recruited patients with thyrotoxicosis in whom (99m)Tc-pertechnetate uptake was measured in clinical settings between 2009 and 2013. Three experienced endocrinologists (who were blinded to the value of (99m)Tc-pertechnetate uptake and initial treatment) diagnosed the cause of thyrotoxicosis based on thyrotropin, free triiodothyronine, free thyroxine, and thyrotropin receptor antibody levels, and by ultrasound findings and using images of thyroid uptake of (99m)Tc-pertechnetate without the actual values. Ninety-four patients diagnosed as having Graves' disease or painless thyroiditis were finally included. According to the diagnosis, the optimal cutoff value of (99m)Tc-pertechnetate uptake was determined by receiver operating characteristics analysis. A cutoff value of 1.0% provided optimal sensitivity and specificity of 96.6% and 97.1%, respectively. Then, its validity was confirmed in 78 patients with confirmed Graves' disease or painless thyroiditis diagnosed at another institute. Applying this cutoff value to the patients with thyrotoxicosis revealed positive and negative predictive values for Graves' disease of 100% and 88.9%, respectively. In conclusion, a cutoff value for (99m)Tc-pertechnetate uptake of 1.0% was useful to discriminate between Graves' disease and painless thyroiditis.

  17. Monoclonal antibodies to the thyrotropin receptor raised by an autoantiidiotypic protocol and their relationship to monoclonal autoantibodies from Graves' patients

    SciTech Connect

    Hill, B.L.; Erlanger, B.F.

    1988-06-01

    Monoclonal antibodies that bind to the TSH receptor were obtained by an autoantiidiotypic approach in which immunization of BALB/c mice was performed with mixtures of bovine (b) and human (h) TSH. Two of 28 positive wells were selected for cloning and characterization: D2 and 4G11. Their antiidiotypic character was evidenced by TSH-inhibitable binding to affinity-purified polyclonal anti-TSH. The specificity of D2 and 4G11 for the hormone-binding region of the TSH receptor was demonstrated by several findings: 1) they inhibited the binding of (125I)iodo-bTSH to receptor in a dose-dependent manner; 2) their binding to partially purified thyroid plasma membranes could be completely inhibited by bTSH and hTSH; and 3) they inhibited the TSH-dependent growth and adenylate cyclase stimulation in FRTL-5 cells in a dose-dependent manner. By Western blot analysis of bovine thyroid membranes, D2 bound to a polypeptide of 188,000-195,000 mol wt under nonreducing conditions and 54,000-59,000 mol wt after treatment of membranes with beta-mercaptoethanol; the 4G11 epitope was undetectable. Scatchard analysis of the binding of 125I-labeled antibodies to receptor showed that 4G11 bound to a single site with a Kd of 5.7 X 10(-9) M, whereas D2 showed complex binding characterized by high affinity (Kd = 1.74 X 10(-11) M) and low affinity (Kd = 1.3 X 10(-8) M) sites. Binding studies in which D2 and 4G11 competed with each other for the TSH receptor showed mutual but unequal inhibition. The data suggest that portions of the D2 and 4G11 epitopes overlap, but that there is a high affinity binding site(s) for D2 for which 4G11 competes less effectively. The binding of D2 and 4G11 to TSH receptor was inhibited by monoclonal antibodies secreted by Graves' heterohybridomas, showing that D2 and 4G11 share characteristics with autoantibodies of Graves' disease.

  18. Hashimoto's Thyroiditis and Graves' Disease in One Patient: The Extremes of Thyroid Dysfunction Associated with Interferon Treatment

    PubMed Central

    Chen, R. C. Y.

    2016-01-01

    Autoimmune thyroid disease associated with interferon therapy can manifest as destructive thyroiditis, Graves' Hyperthyroidism, and autoimmune (often subclinical) hypothyroidism, the latter persisting in many patients. There are scare reports of a single patient developing extremes of autoimmune thyroid disease activated by the immunomodulatory effects of interferon. A 60-year-old man received 48 weeks of pegylated interferon and ribavirin therapy for chronic HCV. Six months into treatment, he reported fatigue, weight gain, and slowed cognition. Serum thyroid stimulating hormone (TSH) was 58.8 mIU/L [0.27–4.2], fT4 11.1 pmol/L [12–25], and fT3 4.2 pmol/L [2.5–6.0] with elevated anti-TPO (983 IU/mL [<35]) and anti-TG (733 U/mL [<80]) antibodies. He commenced thyroxine with initial clinical and biochemical resolution but developed symptoms of hyperthyroidism with weight loss and tremor 14 months later. Serum TSH was <0.02 mIU/L, fT4 54.3 pmol/L, and fT3 20.2 pmol/L, with an elevated TSH receptor (TRAb, 4.0 U/L [<1.0]), anti-TPO (1,163 IU/mL) and anti-TG (114 U/mL) antibodies. Technetium scan confirmed Graves' Disease with bilateral diffuse increased tracer uptake (5.9% [0.5–3.5%]). The patient commenced carbimazole therapy for 6 months. Treatment was ceased following spontaneous clinical and biochemical remission (TSH 3.84 mIU/L, fT4 17pmol/L, fT3 4.5 pmol/L, and TRAb <1 U/L). This raises the need to monitor thyroid function closely in patients both during and following completion of interferon treatment. PMID:27042364

  19. AIRE genetic variants and predisposition to polygenic autoimmune disease: The case of Graves' disease and a systematic literature review.

    PubMed

    Colobran, Roger; Giménez-Barcons, Mireia; Marín-Sánchez, Ana; Porta-Pardo, Eduard; Pujol-Borrell, Ricardo

    2016-08-01

    Autoimmune Regulator (AIRE) is a transcriptional regulator that is crucial for establishing central tolerance as illustrated by the Mendelian Autoimmune Polyendocrinopathy-Candidiasis-Ectodermal Dystrophy (APECED) syndrome associated with AIRE-inactivating recessive or dominant mutations. Polymorphisms in AIRE have been proposed to be implicated in genetic susceptibility to non-Mendelian organ specific autoimmune diseases. Because there is evidence that in predisposition to Graves' disease (GD) central tolerance is crucial, we investigated whether AIRE polymorphisms could modulate risk of GD. A case-control association study using 29 variants and conducted in 150 GD patients and 200 controls did not detect any significant association. This result is not exceptional: a systematic review of the literature, including GWAS, on the association of AIRE variants with organ specific autoimmune diseases did not show clear associations; similarly heterozygous recessive mutations are not associated to non-Mendelian autoimmunity. Dominant negative mutations of AIRE are associated to autoimmunity but as mild forms of APECED rather than to non-Mendelian organ specific autoimmunity. The lack of association of common AIRE polymorphisms with polygenic autoimmune diseases is counterintuitive as many other genes less relevant for immunological tolerance have been found to be associated. These findings give rise to the intriguing possibility that evolution has excluded functionally modifying polymorphisms in AIRE.

  20. A grave matter--dental findings of people buried in the 19th and 20th centuries.

    PubMed

    van Wyk, C W; Theunissen, F; Phillips, V M

    1990-12-01

    The exhumed remains of 181 people, buried during the period 1848-1984 were examined. Because of the carelessness of exhumations, only 125 yielded sufficient information to compare the condition of skulls and jaws with the period in the grave, while 63 yielded information about the teeth. No correlation could be shown between the condition of the skulls and jaws and the period interred, but it was found that the better preserved remains belonged to younger people. Dental findings included the presence of healthy and decayed teeth, gold foil restorations, gold and porcelain inlays, amalgam and silicate fillings, and vulcanite and acrylic dentures. Amalgam restorations were present in people buried from 1875 (114 years ago) and vulcanite dentures from 1882 (107 years ago). The characteristics of the earliest amalgam restorations showed that they could have been placed before 1850. Findings of this study indicate that: (a) one cannot on the appearance of exhumed remains estimate the burial period, (b) dental features were well preserved and can be used for dental identification if antimortem data are available, (c) advanced dentistry could have been practised in South Africa during the last century, and (d) recovery of human skeletal remains from old cemeteries should be undertaken with care to preserve as much information as possible. A plea is made for closer co-operation between developers of old graveyard sites and scientists in order to preserve as much information as possible.

  1. Proposal of success criteria for strabismus surgery in patients with Graves' orbitopathy based on a systematic literature review.

    PubMed

    Jellema, Hinke Marijke; Braaksma-Besselink, Yvette; Limpens, Jacqueline; von Arx, Georg; Wiersinga, Wilmar M; Mourits, Maarten P

    2015-11-01

    Proposal of success criteria for strabismus surgery for patients with Graves' orbitopathy (GO) based on a systematic review of the literature. We performed a systematic search of OVID MEDLINE, OVID Embase, the Cochrane Central Register of Controlled Trials (CENTRAL) and the publisher subset of PubMed, to identify studies reporting on success criteria of strabismus surgery in GO. In addition, we handsearched several orthoptic journals and proceedings of strabismological congresses. Of the 789 articles retrieved, 42 articles described success criteria for strabismus surgery in GO. Most studies defined success in terms of a subjective diplopia-free field in primary and down gaze. Almost half of the studies used a graded scale (excellent, good, acceptable and failure) to describe the outcome of surgery. Three of the eligible studies described a tool to quantify the field of single vision in detail. Quality of life was not reported as an outcome measure in any of the published studies. In conclusion, success criteria for strabismus surgery in patients with GO are poorly defined and no consensus is available. The lack of standardization hampers comparative studies and thus the search for the best surgical treatment for diplopia in patients with GO. Therefore, we propose strict success criteria including a tool for quantification of remaining diplopia plus a disease-specific quality of life questionnaire (the GO-QoL).

  2. Results after En Bloc Lateral Wall Decompression Surgery with Orbital Fat Resection in 111 Patients with Graves' Orbitopathy

    PubMed Central

    Fichter, Nicole; Guthoff, Rudolf F.

    2015-01-01

    Purpose. To evaluate the effect of en bloc lateral wall decompression with additional orbital fat resection in terms of exophthalmos reduction and complications. Methods. A retrospective, noncomparative case series study from 1999 to 2011 (chart review) in Graves' orbitopathy (GO) patients. The standardized surgical technique involved removal of the lateral orbital wall including the orbital rim via a lid crease approach combined with additional orbital fat resection. Exophthalmos, diplopia, retrobulbar pressure sensation, and complications were analyzed pre- and postoperatively. Results. A total of 111 patients (164 orbits) with follow-up >3 months were analysed. Mean exophthalmos reduction was 3.05mm and preoperative orbital pressure sensation resolved or improved in all patients. Visual acuity improved significantly in patients undergoing surgery for rehabilitative or vision threatening purposes. Preoperative diplopia improved in 10 patients (9.0%) but worsened in 5 patients (4.5%), necessitating surgical correction in 3 patients. There were no significant complications; however, one patient had slight hollowing of the temporalis muscle around the scar that did not necessitate revision, and another patient with a circumscribed retraction of the scar itself underwent surgical correction. Conclusions. The study confirms the efficiency of en bloc lateral wall decompression in GO in a large series of patients, highlighting the low risk of disturbance of binocular functions and of cosmetic blemish in the temporal midface region. PMID:26221142

  3. Human breast milk excretion of iodine-131 following diagnostic and therapeutic administration to a lactating patient with Graves' disease

    SciTech Connect

    Dydek, G.J.; Blue, P.W.

    1988-03-01

    Previous reports on the excretion of /sup 131/I into human breast milk have recommended discontinuance of breast feeding from 1 to 12 days following diagnostic tracer doses of /sup 131/I. Recent excretion models have calculated that breast feeding could safely resume 56 days following a 5 microCi (0.185 MBq) /sup 131/I maternal tracer dose. We studied a postpartum patient with Graves' disease following first an uptake dose of 8.6 microCi (0.317 MBq) and then for 38 days following a 9.6 mCi (355 MBq) therapy dose of Na/sup 131/I. We calculated from our data that although nursing could not be safely resumed for 46 days following the 8.6-microCi uptake dose, nursing could resume in this patient 8 days after a 100-nCi (3.7 KBq) dose. Extrapolating this data to impure /sup 123/I (p, 2n or p, 5n) we feel that standard 100-microCi (3.7 MBq) doses of either /sup 123/I preparation is not suitable if nursing is to be resumed.

  4. Le rôle de l’omalizumab dans le traitement de l’asthme allergique grave

    PubMed Central

    Chapman, Kenneth R; Cartier, André; Hébert, Jacques; McIvor, R Andrew; Schellenberg, R Robert

    2006-01-01

    CONTEXTE : Un nouveau traitement anti-immunoglobuline E (anti-IgE) contre l’asthme, l’omalizumab, a été approuvé au Canada. OBJECTIF : Passer en revue les données fondamentales et cliniques sur l’omalizumab et examiner le rôle possible de ce médicament dans la prise en charge de l’asthme au Canada. MÉTHODOLOGIE : Une recherche documentaire a été effectuée dans MEDLINE afin de repérer les études menées de 1960 à 2006 sur l’omalizumab. La recherche a également porté sur les résumés de réunions scientifiques récentes dans le domaine des maladies respiratoires et des allergies; par ailleurs, toute donnée non publiée a été demandée au fabricant. Après avoir revu et résumé les données, un comité mixte constitué de spécialistes des maladies respiratoires et des allergies a rédigé un ensemble de recommandations relatives à l’utilisation de l’omalizumab. RÉSULTATS : L’omalizumab est un anticorps monoclonal humanisé qui se lie au domaine C epsilon 3 de la molécule d’IgE pour former des complexes immuns solubles qui sont éliminés par le système réticulo-endothélial. L’administration d’injections sous-cutanées espacées de deux ou de quatre semaines à la dose recommandée entraîne une diminution rapide des taux d’IgE circulantes libres. Lors de deux essais cliniques de phase III menés auprès de 1 405 adultes et adolescents atteints d’asthme modéré à grave qui recevaient des doses moyennes stables de corticostéroïdes en inhalation (CSI), l’omalizumab a diminué les taux d’exacerbation par rapport au placebo et a été associé à une amélioration des symptômes ainsi qu’à une épargne plus importante des corticostéroïdes. Dans un essai mené auprès de 419 patients atteints d’asthme grave non maîtrisé malgré l’utilisation de doses élevées de CSI et de la prise concomitante d’agonistes bêta-2 à action prolongée, les exacerbations graves étaient de 50 % moins fréquentes chez

  5. Long-term follow-up study of compensated low-dose /sup 131/I therapy for Graves' disease

    SciTech Connect

    Sridama, V.; McCormick, M.; Kaplan, E.L.; Fauchet, R.; DeGroot, L.J.

    1984-08-16

    We treated 187 patients who had Graves' disease with low-dose radioactive iodide (/sup 131/I), using a protocol that included a compensation for thyroid size. The incidence of early hypothyroidism (12 per cent) was acceptably low in the first year after /sup 131/I treatment, but we found a cumulative high incidence (up to 76 per cent) at the end of the 11th year. In contrast, the incidence of permanent hypothyroidism was relatively stable in 166 surgically treated patients, increasing from 19 to 27 per cent at the end of 11 years. Among 122 medically treated patients, only 40 per cent entered remission, and hypothyroidism developed in 2 per cent during the same period of follow-up. The long-term incidence of hypothyroidism in our patients treated with low-dose /sup 131/I therapy was much higher than that found in earlier studies using a comparable dose. Our study suggests that it will be difficult to modify therapy with /sup 131/I alone to produce both early control of thyrotoxicosis and a low incidence of hypothyroidism.

  6. Von Willebrand factor and coagulation factor VIII in Moyamoya disease associated with Graves' disease: A case report

    PubMed Central

    Ren, Shou-Chen; Gao, Bao-Qin; Yang, Wei-Li; Feng, Wei-Xin; Xu, Jian; Li, Shao-Wu; Wang, Yong-Jun

    2016-01-01

    The present study reported the case of a Chinese boy who was diagnosed with Moyamoya disease (MMD) associated with Graves' disease (GD). An overactivation of von Willebrand factor (vWF) and coagulation factor VIII (FVIII) was identified in the plasma of the patient. Thiamazole and metoprolol treatment was thus administrated. After 2 months of treatment, the patient's thyroid function returned to normal and the neurological symptoms improved gradually. At the same time, the activities of vWF and FVIII were depressed. During the 20-month follow-up, information regarding the neurological symptoms, cerebrovascular imaging, thyroid function, thyroid autoantibodies and coagulation parameters was collected. High levels of thyroid autoantibodies persisted throughout the follow-up period, while other coagulation parameters remained in the normal range. In conclusion, considering the vital role of vWF and FVIII in vascular diseases, it is hypothesized that these two factors may serve an important role in the occurrence of GD associated with MMD. PMID:27882137

  7. Bridge Technology with TSH Receptor Chimera for Sensitive Direct Detection of TSH Receptor Antibodies Causing Graves' Disease: Analytical and Clinical Evaluation.

    PubMed

    Frank, C U; Braeth, S; Dietrich, J W; Wanjura, D; Loos, U

    2015-11-01

    Graves' disease is caused by stimulating autoantibodies against the thyrotropin receptor inducing uncontrolled overproduction of thyroid hormones. A Bridge Assay is presented for direct detection of these thyroid-stimulating immunoglobulins using thyrotropin receptor chimeras. A capture receptor, formed by replacing aa residues 261-370 of the human thyrotropin receptor with residues 261-329 from rat lutropin/choriogonadotropin receptor and fixed to microtiter plates, binds one arm of the autoantibody. The second arm bridges to the signal receptor constructed from thyrotropin receptor (aa 21-261) and secretory alkaline phosphatase (aa 1-519) inducing chemiluminescence. The working range of the assay is from 0.3 IU/l to 50 IU/l with a cutoff of 0.54 IU/l and functional sensitivity of 0.3 IU/l. Sensitivity and specificity are 99.8 and 99.1%, respectively, with a diagnostic accuracy of 0.998. The low grey zone is from 0.3-0.54 IU/l. The stimulatory character of the assayed antibodies is shown through a good correlation (r=0.7079, p<10(-7)) to serum T4 levels of untreated patients. In Graves' disease, titers are increased in associated eye disease. In 3 hypothyroid patients with sera positive in the thyrotropin receptor competition assay and in the blocking bioassay, antibodies are not detected by the Bridge Assay, while the monoclonal blocking antibody K1-70 was detected. In Hashimoto disease thyrotropin receptor autoantibodies are detected in some patients, but not in goiter. This Bridge Assay delivers good diagnostic accuracy for identification of Graves' disease patients. Its high sensitivity may facilitate early detection of onset, remission, or recurrence of Graves' disease enabling timely adaption of the treatment.Human genes: TSHR, Homo sapiens, acc. no. M31774.1.

  8. Comparative analysis of plant finds from Early Roman graves in Ilok (Cuccium) and Sćitarjevo (Andautonia), Croatia--a contribution to understanding burial rites in southern Pannonia.

    PubMed

    Sostarić, Renata; Dizdar, Marko; Kusan, Dora; Hrsak, Vladimir; Mareković, Sara

    2006-06-01

    A comparative archaeobotanical analysis of the plant remains from the Early Roman incineration graves in Ilok and Sćitarjevo shows the existence of a complex burial ritual, but at the same time enables a better understanding of the agriculture and trade of the 1st/early 2nd century AD in southern Pannonia. Most of the cereals found (Hordeum vulgare, Panicum miliaceum, Triticum monococcum, T. dicoccon, T. aestivum i T. cf. spelta), the legumes (Lens culinaris, Vicia ervilia) and the fruit contributions (Cucumis melo/sativus, Malus/Pyrus sp., the Prunus avium group, P. domestica, Vitis vinifera) were probably grown in the vicinity of the investigated localities, but they might at the same time have been trade goods. Trade was undoubtedly well developed at that period, as shown by the remains of the fig (Ficus carica) and olive (Olea europaea), typically Mediterranean crops, in the finds. All the species of cereals, except millet (Panicum miliaceum) in Sćitarjevo, and of bitter vetch (Vicia ervilia) found in the Ilok grave were carbonised and were probably placed on the funeral pyre with the departed. The lentil (Lens culinaris) and the other fruit remains were non-carbonised and mineralised, which means that they were placed in the grave in fresh, dried or cooked form as food for the deceased (belief in an immortal soul), as remains of the funerary feast, or as a sacrifice to the goods.

  9. Digging up the recent Spanish memory: genetic identification of human remains from mass graves of the Spanish Civil War and posterior dictatorship.

    PubMed

    Baeta, Miriam; Núñez, Carolina; Cardoso, Sergio; Palencia-Madrid, Leire; Herrasti, Lourdes; Etxeberria, Francisco; de Pancorbo, Marian M

    2015-11-01

    The Spanish Civil War (1936-1939) and posterior dictatorship (until 1970s) stands as one of the major conflicts in the recent history of Spain. It led to nearly two hundred thousand men and women executed or murdered extra-judicially or after dubious legal procedures. Nowadays, most of them remain unidentified or even buried in irretraceable mass graves across Spain. Here, we present the genetic identification of human remains found in 26 mass graves located in Northern Spain. A total of 252 post-mortem remains were analyzed and compared to 186 relatives, allowing the identification of 87 victims. Overall, a significant success of DNA profiling was reached, since informative profiles (≥ 12 STRs and/or mitochondrial DNA profile) were obtained in 85.71% of the remains. This high performance in DNA profiling from challenging samples demonstrated the efficacy of DNA extraction and amplification methods used herein, given that only around 14.29% of the samples did not provide an informative genetic profile for the analysis performed, probably due to the presence of degraded and/or limited DNA in these remains. However, this study shows a partial identification success rate, which is clearly a consequence of the lack of both appropriate family members for genetic comparisons and accurate information about the victims' location. Hence, further perseverance in the exhumation of other intact graves as well as in the search of more alleged relatives is crucial in order to facilitate and increase the number of genetic identifications.

  10. Association between the CTLA-4 +49A/G polymorphism and Graves' disease: A meta-analysis.

    PubMed

    Si, Xiaoyu; Zhang, Xiufeng; Tang, Wenru; Luo, Ying

    2012-09-01

    The +49A/G polymorphism of the cytotoxic T-lymphocyte-associated antigen-4 gene (CTLA-4) has been associated with Graves' disease (GD). However, results have been inconsistent. The aim of this study was to quantitatively summarize the evidence for CTLA-4 +49A/G polymorphism and GD. Electronic search of PubMed was conducted to select studies. Case-control studies containing available genotype frequencies of CTLA-4 +49 were chosen, and Odds ratio (OR) with 95% confidence interval (CI) was used to assess the strength of this association. Forty-two case-control studies including 8,288 cases and 9,372 controls were identified. Three studies were eliminated from the total 42 studies due to a p-value <0.05 (p-value for Hardy-Weinberg equilibrium in control group) in these studies which induced significant publication bias. The overall results suggested that the variant genotypes were highly associated (p<0.01) with GD risk in all genetic models (additive model: OR, 1.443; 95% CI, 1.319-1.578; p<0.001; recessive model: OR, 1.589; 95% CI, 1.396-1.808; p<0.001; dominant model: OR, 1.621; 95% CI, 1.430-1.837; p<0.001). Similarly, in the subgroup analyses for ethnicity (Caucasian, Asian), the results were positive. This meta-analysis suggests that the CTLA-4 +49A/G polymorphism is highly associated (p<0.01) with increased risk of GD, especially in Caucasians and Asians. To validate this association, further studies with larger participants worldwide are needed to examine associations between this polymorphism and GD.

  11. Thyroid Stimulating Hormone Receptor (TSHR) Intron 1 Variants Are Major Risk Factors for Graves' Disease in Three European Caucasian Cohorts

    PubMed Central

    Jurecka-Lubieniecka, Beata; Franaszczyk, Maria; Kula, Dorota; Krajewski, Paweł; Karamat, Muhammad A.; Simmonds, Matthew J.; Franklyn, Jayne A.; Gough, Stephen C. L.; Jarząb, Barbara; Bednarczuk, Tomasz

    2010-01-01

    Background The thyroid stimulating hormone receptor (TSHR) gene is an established susceptibility locus for Graves' disease (GD), with recent studies refining association to two single nucleotide polymorphisms (SNPs), rs179247 and rs12101255, within TSHR intron 1. Methodology and Principal Findings We aimed to validate association of rs179247 and rs12101255 in Polish and UK Caucasian GD case-control subjects, determine the mode of inheritance and to see if association correlates with specific GD clinical manifestations. We investigated three case-control populations; 558 GD patients and 520 controls from Warsaw, Poland, 196 GD patients and 198 controls from Gliwice, Poland and 2504 GD patients from the UK National collection and 2784 controls from the 1958 British Birth cohort. Both rs179247 (P = 1.2×10−2–6.2×10−15, OR = 1.38–1.45) and rs12101255 (P = 1.0×10−4–3.68×10−21, OR = 1.47–1.87) exhibited strong association with GD in all three cohorts. Logistic regression suggested association of rs179247 is secondary to rs12101255 in all cohorts. Inheritance modeling suggested a co-dominant mode of inheritance in all cohorts. Genotype-phenotype correlations provided no clear evidence of association with any specific clinical characteristics. Conclusions We have validated association of TSHR intron 1 SNPs with GD in three independent European cohorts and have demonstrated that the aetiological variant within the TSHR is likely to be in strong linkage disequilibrium with rs12101255. Fine mapping is now required to determine the exact location of the aetiological DNA variants within the TSHR. PMID:21124799

  12. Differentiation between Graves' disease and painless thyroiditis by diffusion-weighted imaging, thyroid iodine uptake, thyroid scintigraphy and serum parameters.

    PubMed

    Meng, Zhaowei; Zhang, Guizhi; Sun, Haoran; Tan, Jian; Yu, Chunshun; Tian, Weijun; Li, Weidong; Yang, Zhiqiang; Zhu, Mei; He, Qing; Zhang, Yujie; Han, Shugao

    2015-06-01

    The aim of the present study was to assess the apparent diffusion coefficient (ADC) in diffusion-weighted imaging (DWI), thyroid radioactive iodine uptake (RAIU), thyroid scintigraphy and thyrotropin receptor antibody (TRAb) levels in the differential diagnosis between Graves' disease (GD) and painless thyroiditis (PT). A total of 102 patients with GD and 37 patients with PT were enrolled in the study. DWI was obtained with a 3.0-T magnetic resonance scanner, and ADC values were calculated. RAIU and thyroid scintigraphy were performed. Tissue samples were obtained from patients with GD (6 cases) following thyroidectomy, and from patients with PT (2 cases) following biopsy. Receiver operating characteristic (ROC) curves were drawn, optimal cut-off values were selected, and the sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were assessed. It was found that the ADC, TRAb and RAIU were significantly higher in GD than in PT (P<0.05). ROC curves showed areas under the curves for RAIU, ADC and TRAb that were >0.900. RAIU was the reference method. Sensitivity, specificity, accuracy, PPV and NPV were 96.078, 91.892, 95.000, 97.059 and 89.474% for ADC, and 88.235, 75.676, 84.892, 90.909 and 70.000% for TRAb, after the optimal thresholds of 1.837×10(-3) mm(2)/sec and 1.350 IU/ml were determined respectively. Histopathology showed that tissue cellularity in PT was much higher than in GD due to massive lymphocytic infiltration. The results of the present study indicate that RAIU, ADC and TRAb are of diagnostic value for differentiating between GD and PT. DWI has great potential for thyroid pathophysiological imaging because it reflects differences in tissue cellularity between GD and PT.

  13. Diagnosis and discrimination of autoimmune Graves' disease and Hashimoto's disease using thyroid-stimulating hormone receptor-containing recombinant proteoliposomes.

    PubMed

    Fukushima, Hidetaka; Matsuo, Hideaki; Imamura, Koji; Morino, Kazuhiko; Okumura, Katsuzumi; Tsumoto, Kanta; Yoshimura, Tetsuro

    2009-12-01

    Graves' disease (GD) is an autoimmune disease of the thyroid gland caused by autoantibodies against thyroid-stimulating hormone receptor (TSHR). Currently, the diagnostic test for TSHR autoantibodies is based on an indirect competitive binding assay that measures the ability of TSHR autoantibodies to inhibit the binding of thyroid-stimulating hormone (TSH) to TSHR. Here, we have developed a specific and direct diagnostic method for autoantibodies in GD that incorporates immobilized TSHR-containing recombinant proteoliposomes into an enzyme-linked immunosorbent assay (ELISA). To reduce non-specific binding of autoantibodies to recombinant proteoliposomes, we investigated the effect of polyethylene glycol (PEG)-lipid on the binding of commercially available anti-TSHR antibodies (aTSHRAb). The incorporation of PEG-lipids into liposomes decreased non-specific binding, as compared to liposomes that did not contain PEG-lipids, and the addition of blocking reagents further decreased non-specific reactivity. aTSHRAb exhibited higher reactivity towards PEG-modified TSHR recombinant proteoliposomes than PEG-modified liposomes without TSHR (bare liposomes). Importantly, serum autoantibodies from patients with GD, which is associated with hyperthyroidism, exhibited remarkably specific binding to TSHR recombinant proteoliposomes. Serum autoantibodies from patients with Hashimoto's disease (HD), which is associated with hypothyroidism, also reacted specifically with proteoliposomal TSHR. These results suggest that immobilized TSHR recombinant proteoliposomes can serve as a direct diagnostic test for GD and HD. Furthermore, given that there is no competition test currently available for detecting autoantibodies in HD, the combination of TSHR recombinant proteoliposome ELISA and indirect competitive TSHR binding assay might be an effective way to discriminate between GD and HD.

  14. The Effect of Early Thyroidectomy on the Course of Active Graves' Orbitopathy (GO): A Retrospective Case Study.

    PubMed

    Meyer Zu Horste, M; Pateronis, K; Walz, M K; Alesina, P; Mann, K; Schott, M; Esser, J; Eckstein, A K

    2016-07-01

    The aim of the work was to investigate the effect of early thyroidectomy on the course of active Graves' orbitopathy (GO) in patients with low probability of remission [high TSH receptor antibody (TRAb) serum levels, severe GO] compared to that of continued therapy with antithyroid drugs. Two cohorts were evaluated retrospectively (total n=92 patients with active GO, CAS≥4). Forty-six patients underwent early thyroidectomy (Tx-group) 6±2 months after initiation of antithyroid drug (ATD) therapy, while ATD was continued for another 6±2 months in the ATD-group (n=46). These controls were consecutively chosen from a database and matched to the Tx-group. GO was evaluated (activity, severity, TRAb) at baseline and at 6 month follow-up. At baseline, both cohorts were virtually identical as to disease severity, activity and duration, as well as prior anti-inflammatory treatment, age, gender, and smoking behavior. At 6 month follow-up, NOSPECS severity score was significantly decreased within each group, but did not differ between both groups. However, significantly more patients of the Tx-group presented with inactive GO (89.1 vs. 67.4%, * p=0.02), and mean CAS score was significantly lower in Tx-group (2.1) than in ADT-group (2.8; * p=0.02) at the end of follow-up. TRAb levels declined in both groups (Tx-group: from 18.6 to 5.2 vs. ATD-group: 12.8-3.2 IU/l, p0=0.07, p6months=0.32). Residual GO activity was lower in Tx-group, associated with a higher rate of inactivation of GO. This allows an earlier initiation of ophthalmosurgical rehabilitation in patients with severe GO, which may positively influence quality of life of the patients.

  15. The alterations of CD11A expression on peripheral blood lymphocytes/monocytes and CD62L expression on peripheral blood lymphocytes in Graves' disease and type 1 diabetes.

    PubMed

    Kretowski, A; Myśliwiec, J; Kinalska, I

    1999-01-01

    There is increasing evidence that the alterations of function and/or level of adhesion molecules play a key role in the pathogenesis of autoimmune diseases, such as Graves' disease or type 1 diabetes. The aim of the present study was to evaluate the expression of lymphocyte function-associated antigen 1 alpha (LFA-1 alpha, CD11a) and L-selectin (CD62L) molecules on peripheral mononuclear cells in Graves disease and type 1 diabetes in comparison to healthy controls, since they were shown to play an important role in lymphocytes and/or monocytes migration into the organs affected by immune process and are suggested to contribute to the pathogenesis of Graves disease and type 1 diabetes. The percentages of monocytes/lymphocytes expressing LFA-1 alpha antigen and lymphocytes expressing L-selectin antigen and the fluorescence intensity of the studied molecules were measured by flow cytometry. At the onset of both autoimmune diseases the percentage of highly CD11a positive lymphocytes and the mean fluorescence intensity were statistically higher than in the healthy controls and patients with Graves' disease after thyreostatic therapy. The fluorescence intensity of LFA-1 alpha on monocytes was also increased in type 1 diabetic patients, but not in Graves' disease. The analysis of CD62L antigen expression on peripheral blood lymphocytes revealed decreased percentages of L-selectin positive cells in patients with Graves' disease (before and after treatment) and insulin-dependent diabetes in comparison to the controls. Our study suggests that the alterations of the expression of CD11a and/or CD62L molecules on peripheral blood lymphocytes could be the markers of ongoing autoimmune process in Graves disease and type 1 diabetes.

  16. Clandestine grave detector

    DOEpatents

    Andrews, Jr., William H.; Thompson, Cyril V [Knoxville, TN; Vass, Arpad A [Oak Ridge, TN; Smith, Rob R [Knoxville, TN

    2011-12-13

    An apparatus and a method for detecting a burial site of human remains are disclosed. An air stream is drawn through an air intake conduit from locations near potential burial sites of human remains. The air stream is monitored by one or more chemical sensors to determine whether the air stream includes one or more indicator compounds selected from halogenated compounds, hydrocarbons, nitrogen-containing compounds, sulfur-containing compounds, acid/ester compounds, oxygen-containing compounds, and naphthalene-containing compounds. When it is determined that an indicator compound is present in the air stream, this indicates that a burial site of human remains is below or nearby. Each sensor may be in electrical communication with an indicator that signals when the sensor has detected the presence of the indicator compound in the air stream. In one form, the indicator compound is a halogenated compound and/or a hydrocarbon, and the presence of the halogenated compound and/or the hydrocarbon in the air stream indicates that a burial site of human remains is below or nearby.

  17. Grave Songs in Stone.

    ERIC Educational Resources Information Center

    Hunter, J. Mark

    A survey of images on gravestones yields a fascinating array of symbols and visual communication. This paper describes a project in which over 300 symbols in graveyards of the southeastern United States were examined. The method of recording the images and information about them was to photograph the symbol with a 35mm single lens reflex (SLR) and…

  18. Transport aérien longue distance des brûlés graves: revue de la littérature et application pratique

    PubMed Central

    Leclerc, T.; Hoffmann, C.; Forsans, E.; Cirodde, A.; Boutonnet, M.; Jault, P.; Tourtier, J.-P.; Bargues, L.; Donat, N.

    2015-01-01

    Summary Les brûlés graves nécessitent une prise en charge multidisciplinaire dans des centres hautement spécialisés. La rareté de ces centres impose souvent le transport aérien médicalisé longue distance. Cependant, il y a peu de données publiées sur ces transferts. Dans cette mise au point, pour optimiser la prise en charge des brûlés dès qu’un transport aérien est décidé ou même seulement envisagé, nous proposons d’extraire de cette littérature limitée des principes simples s’appuyant aussi sur l’expérience pratique du Service de Santé des Armées françaises. Nous décrivons d’abord comment les contraintes aéronautiques peuvent affecter le transport de brûlés graves à bord d’aéronefs. Nous abordons ensuite la régulation de ces missions, en analysant les risques associés au transport aérien des brûlés graves et leurs implications sur les indications, la chronologie et les modalités du transport. Enfin, nous développons la conduite de la mission, comprenant la préparation du matériel et des consommables avant le vol, l’évaluation et la mise en condition du patient avant l’embarquement, et la poursuite de la prise en charge en vol. PMID:26668564

  19. Use of Color Doppler Ultrasonography to Measure Thyroid Blood Flow and Differentiate Graves' Disease from Painless Thyroiditis

    PubMed Central

    Hiraiwa, Tetsuya; Tsujimoto, Naoyuki; Tanimoto, Keiji; Terasaki, Jungo; Amino, Nobuyuki; Hanafusa, Toshiaki

    2013-01-01

    Backgrounds Color Doppler ultrasonography (CDU) has not yet been established as a method to investigate the pathogenesis of thyrotoxicosis. Objectives Our first objective was to determine whether the measurement of peak systolic blood-flow velocity in the superior thyroid artery (STV) and thyroid tissue blood flow (TBF) using CDU could differentiate Graves' disease (GD) from painless thyroiditis (PT). The second objective was to examine the factors mediating increased blood flow to the thyroid gland in GD. Methods Recruited patients had untreated GD or PT and visited the Department of Internal Medicine (I), Osaka Medical College, between April 1, 2006 and May 31, 2010. Age, gender, blood pressure, pulse rate, thyroid-stimulating hormone, free thyroxine, tri-iodothyronine, TSH receptor antibody and thyroid volume were evaluated in patients. In addition, bilateral measurements of STV, TBF and peak systolic velocity in the common carotid artery (CCV) were also performed. TBF was quantified by calculating the ratio of blood-flow pixels to total pixels in the region of interest using sagittal section images of the thyroid gland. Receiver-operating characteristic curve analysis was performed to determine the ability of STV and TBF measurements to differentiate GD from PT. Results For the average of STV measured on both sides, the area under the receiver-operating characteristic curve (AUC) was 0.956. For the average of TBF measured on both sides, the AUC was 0.920. At an average STV cut-off value of 43 cm/s, the sensitivity to discriminate GD from PT was 0.87 and the specificity was 1.00. At an average TBF cut-off value of 3.8%, the sensitivity was 0.71 and the specificity was 1.00. In the GD group, neither blood pressure nor pulse rate correlated with the average STV or TBF. Moreover, there was no correlation between STV and CCV or between TBF and CCV on either side. However, STV was correlated with TBF (right side: R = 0.47; left side: R = 0.52). Conclusions The

  20. Coagulopathie aigue précoce des traumatismes crâniens graves: mortalité et facteurs pronostiques

    PubMed Central

    Hachimi, Abdelhamid; Elkhayari, Mina; Chaibi, Ibtissam; Razine, Rachid; Ziadi, Amra; Samkaoui, Mohamed Abdenasser

    2014-01-01

    Introduction Le but de ce travail était d'étudier la mortalité et les facteurs pronostiques de la Coagulopathie Traumatique (CoT) aigue précoce. Méthodes Il s'agissait d'une étude prospective sur 21 mois, incluant tous les traumatisés crâniens graves > 16 ans. Les données clinico-démographiques, biologiques et radiologiques ont été collectées à l'admission. La CoT a été définie par une thrombopénie < 120 000 /mm3 t/ou un Taux de Prothrombine (TP) < 70% et/ou un International Normalized Ratio (INR) > 1,3 et/ou un Temps de Céphaline Activé (TCA) > 40 sec. Résultats Nous avons colligé 69 patients ayant une CoT avec une médiane d'âge à 29 ans avec un intervalle interquartile à (23-41), et une prédominance masculine dans 87% des cas (60 patients). L'ISS médian à 56 avec un intervalle interquartile à (42-75). La mortalité était de 52,2% des cas (36 patients) suite à une souffrance cérébrale dans 74,3% des cas (26 patients). La durée médiane de séjour était de 10 jours avec un intervalle interquartile à (5-19). Les facteurs associés à la mortalité en analyse univariée étaient: le passager de véhicule, le délai de prise en charge, l'hématome sous dural aigu, l'AIS tête et l'ISS à l'admission; alors qu'en analyse multivariée c'étaient le délai de prise en charge (OR: 1,01; IC à 95%: 1,001-1,02) et l'ISS à l'admission (OR: 1,1; IC à 95%: 1,04-1,15) étaient des facteurs pronostiques indépendants. Conclusion L'amélioration du pronostic de ces patients repose essentiellement sur un développement de la médecine pré-hospitalière. PMID:25018842

  1. [Not Available].

    PubMed

    Angulo, Daniela; Bustos, Edson; Sánchez, Andrés; Barja, Salesa

    2016-07-19

    Introducción: la rehabilitación de la alimentación por vía oral (RVO) es compleja en pacientes que han recibido nutrición enteral (NE) prolongada. Objetivo: describir este proceso en niños con enfermedades respiratorias crónicas y sonda nasoenteral (SNE) o gastrostomía (GT).Pacientes y métodos: estudio retrospectivo con revisión de registros clínicos de niños con NE mayor a dos meses, ingresados entre 2005 y 2014 al Hospital Josefina Martínez.Resultados: Se incluyeron 116 pacientes, con mediana de edad 10 meses (Rango: 3 a 101), 56% hombres. Diagnóstico: 34,5% Daño pulmonar crónico postinfeccioso (DPC), 29,3% Insuficiencia respiratoria por enfermedad neuromuscular, 19% Displasia broncopulmonar y 17,2% enfermedad de la vía aérea. Con traqueostomía: 82,8%. Eran usuarios de GT 89,7% y de SNG 10,3%, instaladas con mediana de edad 6 meses (0 a 74), por ingesta insuficiente (6,6%) o trastorno de deglución (92,4%). Del grupo total, 36,2% (42/116) tenía indicación de RVO, los cuales habían recibido NE durante 12,2 meses (2 a 41); de estos 50% (21/42) logró alimentarse exclusivamente por vía oral (91% SNG y 35,4% GT, Chi2 p = 0,023), 14% parcialmente y 36% no lo logró. El tiempo para lograr la vía oral exclusiva fue de 9,75 meses (0,5 a 47), sin diferencia por edad, sexo, vía de acceso, duración NE ni presencia de enfermedad neurológica.Conclusión: en pacientes con enfermedades respiratorias crónicas graves y NE prolongada, la RVO es un proceso lento pero posible: 64% lo logra de modo completo o parcial.

  2. Discovering the 60 years old secret: identification of the World War II mass grave victims from the island of Daksa near Dubrovnik, Croatia

    PubMed Central

    Borić, Igor; Ljubković, Jelena; Sutlović, Davorka

    2011-01-01

    Aim To describe the organization, field work, forensic anthropological examination, and DNA analysis conducted to identify the victims from a World War II mass grave found on the Dalmatian island of Daksa near Dubrovnik (Croatia) in 2009. Methods Excavation of the site was performed according to standard archeological procedures. Basic anthropological examination was made to determine the minimum number of victims, sex, age at death, and height. The bones with pathological and traumatic changes were identified. DNA was extracted from powdered bones and relatives’ blood samples. Y-chromosome and autosomal short tandem repeats (STR) were used to establish the relationship of the remains with the putative family members. Results The remains were found to belong to at least 53 distinctive victims. All were male, mostly with gunshot wounds to the head. DNA analysis and cross-matching of the samples with relatives resulted in 14 positive identifications using the Y-chromosomal STRs and 4 positive identifications using the autosomal STRs. Conclusions This study showed that even in cases of more than 50-year-old, highly degraded human remains from mass graves, Y-chromosomal and autosomal STRs analysis can contribute to identification of the victims. PMID:21674828

  3. Long-term Geophysical Monitoring of Simulated Clandestine Graves using Electrical and Ground Penetrating Radar Methods: 4-6 Years After Burial.

    PubMed

    Pringle, Jamie K; Jervis, John R; Roberts, Daniel; Dick, Henry C; Wisniewski, Kristopher D; Cassidy, Nigel J; Cassella, John P

    2016-03-01

    This ongoing monitoring study provides forensic search teams with systematic geophysical data over simulated clandestine graves for comparison to active cases. Simulated "wrapped," "naked," and "control" burials were created. Multiple geophysical surveys were collected over 6 years, here showing data from 4 to 6 years after burial. Electrical resistivity (twin electrode and ERI), multifrequency GPR, grave and background soil water were collected. Resistivity surveys revealed that the naked burial had low-resistivity anomalies up to year four but then difficult to image, whereas the wrapped burial had consistent large high-resistivity anomalies. GPR 110- to 900-MHz frequency surveys showed that the wrapped burial could be detected throughout, but the naked burial was either not detectable or poorly resolved. 225-MHz frequency GPR data were optimal. Soil water analyses showed decreasing (years 4 to 5) to background (year 6) conductivity values. Results suggest both resistivity and GPR surveying if burial style unknown, with winter to spring surveys optimal and increasingly important as time increases.

  4. A method for identification of the peptides that bind to a clone of thyroid-stimulating antibodies in the serum of Graves' disease patients.

    PubMed

    Na, Chan Hyun; Lee, Mi Hwa; Cho, Bo Youn; Chae, Chi-Bom

    2003-04-01

    A method was developed for identification of the peptide sequences that bind to thyroid-stimulating antibody (TSAb) clones from phage-displayed peptide library. Immunoglobulin G (IgG) was purified from the serum of a Graves' disease patient that stimulates the synthesis of cAMP in the cells that express TSH receptor (TSHR). The IgG that binds to TSHR was purified by an affinity column packed with the resin cross-linked with the extracellular domain of human TSHR. The receptor-binding IgG was then mixed with phages that display linear or cyclic peptides at the end of tail protein pIII. The bound phages were eluted with acidic glycine after extensive washing. From sequencing of the pIII gene of the bound phages, one can deduce the sequences of the peptides that bind to the receptor-binding IgG. Each peptide sequence was then tested for inhibition of the synthesis of cAMP from thyroid cells induced by the serum of a Graves' patient. In this way, one can obtain the peptides that bind to a clone of TSAb. We obtained a peptide sequence that inhibits the action of TSAb at an extremely low concentration (<10(-14) M). Such a peptide will be useful for various studies on TSAb.

  5. The massacre mass grave of Schöneck-Kilianstädten reveals new insights into collective violence in Early Neolithic Central Europe

    PubMed Central

    Meyer, Christian; Lohr, Christian; Gronenborn, Detlef; Alt, Kurt W.

    2015-01-01

    Conflict and warfare are central but also disputed themes in discussions about the European Neolithic. Although a few recent population studies provide broad overviews, only a very limited number of currently known key sites provide precise insights into moments of extreme and mass violence and their impact on Neolithic societies. The massacre sites of Talheim, Germany, and Asparn/Schletz, Austria, have long been the focal points around which hypotheses concerning a final lethal crisis of the first Central European farmers of the Early Neolithic Linearbandkeramik Culture (LBK) have concentrated. With the recently examined LBK mass grave site of Schöneck-Kilianstädten, Germany, we present new conclusive and indisputable evidence for another massacre, adding new data to the discussion of LBK violence patterns. At least 26 individuals were violently killed by blunt force and arrow injuries before being deposited in a commingled mass grave. Although the absence and possible abduction of younger females has been suggested for other sites previously, a new violence-related pattern was identified here: the intentional and systematic breaking of lower limbs. The abundance of the identified perimortem fractures clearly indicates torture and/or mutilation of the victims. The new evidence presented here for unequivocal lethal violence on a large scale is put into perspective for the Early Neolithic of Central Europe and, in conjunction with previous results, indicates that massacres of entire communities were not isolated occurrences but rather were frequent features of the last phases of the LBK. PMID:26283359

  6. Icariin Inhibits AMPK-Dependent Autophagy and Adipogenesis in Adipocytes In vitro and in a Model of Graves' Orbitopathy In vivo

    PubMed Central

    Li, Hong; Yuan, Yifei; Zhang, Yali; Zhang, Xia; Gao, Long; Xu, Rongjuan

    2017-01-01

    Graves' orbitopathy (GO), an extrathyroidal manifestation of Graves' disease, is an inflammatory autoimmune disorder of the orbit that involves the differentiation of precursor cells into mature adipocytes and retro-orbital adipose tissue accumulation. Here, we examined the involvement of autophagy in adipogenesis and explored the effects of icariin, a flavonoid isolated from the genus Epimedium with a wide range of biological and pharmacological effects, on autophagy and adipogenesis in 3T3-L1 preadipocytes and in a mouse model of GO. Microscopic examination of autophagosome formation and lipid droplet accumulation by Oil Red O staining, and western blot assessment of autophagic markers in the presence of the autophagy inhibitors Asn and 3-MA showed that autophagy is essential for adipogenesis. Icariin inhibited the differentiation of preadipocytes into mature adipocytes by suppressing autophagy, and these effects were mediated by the inhibition of AMPK/mTOR pathway activation. In a mouse model of thyroid stimulating hormone receptor induced GO, icariin reduced orbital muscle adipose tissue expansion and lipid droplet accumulation by inhibiting AMPK/mTOR mediated autophagy. Collectively, these results reveal a potential mechanism underlying the protective effects of icariin against autophagy induced adipogenesis and suggest that icariin could be developed as a new therapeutic candidate for the prevention and treatment of GO. PMID:28243204

  7. Prolonged TSH receptor A subunit immunization of female mice leads to a long-term model of Graves' disease, tachycardia, and cardiac hypertrophy.

    PubMed

    Holthoff, Hans-Peter; Goebel, Sylvia; Li, Zhongmin; Faßbender, Julia; Reimann, Andreas; Zeibig, Stefan; Lohse, Martin J; Münch, Götz; Ungerer, Martin

    2015-04-01

    A transient model for human Graves' disease was successfully established in mice using up to 3 immunizations with recombinant adenovirus expressing the extracellular A-subunit of the human TSH receptor (TSHR) (Ad-TSHR). We studied extension of adenovirally induced TSHR A-subunit immunization in mice by using a novel protocol of long-term 3- and 4-weekly injections. Generation of TSHR binding stimulatory antibodies (capacity to stimulate cAMP activity in TSHR-expressing test cells), goiter, and histological thyroid alterations were maintained for at least 9 months in all Ad-TSHR-immunized mice. In response to injection of 10(10) plaque-forming units of Ad-TSHR, also elevated mean serum T4 levels were observed throughout the study. Moreover, cardiac organ involvement (tachycardia and hypertrophy) were consistently observed in these mice. Higher doses of Ad-TSHR (10(11) plaque-forming units) did not produce consistent elevation of T4 and were not associated with a clear increase in heart rate vs controls, probably because these high doses provoked an immune response-induced tachycardia on their own. In summary, a long-term model of Graves' disease induced by a relatively simple protocol of continuing monthly immunizations should allow to investigate long-term disease mechanisms and may possibly obviate the need for more complicated disease models. Moreover, the clinical outcome predictor of tachycardia and cardiac involvement was reliably detected in the model.

  8. The massacre mass grave of Schöneck-Kilianstädten reveals new insights into collective violence in Early Neolithic Central Europe.

    PubMed

    Meyer, Christian; Lohr, Christian; Gronenborn, Detlef; Alt, Kurt W

    2015-09-08

    Conflict and warfare are central but also disputed themes in discussions about the European Neolithic. Although a few recent population studies provide broad overviews, only a very limited number of currently known key sites provide precise insights into moments of extreme and mass violence and their impact on Neolithic societies. The massacre sites of Talheim, Germany, and Asparn/Schletz, Austria, have long been the focal points around which hypotheses concerning a final lethal crisis of the first Central European farmers of the Early Neolithic Linearbandkeramik Culture (LBK) have concentrated. With the recently examined LBK mass grave site of Schöneck-Kilianstädten, Germany, we present new conclusive and indisputable evidence for another massacre, adding new data to the discussion of LBK violence patterns. At least 26 individuals were violently killed by blunt force and arrow injuries before being deposited in a commingled mass grave. Although the absence and possible abduction of younger females has been suggested for other sites previously, a new violence-related pattern was identified here: the intentional and systematic breaking of lower limbs. The abundance of the identified perimortem fractures clearly indicates torture and/or mutilation of the victims. The new evidence presented here for unequivocal lethal violence on a large scale is put into perspective for the Early Neolithic of Central Europe and, in conjunction with previous results, indicates that massacres of entire communities were not isolated occurrences but rather were frequent features of the last phases of the LBK.

  9. Circulating T-cell subsets in Graves' disease: differences between patients with active disease and in remission after /sup 131/I-therapy

    SciTech Connect

    Canonica, G.W.; Bagnasco, M.; Ferrini, S.; Biassoni, P.; Giordano, G.; Corte, G.

    1983-08-01

    In the present investigation some surface markers in peripheral blood T lymphocytes of patients with active Graves' disease and subjects in remission after /sup 131/I-therapy have been studied. We confirmed low TG levels in untreated patients and normal values in treated subjects. Increased percentages of DR+, MLR4+ (activated T cells), and 5/9+ (inducer-helper) T cells were detected in patients with active disease, thus indicating the presence of activated T cells and suggesting increased levels of helper T cells. High percentages of MLR4+ and 5/9+, but normal levels of DR+ were found in /sup 131/I-treated subjects. The different distribution of DR and MLR4 positivities on 5/9+ and 5+9-T cells confirm the different meaning of these two markers of the activation state. The imbalance of T-cell subsets found in /sup 131/I-treated subjects and the normal values observed in patients with hyperthyroidism due to toxic adenoma indicate that hyperthyroidism per se is not sufficient to explain the T-cell alterations. The possible meaning of these findings is discussed with respect to previous hypotheses on the pathogenesis of Graves' disease.

  10. An improved method for the establishment of a model of Graves' disease in BALB/c mice.

    PubMed

    Zheng, Wei; Wang, Renfei; Tan, Jian; Li, Ning; Meng, Zhaowei

    2017-04-01

    The present study aimed to develop a stable Graves' disease (GD) model in BALB/c mice by immunization and electroporation (EP). A total of 90 mice were divided into experimental (n=50), control (n=20) and blank (n=20) groups. The recombinant plasmid pcDNA3.1/thyroid‑stimulating hormone (TSH) receptor 268 was constructed and injected into the bilateral gastrocnemius of experimental group mice at weeks 1, 4, 7 and 10. Equal volumes of saline were injected into the control and blank groups at the same time. The experimental and control groups were subjected to EP at the same time and location to enhance immunization. The levels of total serum thyroxine (T4) and serum TSH were examined by radioimmunoassay and immunoradiometric assay, respectively. The levels of serum thyrotropin receptor N‑terminal (TRAb N) and C‑terminal (TRAb C) antibodies were assessed by ELISA. Whole body pertechnetate (99mTcO4‑) imaging was performed. Mouse weight and thyroid morphology and pathology were analyzed. The GD BALB/c mouse model was successfully established, with a positive rate of 79.17% (38/48). T4 levels increased from baseline levels of 12.05±4.23 to 52.51±23.58 ng/ml by week 12 (P<0.0001). TSH levels decreased from baseline levels of 5.53±2.78 to 1.43±0.89 µIU/ml by week 12 (P<0.0001). TRAb N antibody levels increased from baseline levels of 0.006±0.002 to 0.278±0.106 mIU/ml by week 12 (P<0.0001). TRAb C antibody levels increased from baseline levels of 11.111±2.808 to 46.701±26.436 arbitrary units/ml by week 12 (P<0.0001). At week 21, TSH levels remained reduced compared with pre‑immunization levels (P<0.0001). Although T4, and TRAb N and C levels decreased, they remained increased compared with preimmunization levels (P<0.0001, P<0.0001, P=0.001). There were no significant alterations in antibody levels between the control and blank groups. Following four immunizations, the uptake of 99mTcO4‑ by the thyroid was significantly increased in the

  11. Le paludisme grave d’importation chez l’adulte: étude rétrospective de treize cas admis en réanimation à Marrakech

    PubMed Central

    El Mezouari, El Mostafa; Belhadj, Ayoub; Ziani, Mohamed; Boughanem, Mohamed; Moutaj, Redouane

    2016-01-01

    Le paludisme d’importation est une affection de plus en plus fréquente en zone non endémique. Les formes graves représentent 10 % des cas de paludisme à Plasmodium falciparum. Au Maroc, plus de 50 cas de paludisme sont enregistrés chaque année dont 83 % à P. falciparum. Ont été inclus dans l’étude tous les patients ayant développé un paludisme grave, admis au service de réanimation durant la période comprise entre le 1er Novembre 2009 et le 31 décembre 2015. Les principales données épidémiologiques, les motifs d’admission, la prise en charge et l’évolution ont été étudiés. Treize patients sont retenus. L’âge moyen est de 31 ans. Tous les patients ont séjourné en afrique subsaharienne et étaient non-immuns. La chimioprophylaxie était adéquate dans 33% des cas. Le délai moyen entre le début des symptômes et l’instauration du traitement était de six jours. La parasitémie moyenne initiale était de 12 %. Les motifs d’admission en réanimation étaient un coma (15%), une convulsion (07%), une détresse respiratoire (07%), une prostration (07%), une insuffisance rénale (07%), un choc associé à un ictère et une acidose (07%) et enfin une insuffisance rénale conjuguée à un coma (07%). Tous les patients ont reçu un traitement par la quinine intraveineuse avec une dose de charge dans 100 % des cas. Le taux de mortalité était de 23 %. Les causes du décès étaient dues à la défaillance multi viscérale et au syndrome de détresse respiratoire aigu. La mortalité des formes graves du paludisme reste élevée. L’adéquation de la chimioprophylaxie associée à la précocité du diagnostic et du traitement permettrait d’améliorer significativement le pronostic de cette parasitose. PMID:28292141

  12. Thr92Ala polymorphism of human type 2 deiodinase gene (hD2) affects the development of Graves' disease, treatment efficiency, and rate of remission.

    PubMed

    Alina, Babenko; Daria, Popkova; Olga, Freylihman; Vladislav, Solncev; Anna, Kostareva; Elena, Grineva

    2012-01-01

    Clinical symptoms vary in thyrotoxicosis, and severity of these depends on many factors. Over the last years, impact of genetic factors upon the development and clinical significance of thyrotoxic symptoms became evident. It is known that a production of T3 in various tissues is limited by deiodinase 2 (D2). Recent studies revealed that certain single nucleotide polymorphisms (including threonine (Thr) to alanine (Ala) replacement in D2 gene codon 92, D2 Thr92Ala) affect T3 levels in tissues and in serum. Individuals with Ala92Ala genotype have lower D2 activity in tissues, compared with that in individuals with other genotypes. In our study, we have assessed an association of D2 Thr92Ala polymorphism with (1) frequency of disease development, (2) severity of clinical symptoms of thyrotoxicosis, and (3) rate of remissions, in Graves' disease patients.

  13. Extensive scaling and nonuniformity of the Karhunen-Lo{grave e}ve decomposition for the spiral-defect chaos state

    SciTech Connect

    Zoldi, S.M.; Liu, J.; Liu, J.; Greenside, H.S.

    1998-12-01

    By analyzing large-aspect-ratio spiral-defect chaos (SDC) convection images, we show that the Karhunen-Lo{grave e}ve decomposition (KLD) scales extensively for subsystem sizes larger than 4d ({ital d} is the fluid depth), which strongly suggests that SDC is extensively chaotic. From this extensive scaling, the intensive length {xi}{sub KLD} is computed and found to have a different dependence on the Rayleigh number than the two-point correlation length {xi}{sub 2}. Local computations of {xi}{sub KLD} reveal a spatial nonuniformity of SDC images that extends over radii 18d{lt}r{lt}45d in a {Gamma}=109 aspect-ratio cell. {copyright} {ital 1998} {ital The American Physical Society}

  14. Location and assessment of an historic (150-160 years old) mass grave using geographic and ground penetrating radar investigation, NW Ireland.

    PubMed

    Ruffell, Alastair; McCabe, Alan; Donnelly, Colm; Sloan, Brian

    2009-03-01

    Reburial of human remains and concerns regarding pathogens and pollution prompted the search for, and assessment of, a 156-year-old graveyard. To locate this graveyard, historic and anecdotal information was compared to landscape interpretation from aerial photography. To assess and map the contents, surface collapses, metal detector indications, and ground-penetrating radar (GPR) were used. Some 170 anomalies compatible with burials were identified on 200 MHz GPR data, 84 of which coincided with surface collapses, suggesting both noncollapsed ground, subsequent infill, and multiple inhumations. The graveyard was possibly split into Roman Catholic plots with multiple inhumations; Protestant plots; and a kileen, or graveyard for the unbaptized (often children). The work serves as one approach to the location and mapping of recent and historic unmarked graves.

  15. Supplement Analysis for the Watershed Management Program EIS (DOE/EIS-0265/SA-161) - Grave Creek Channel Stabilization Project – Phase II

    SciTech Connect

    Keller, Carl J.

    2004-07-22

    BPA proposes to fund MFWP to accomplish Phase II of channel stabilization along Graves Creek. The current proposal is very much the same as for Phase I (as per our Oct. 15, 2002 Memo.): stabilize about 4,800 feet of the creek by realigning and shaping the channel; install log and rock vanes, and root wads; install debris jams and cobble patches, and planting native vegetation along the riparian corridor to stabilize the banks. The Phase II work is immediately adjacent and downstream from that the Phase I work that was accomplished in 2002. The purpose of the project is to stabilize that channel, provide for floodplain function, improve rearing and adult holding habitat for westslope cutthroat trout and bull trout.

  16. Unilateral symptomatic intracranial arterial stenosis and myopathy in an adolescent with Graves disease: a case report of an high-resolution magnetic resonance imaging study.

    PubMed

    Yin, Jia; Zhu, Jiajia; Huang, Dongling; Shi, Changzheng; Guan, Yuqing; Zhou, Liang; Pan, Suyue

    2015-01-01

    Vascular and muscular involvements in Graves disease (GD) are rare. Here, we report a case of a 17-year-old patient with unilateral symptomatic middle cerebral artery stenosis concurrent with GD and myopathy. He presented with a 1-day history of acute severe right-sided hemiparesis and aphasia and a 3-week history of high metabolic syndrome. The pathogenesis of the stenosis is most likely vasculitis rather than atherosclerosis, based on contrast-enhanced high-resolution magnetic resonance imaging showing concentric wall enhancement. We suggest that lipid storage myopathy is secondary to GD, and it is likely mitochondrial dysfunction or immune dysfunction induced by GD responsible for the myopathy and that magnetic resonance spectroscopy (MRS) is capable of establishing the diagnosis of myopathy. Thus, MRS can be used for follow-up evaluations of the myopathy along with the pathology biopsy.

  17. Gender-dependent and age-of-onset-specific association of the rs11675434 single-nucleotide polymorphism near TPO with susceptibility to Graves' ophthalmopathy.

    PubMed

    Kuś, Aleksander; Szymański, Konrad; Jurecka-Lubieniecka, Beata; Pawlak-Adamska, Edyta; Kula, Dorota; Miśkiewicz, Piotr; Bolanowski, Marek; Płoski, Rafał; Bossowski, Artur; Daroszewski, Jacek; Jarząb, Barbara; Bednarczuk, Tomasz

    2017-03-01

    The role of TPO gene polymorphism in the susceptibility to Graves' disease (GD) remains unclear. However, single-nucleotide polymorphisms (SNPs) near TPO have been recently associated with serum levels of thyroid peroxidase (TPO) antibody in two independent genome-wide association studies. Moreover, we have observed a strong association between the rs11675434 SNP located near TPO and the presence of clinically evident Graves' ophthalmopathy (GO). The aim of the current study was to reevaluate and dissect this association in an extended group of 1231 well-characterized patients with GD (1043 adults and 188 children) and 1130 healthy controls from the Polish Caucasian population, considering possible gender-dependent and age-of-onset-specific effects of the studied SNP. We found that the T allele of rs11675434 was significantly more frequent in GD patients with than without GO (odds ratio (OR)=1.26, 95% confidence interval (CI)=1.05-1.51, P=0.012), which was consistent with our previous findings. Further analyses performed in subgroups of patients showed that the association with GO was significant in adult patients with age of GD onset ⩾45 years (OR=1.34, 95% CI=1.03-1.75, P=0.031), but not in children and adolescents or adult patients with earlier onset of the disease (OR=1.72, 95% CI=0.77-3.84, P=0.18 and OR=1.05, 95% CI=0.79-1.40, P=0.75, respectively). Moreover, a strong association with GO was present in males (OR=2.06, 95% CI=1.40-3.02, P=0.0002), whereas it was absent in females (OR=1.10, 95% CI=0.90-1.35, P=0.35). The results of our study further suggest that rs11675434 SNP located near TPO is associated with the development of GO, especially in males and patients with later age of GD onset.

  18. Late effect of subtotal thyroidectomy and radioactive iodine therapy on calcitonin secretion and bone mineral density in women treated for Graves' disease

    SciTech Connect

    Lowery, W.D.; Thomas, C.G. Jr.; Awbrey, B.J.; Rosenstein, B.D.; Talmage, R.V.

    1986-12-01

    This study was designed to evaluate the effect of subtotal thyroidectomy and/or radioactive iodine therapy on plasma immunocalcitonin (iCT) levels and bone densities in patients treated for Graves' disease. Forty-eight women whose ages ranged from 29 to 79 years (mean, 55 years) were evaluated. All were at least 10 years beyond treatment. Fourteen patients had undergone subtotal thyroidectomy, 22 had received radioactive iodine therapy, and 12 had received both. Serum calcitonin levels were measured with the patient fasting and at 30 minutes and 2 hours after the ingestion of 15 mg of calcium in orange juice. Single photon absorptiometry was used to measure bone mineral density of the middle and distal radius. The mean fasting plasma levels of iCT for patients undergoing subtotal thyroidectomy was 27 +/- 2 mumol/L; women treated with radioactive iodine, 26 +/- 2; women undergoing subtotal thyroidectomy followed by radioactive iodine, 24 +/- 2, and for normal control women, 48.5 +/- 4.7. The mean stimulated iCT level of each of the patient groups was significantly lower than that of the normal controls (p = 0.01). There were no significant differences among the groups. Although there was an increased loss of bone mineral density in postmenopausal patients, with age and race as covariates, the bone densities of the distal radius in women undergoing subtotal thyroidectomy and/or receiving radioactive iodine were not significantly lower than those of normal control subjects (p greater than 0.05). These findings are consistent with other observations that patients treated by thyroidectomy and/or radioactive iodine for Graves' disease have lower basal levels of calcitonin and decreased calcitonin response to a provocative stimulus. Whether this loss of calcitonin reserve is a significant factor in development of postmenopausal osteoporosis remains unanswered.

  19. Performance of Irikura's Recipe Rupture Model Generator in Earthquake Ground Motion Simulations as Implemented in the Graves and Pitarka Hybrid Approach.

    SciTech Connect

    Pitarka, A.

    2016-11-22

    We analyzed the performance of the Irikura and Miyake (2011) (IM2011) asperity-­ based kinematic rupture model generator, as implemented in the hybrid broadband ground-­motion simulation methodology of Graves and Pitarka (2010), for simulating ground motion from crustal earthquakes of intermediate size. The primary objective of our study is to investigate the transportability of IM2011 into the framework used by the Southern California Earthquake Center broadband simulation platform. In our analysis, we performed broadband (0 -­ 20Hz) ground motion simulations for a suite of M6.7 crustal scenario earthquakes in a hard rock seismic velocity structure using rupture models produced with both IM2011 and the rupture generation method of Graves and Pitarka (2016) (GP2016). The level of simulated ground motions for the two approaches compare favorably with median estimates obtained from the 2014 Next Generation Attenuation-­West2 Project (NGA-­West2) ground-­motion prediction equations (GMPEs) over the frequency band 0.1–10 Hz and for distances out to 22 km from the fault. We also found that, compared to GP2016, IM2011 generates ground motion with larger variability, particularly at near-­fault distances (<12km) and at long periods (>1s). For this specific scenario, the largest systematic difference in ground motion level for the two approaches occurs in the period band 1 – 3 sec where the IM2011 motions are about 20 – 30% lower than those for GP2016. We found that increasing the rupture speed by 20% on the asperities in IM2011 produced ground motions in the 1 – 3 second bandwidth that are in much closer agreement with the GMPE medians and similar to those obtained with GP2016. The potential implications of this modification for other rupture mechanisms and magnitudes are not yet fully understood, and this topic is the subject of ongoing study.

  20. Cutting edge: retrobulbar inflammation, adipogenesis, and acute orbital congestion in a preclinical female mouse model of Graves' orbitopathy induced by thyrotropin receptor plasmid-in vivo electroporation.

    PubMed

    Moshkelgosha, Sajad; So, Po-Wah; Deasy, Neil; Diaz-Cano, Salvador; Banga, J Paul

    2013-09-01

    Graves' orbitopathy (GO) is a complication in Graves' disease (GD) but mechanistic insights into pathogenesis remain unresolved, hampered by lack of animal model. The TSH receptor (TSHR) and perhaps IGF-1 receptor (IGF-1R) are considered relevant antigens. We show that genetic immunization of human TSHR (hTSHR) A-subunit plasmid leads to extensive remodeling of orbital tissue, recapitulating GO. Female BALB/c mice immunized with hTSHR A-subunit or control plasmids by in vivo muscle electroporation were evaluated for orbital remodeling by histopathology and magnetic resonance imaging (MRI). Antibodies to TSHR and IGF-1R were present in animals challenged with hTSHR A-subunit plasmid, with predominantly TSH blocking antibodies and were profoundly hypothyroid. Orbital pathology was characterized by interstitial inflammation of extraocular muscles with CD3+ T cells, F4/80+ macrophages, and mast cells, accompanied by glycosaminoglycan deposition with resultant separation of individual muscle fibers. Some animals showed heterogeneity in orbital pathology with 1) large infiltrate surrounding the optic nerve or 2) extensive adipogenesis with expansion of retrobulbar adipose tissue. A striking finding that underpins the new model were the in vivo MRI scans of mouse orbital region that provided clear and quantifiable evidence of orbital muscle hypertrophy with protrusion (proptosis) of the eye. Additionally, eyelid manifestations of chemosis, including dilated and congested orbital blood vessels, were visually apparent. Immunization with control plasmids failed to show any orbital pathology. Overall, these findings support TSHR as the pathogenic antigen in GO. Development of a new preclinical model will facilitate molecular investigations on GO and evaluation of new therapeutic interventions.

  1. Increased TRAb and/or low anti-TPO titers at diagnosis of graves' disease are associated with an increased risk of developing ophthalmopathy after onset.

    PubMed

    Lantz, M; Planck, T; Asman, P; Hallengren, B

    2014-02-01

    Patients with low thyroid peroxidase antibodies (anti-TPO) and increased TSH-receptor antibodies (TRAb) at diagnosis of Graves' disease (GD) have been suggested to have an increased risk to develop Graves' ophthalmopathy (GO). The aim was to evaluate if GO development can be predicted.This is an observational study with registration of possible GD and GO risk factors.399 patients with GD were registered 2003-2008 in Malmö, Sweden and out of these 310 were retrospectively followed up to 6 years. The main outcome measures were anti-TPO titer, TRAb titer, smoking habits, radioiodine treatment and GO development.TRAb was assessed with a third generation assay at GD diagnosis in 231 patients. The proportion of patients with GO increased above the median 6.3 IU/L both at diagnosis of GD (p=0.001) and at follow-up (p=0.0001).The distribution of GO patients anti-TPO above or below 20 kIU/L at diagnosis of GD was similar between groups (p=0.239). However at follow-up anti-TPO<20 kIU/L was associated with an increased proportion of newly developed GO as compared to the cohort with anti-TPO>20 kIU/L (p=0.018).87% of patients who developed GO after GD diagnosis had TRAb above 6.3 IU/L and/or anti-TPO below 20 kIU/L. The proportion of GO was doubled in GD patients treated with radioiodine but could not explain the described findingsAnti-TPO<20 kIU/L and/or TRAb>6.3 IE/L at the time of GD diagnosis were associated with an increased risk to develop GO after diagnosis of GD.

  2. Recent trends in the management of Graves' hyperthyroidism in Japan: opinion survey results, especially on the combination therapy of antithyroid drug and thyroid hormone.

    PubMed

    Mori, T; Sugawa, H; Kosugi, S; Ueda, M; Hai, N; Matsuda, A

    1997-08-01

    An opinion survey concerning the management of Graves' hyperthyroidism was conducted among the council members of the Japan Thyroid Association. The selection of 3 major treatments by 90 respondents for their patients was 98.6 +/- 4.2% for antithyroid drug (ATD), 7.8 +/- 12.6% for partial thyroidectomy and 5.2 +/- 8.1% for radioiodide. They expressed a movement away from the past trend of surgery because of postoperative complications and unsatisfactory therapeutic results, and they assumed a further reduction in the future. On the other hand, the frequency of radioiodide treatment was not considered to have decreased greatly, and they expected a slight increase in the future. Of the respondents, 65% suggested that hyperthyroidism should be completely cured even if the patient would fall into hypothyroidism. The major reasons for choosing surgery or radioiodide after ATD were the adverse effects of ATD and the age and social backgrounds of the patients. Large goiter size was the 3rd reason for surgery but was a minimal indicator for radioiodide. As for ATD treatment, none of the respondents reported the routine application of any uniform fixed-time therapy protocol. Japanese Graves' patients were shown to be less responsive to ATD than Caucasian patients. This was assumed to result at least from high iodide intake, and half of them had ordered their patients to restrict iodide intake. Furthermore, 78% of them had treated with a combined therapy of ATD and thyroid hormone. Most of them apply this for selected patients mainly to lower TSH receptor antibody activity, to better control their patients and to reduce the goiter size. All but 8 (9%) did not give T4 (or T3) after the cessation of ATD, and they felt this to be unnecessary, doubtful about the effect, unsuitable or even possible to induce recurrence. The excellent findings reported by Hashizume et al. (N Engl J Med 324: 947-953, 1991) are well known among them. However, most of them did not agree with the

  3. Analyze of waves dynamic over an intertidal mudflat of a sandy-gravely estuarine beach - Field survey and preliminary modeling approach

    NASA Astrophysics Data System (ADS)

    Morio, Olivier; Sedrati, Mouncef; Goubert, Evelyne

    2014-05-01

    As well as marine submersion or erosive phenomena, clay-silted sediment in-filling on estuarial and bay beaches are a main issue in these human-attractive areas. Coupled sandy/gravely and clay/silty intertidal areas can be observed in these particular coastal areas, depending of rivers characteristic (discharge of particle, water flow), ocean dynamics (wave exposure, current) and sediments sources. All around the world, sandy/gravely beaches are exposed to punctual or continuous input clay sediments. Vilaine estuary, Bay of Arcachon and Bay of Seine in France, Plymouth Bay in UK and also Wadden Sea in Deutschland are few examples of muddy/sandy coupled or mixed system. The beach of Bétahon (Ambon town, Brittany - France) is located on the external Vilaine estuary and is an example of this issue. This meso-macrotidal intermediate (low tide terrace) beach presents heterogeneous sediments. The upper intertidal zone is composed by sand and gravel and characterized by a steep slope. A very gentle slope characterized the lower part of the beach and is constituted by silt and clay. Clay/sand limit is characterized by a decimetric erosion cliff of mudflat along the beach. In order to understand bed variations and sediment transport of this complex heterogeneous beach, a well understanding of wave dynamic across the beach is necessary. This study focus on wave dynamics over the beach, using field observations and MIKE 21 3D wave numerical model. This paper is a preliminary approach of an upcoming global understanding of this estuarial beach behavior. Swell from deep-sea to near-shore area is modeled over a 100 km² area and real wind, deep sea wave characteristic, river water flow and tidal level are defined as open boundary conditions for the regional model. This last one is based on multiple bathymetric surveys over the last 50 years. Local model, triangular mesh gridded to 5 meters, covering Bétahon beach , is based on topographic and photographic survey of the mudflat

  4. An assessment of a massively parallel sequencing approach for the identification of individuals from mass graves of the Spanish Civil War (1936-1939).

    PubMed

    Calafell, Francesc; Anglada, Roger; Bonet, Núria; González-Ruiz, Mercedes; Prats-Muñoz, Gemma; Rasal, Raquel; Lalueza-Fox, Carles; Bertranpetit, Jaume; Malgosa, Assumpció; Casals, Ferran

    2016-10-01

    Next-generation sequencing technologies have opened new opportunities in forensic genetics. Here, we assess the applicability and performance of the MiSeq FGx™ & ForenSeq™ DNA Signature Prep Kit (Illumina) for the identification of individuals from the mass graves of the Spanish Civil War (1936-1939). The main limitations for individual identification are the low number of possible first-degree living relatives and the high levels of DNA degradation reported in previous studies. Massively parallel sequencing technologies enabling the analysis of hundreds of regions and prioritizing short length amplicons constitute a promising tool for this kind of approaches. In this study, we first explore the power of this new technology to detect first- and second-degree kinship given different scenarios of DNA degradation. Second, we specifically assess its performance in a set of low DNA input samples previously analyzed with CE technologies. We conclude that this methodology will allow identification of up to second-degree relatives, even in situations with low sequencing performance and important levels of allele drop-out; it is thus a technology that resolves previous drawbacks and that will allow a successful approximation to the identification of remains.

  5. Expression Profile of Human Fc Receptor-Like 1, 2, and 4 Molecules in Peripheral Blood Mononuclear Cells of Patients with Hashimoto's Thyroiditis and Graves' Disease.

    PubMed

    Rostamzadeh, D; Dabbaghmanesh, M H; Shabani, M; Hosseini, A; Amirghofran, Z

    2015-08-01

    Recently identified Fc receptor-like (FCRL) molecules are new members of the immunoglobulin superfamily dominantly expressed by B cells. Although FCRL expression patterns have been studied in normal and malignant cells, their biological functions and roles remain to be clearly identified in humans. Research has particularly focused on FCRL gene polymorphisms in autoimmune diseases, however, their involvement in the pathogenesis of autoimmune diseases is an interesting field for investigation. In the present study, we have investigated the gene expression profiles of FCRL1, 2, and 4 in 2 common thyroid diseases, Hashimoto's thyroiditis (HT) and Graves' disease (GD). FCRL1, 2, and 4 expressions were determined in peripheral blood samples of 55 HT patients, 40 GD patients and equal numbers of normal subjects by quantitative real-time PCR. Our results showed downregulation of FCRL1 and upregulation of FCRL2 transcripts in both HT and GD groups compared to healthy counterparts. Overexpression of FCRL4 was observed only in GD patients compared to controls. A significant correlation was observed between all FCRL gene expression levels in HT patients. Only FCRL2 and 4 had a correlation in GD patients. In addition, FCRL1, 2, and 4 gene expressions showed no correlations with the level of anti-thyroid peroxidase antibody (anti-TPO) or anti-thyroglobulin (anti-Tg) antibody from patients' sera. In conclusion, expressions of activating or inhibitory FCRL1, 2, and 4 showed significant alterations in HT and GD patients compared to healthy subjects.

  6. A partial melting study of an ordinary (H) chondrite composition with application to the unique achondrite Graves Nunataks 06128 and 06129

    NASA Astrophysics Data System (ADS)

    Usui, Tomohiro; Jones, John H.; Mittlefehldt, David W.

    2015-04-01

    Melting experiments of a synthesized, alkali-bearing, H-chondrite composition were conducted at ambient pressure with three distinct oxygen fugacity conditions (IW-1, IW, and IW+2). Oxygen fugacity conditions significantly influence the compositions of partial melts. Partial melts at IW-1 are distinctly enriched in SiO2 relative to those of IW and IW+2 melts. The silica-enriched, reduced (IW-1) melts are characterized by high alkali contents and have silica-oversaturated compositions. In contrast, the silica-depleted, oxidized (≥IW) melts, which are also enriched in alkali contents, have distinctly silica-undersaturated compositions. These experimental results suggest that alkali-rich, felsic, asteroidal crusts as represented by paired achondrites Graves Nunataks 06128 and 06129 should originate from a low-degree, relatively reduced partial melt from a parent body having near-chondritic compositions. Based on recent chronological constraints and numerical considerations as well as our experimental results, we propose that such felsic magmatism should have occurred in a parent body that is smaller in size and commenced accreting later than those highly differentiated asteroids having basaltic crusts and metallic cores.

  7. Mécanismes et traitement de l’anémie aiguë chez le brûlé grave

    PubMed Central

    Siah, S.; El Khatib, K.; Messaoudi, N.

    2016-01-01

    Summary Les brûlés graves présentent souvent, au cours de la phase aiguë, des anémies plus au moins profondes pouvant nécessiter des transfusions. L’anémie du brûlé a deux origines principales: le saignement péri-opératoire (des stratégies doivent être mises en place pour le réduire) et l’anémie de réanimation (que l’on peut en partie réduire en évitant les bilans inutiles) chez un patient ayant des troubles de l’hématopoïèse. Le traitement, chez ces patients à l’hématopoïèse altérée, repose sur la transfusion. Celle-ci n’est pas dénuée d’effets secondaires et une stratégie transfusionnelle restrictive doit être appliquée. PMID:28149231

  8. Follow-up of potential novel Graves' disease susceptibility loci, identified in the UK WTCCC genome-wide nonsynonymous SNP study.

    PubMed

    Newby, Paul R; Pickles, Oliver J; Mazumdar, Samaresh; Brand, Oliver J; Carr-Smith, Jaqueline D; Pearce, Simon H S; Franklyn, Jayne A; Evans, David M; Simmonds, Matthew J; Gough, Stephen C L

    2010-09-01

    A recent association scan using a genome-wide set of nonsynonymous coding single-nucleotide polymorphisms (nsSNPs) conducted in four diseases including Graves' disease (GD), identified nine novel possible regions of association with GD. We used a case-control approach in an attempt to replicate association of these nine regions in an independent collection of 1578 British GD patients and 1946 matched Caucasian controls. Although none of these loci showed evidence of association with GD in the independent data set, when combined with the original Wellcome Trust Case-Control Consortium study group, minor differences in allele frequencies (P>or=10(-3)) remained in the combined collection of 5924 subjects for four of the nsSNPs, present within HDLBP, TEKT1, JSRP1 and UTX. An additional 29 Tag SNPs were screened within these four gene regions to determine if further associations could be detected. Similarly, minor differences only (P=0.042-0.002) were detected in two HDLBP and two TEKT1 Tag SNPs in the combined UK GD collection. In conclusion, it is unlikely that the SNPs selected in this replication study have a significant effect on the risk of GD in the United Kingdom. Our study confirms the need for large data sets and stringent analysis criteria when searching for susceptibility loci in common diseases.

  9. Predictive factors for early response to methimazole in children and adolescents with Graves disease: a single-institute study between 1993 and 2013

    PubMed Central

    Hwang, Sun Mi; Lee, Dae-Yeol

    2016-01-01

    Purpose We aimed to investigate the predictive factors for early response to methimazole (MMI) in pediatric patients with Graves disease (GD). Methods Our study included 44 pediatric patients who were diagnosed with GD between January 1, 1993, and December 31, 2013, and were available for follow-up, achieving a normalization of thyroid functions (TFs) at the Chonbuk National University Hospital Pediatric Department. We retrospectively analyzed TFs such as tri-iodothyronine (T3), free thyroxine (fT4), thyroid-stimulating hormone (TSH), and thyroid antibody levels at diagnosis. We also examined their family history of thyroid disease, symptoms at presentation, and normalization time for TF after treatment. We divided our clinical series of patients into the following 4 age groups: <7 years old, 7–12 years old, 13–15 years old, and 16–18 years old. Results At diagnosis, the time of normalization of T3 was significantly shorter in the higher antimicrosomal antibody (AMA) group compared with the lower AMA group (2.53 months vs. 6.18 months) (P<0.05). However, the time of normalization of T3/fT4/TSH had no significant correlations with other variables such as age, sex, a family history of thyroid diseases, thyroglobulin, thyroid-stimulating immunoglobulin, or antithyroglobulin antibody (ATA). Conclusion Higher serological titers of AMA at diagnosis may have prognostic value in the response to initial MMI treatment in pediatric hyperthyroid GD patients. PMID:27462582

  10. Successful Re-administration of Low-dose of Methimazole (MMI) in Graves' Disease Patients Who Experienced Allergic Cutaneous Reactions to MMI at Initial Treatment and Had Received Long-term Propylthiouracil (PTU)

    PubMed Central

    Kubota, Sumihisa

    2016-01-01

    Objective When patients with Graves' disease show severe allergic cutaneous reactions, physicians often suggest that they undergo radioiodine therapy instead of receiving propylthiouracil (PTU), another antithyroid drug, because anti-neutrophil cytoplasmic antibody (ANCA)-related vasculitis can occur with PTU, especially with long-term use. However, some patients refuse radioiodine therapy and chose PTU. Sometimes PTU treatment may be prolonged. Since the frequency of adverse effects of methimazole (MMI) is dose-related, there is a possibility that we can re-administer a low dose without adverse effects to patients well-controlled with PTU who once experienced an allergic reaction to MMI. Methods I prospectively re-administered a low dose of MMI to patients who previously experienced an allergic reaction to MMI at initial treatment. The dose of re-administered MMI ranged from 5 mg twice a week to 5 mg daily. Patients Nine patients with Graves' disease who developed urticaria at initial treatment with MMI and had been treated with PTU for 6 to 21 years were recruited. Results Eight of the 9 patients were successfully controlled with MMI without allergic cutaneous reactions. Only one patient felt itchiness 2 days after switching to MMI. However, skin change was not observed. Conclusion If the patients show allergic cutaneous reactions as a side effect of MMI at the initial treatment for Graves' disease, then there is a strong possibility that such patients can tolerate a low dose of MMI without adverse effects after the disease activity has subsided. PMID:27853063

  11. [Clinical features of patients with influenza-like illness who went to a third level center in the winter of 2013-2014].

    PubMed

    Albarrán-Sánchez, Alejandra; Ramírez-Rentería, Claudia; Huerta-Montiel, Fernando; Martínez-Jerónimo, Angélica; Herrera-Landero, Alejandro; García-Álvarez, José Luis; Ortiz-Rodríguez, Elia; Palmas-Pineda, Lorena

    2016-01-01

    Introducción: el Centro para el Control y Prevención de Enfermedades (CDC, por sus siglas en inglés) registró, entre octubre de 2013 y abril de 2014, el pico más alto de casos relacionados con la influenza AH1N1. No todos los casos sospechosos de influenza resultan positivos, pero todos les generan costos a las instituciones. Nuestro objetivo fue describir las características de la población que acude con sospecha de influenza al Hospital de Especialidades del Centro Médico Nacional Siglo XXI durante una nueva epidemia. Métodos: estudio transversal de casos admitidos al servicio de Urgencias del hospital mencionado por sospecha de influenza de acuerdo con las guías de práctica clínica. Con base en estas se analizaron los factores asociados a la severidad de la infección. Resultados: se registraron 109 pacientes con promedio de 44 años edad; el 78 % de ellos tenía menos de 60 años; el 62 % fueron mujeres; 75 % tenía por lo menos un factor de riesgo como obesidad (26 %) o hipertensión (27 %). Solo 65 pacientes tuvieron prueba confirmatoria, 33.8 % fueron diagnóstico positivo y 21 % de ellos fallecieron. Conclusiones: la frecuencia de casos confirmados de influenza es baja. Los factores asociados a mortalidad en los casos confirmados son la presencia de hipertensión, de leucocitosis y la presentación clínica de insuficiencia respiratoria aguda grave (IRAG).

  12. Quantification des besoins en intrants antipaludiques: contribution à l'actualisation des hypothèses pour la quantification des intrants de prise en charge des cas de paludisme grave en République Démocratique du Congo

    PubMed Central

    Likwela, Joris Losimba; Otokoye, John Otshudiema

    2015-01-01

    Les formes graves de paludisme à Plasmodium falciparum sont une cause majeure de décès des enfants de moins de 5 ans en Afrique Sub-saharienne. Un traitement rapide dépend de la disponibilité de médicaments appropriés au niveau des points de prestation de service. La fréquence des ruptures de stock des commodités antipaludiques, en particuliers celles utilisées pour le paludisme grave, avait nécessité une mise à jour des hypothèses de quantification. Les données issues de la collecte de routine du PNLP de 2007 à 2012 ont été comparées à celles rapportés par d'autres pays africains et utilisées pour orienter les discussions au cours d'un atelier organisé par le PNLP et ses partenaires techniques et financiers afin de dégager un consensus national. La proportion des cas de paludisme rapportés comme grave en RDC est resté autour d'une médiane de 7% avec un domaine de variation de 6 à 9%. Hormis la proportion rapportée au Kenya (2%), les pays africains ont rapporté une proportion de cas grave variant entre 5 et 7%. Il apparaît que la proportion de 1% précédemment utilisée pour la quantification en RDC a été sous-estimée dans le contexte de la gestion des cas graves sur terrain. Un consensus s'est dégagé autour de la proportion de 5% étant entendu que des efforts de renforcement des capacités seraient déployés afin d'améliorer le diagnostic au niveau des points de prestation des services. PMID:26213595

  13. A novel hypothesis for the etiology of Graves' disease: TSAb may be thyroid stimulating animal IgG-like hormone and TBAb may be the precursor of TSAb.

    PubMed

    Ochi, Yukio; Kajita, Yoshihiro; Hachiya, Takashi; Hamaoki, Masaru

    2012-06-01

    There are doubtful points about the theory that autoimmunity with auto-antibody (Ab) to TSH receptor (R) causes hyperthyroidism in Graves' disease (GD). A main doubtful point is no curative effect of corticosteroid on Graves' hyperthyroidism in spite of curative effect of corticosteroid for all autoimmune diseases. Recently we demonstrated the immunological similarity of TSAb and TBAb-IgG to animal IgGs, except for human (h)IgG, by neutralization and purification of TSAb and TBAb-IgG using (1) heterophilic Ab to animal IgG in GD sera and (2) experimentally generated anti-animal IgG Abs [such as dog (d), bovine (b), porcine (p), and rabbit (rb)]. Furthermore, greater immunological similarity of Fab- and F(ab')(2)-portion of TSAb- and TBAb-IgG to bovine Fab, compared to hFab, was demonstrated using goat anti-bovine F(ab')(2) Ab. Existence of b and p TSH-like portions in the LATS-IgG molecule (probably Fab portion) was suggested by a previous report of neutralization of LATS activity by anti-b- or anti-p-TSH Ab. We suggested the existence of a mammalian animal-TSH-like structure, excepting hTSH, in the TSAb-IgG molecule (probably Fab portion), by discovery of anti-mammalian TSH Ab (such as d, b, p, guinea-pig, rat, whale, except h) in sera of GD. Lately, similar TSHR binding of H- and L-chain of human stimulating monoclonal TSHR Ab (M22)-Fab with TSH-α and-β subunit was reported. This evidence suggests that Fab portion of TSAb has a structure like mammalian TSH, but not hTSH. IgG-λ type of d, horse, b, p, goat, ovine is 95% and IgG-κ type is 5%, while human κ and λ chain is 60:40. Previous report that LATS (TSAb)-IgG composed of predominant λ type is supporting evidence that TRAb-IgG has immunological similarity with these animal IgGs compared to hIgG. We speculate that TSAb-IgG may be referred as a mermaid consisted in face (Fab) and trunk-leg (Fc). Face may be a kind of hormone with animal TSH-like structure and trunk-leg has animal IgG-like structure (in

  14. Opaque assemblages in CR2 Graves Nunataks (GRA) 06100 as indicators of shock-driven hydrothermal alteration in the CR chondrite parent body

    NASA Astrophysics Data System (ADS)

    Abreu, Neyda M.; Bullock, Emma S.

    2013-12-01

    We have studied the petrologic characteristics of sulfide-metal lodes, polymineralic Fe-Ni nodules, and opaque assemblages in the CR2 chondrite Graves Nunataks (GRA) 06100, one of the most altered CR chondrites. Unlike low petrologic type CR chondrites, alteration of metal appears to have played a central role in the formation of secondary minerals in GRA 06100. Differences in the mineralogy and chemical compositions of materials in GRA 06100 suggest that it experienced higher temperatures than other CR2 chondrites. Mineralogic features indicative of high temperature include: (1) exsolution of Ni-poor and Ni-rich metal from nebular kamacite; (2) formation of sulfides, oxides, and phosphates; (3) changes in the Co/Ni ratios; and (4) carbidization of Fe-Ni metal. The conspicuous absence of pentlandite may indicate that peak temperatures exceeded 600 °C. Opaques appear to have been affected by the action of aqueous fluids that resulted in the formation of abundant oxides, Fe-rich carbonates, including endmember ankerite, and the sulfide-silicate-phosphate scorzalite. We suggest that these materials formed via impact-driven metamorphism. Mineralogic features indicative of impact metamorphism include (1) the presence of sulfide-metal lodes; (2) the abundance of polymineralic opaque assemblages with mosaic-like textures; and (3) the presence of suessite. Initial shock metamorphism probably resulted in replacement of nebular Fe-Ni metal in chondrules and in matrix by Ni-rich, Co-rich Fe metal, Al-Ti-Cr-rich alloys, and Fe sulfides, while subsequent hydrothermal alteration produced accessory oxides, phosphates, and Fe carbonates. An extensive network of sulfide-metal veins permitted effective exchange of siderophile elements from pre-existing metal nodules with adjacent chondrules and matrix, resulting in unusually high Fe contents in these objects.

  15. Accuracy of two simple methods for estimation of thyroidal {sup 131}I kinetics for dosimetry-based treatment of Graves' disease

    SciTech Connect

    Traino, A. C.; Xhafa, B.

    2009-04-15

    One of the major challenges to the more widespread use of individualized, dosimetry-based radioiodine treatment of Graves' disease is the development of a reasonably fast, simple, and cost-effective method to measure thyroidal {sup 131}I kinetics in patients. Even though the fixed activity administration method does not optimize the therapy, giving often too high or too low a dose to the gland, it provides effective treatment for almost 80% of patients without consuming excessive time and resources. In this article two simple methods for the evaluation of the kinetics of {sup 131}I in the thyroid gland are presented and discussed. The first is based on two measurements 4 and 24 h after a diagnostic {sup 131}I administration and the second on one measurement 4 h after such an administration and a linear correlation between this measurement and the maximum uptake in the thyroid. The thyroid absorbed dose calculated by each of the two methods is compared to that calculated by a more complete {sup 131}I kinetics evaluation, based on seven thyroid uptake measurements for 35 patients at various times after the therapy administration. There are differences in the thyroid absorbed doses between those derived by each of the two simpler methods and the ''reference'' value (derived by more complete uptake measurements following the therapeutic {sup 131}I administration), with 20% median and 40% 90-percentile differences for the first method (i.e., based on two thyroid uptake measurements at 4 and 24 h after {sup 131}I administration) and 25% median and 45% 90-percentile differences for the second method (i.e., based on one measurement at 4 h post-administration). Predictably, although relatively fast and convenient, neither of these simpler methods appears to be as accurate as thyroid dose estimates based on more complete kinetic data.

  16. Peroxisome proliferator-activated receptor {alpha} agonists modulate Th1 and Th2 chemokine secretion in normal thyrocytes and Graves' disease

    SciTech Connect

    Antonelli, Alessandro; Ferrari, Silvia Martina; Frascerra, Silvia; Corrado, Alda; Pupilli, Cinzia; Bernini, Giampaolo; Benvenga, Salvatore; Ferrannini, Ele; Fallahi, Poupak

    2011-07-01

    Until now, no data are present about the effect of peroxisome proliferator-activated receptor (PPAR){alpha} activation on the prototype Th1 [chemokine (C-X-C motif) ligand (CXCL)10] (CXCL10) and Th2 [chemokine (C-C motif) ligand 2] (CCL2) chemokines secretion in thyroid cells. The role of PPAR{alpha} and PPAR{gamma} activation on CXCL10 and CCL2 secretion was tested in Graves' disease (GD) and control primary thyrocytes stimulated with interferon (IFN){gamma} and tumor necrosis factor (TNF){alpha}. IFN{gamma} stimulated both CXCL10 and CCL2 secretion in primary GD and control thyrocytes. TNF{alpha} alone stimulated CCL2 secretion, while had no effect on CXCL10. The combination of IFN{gamma} and TNF{alpha} had a synergistic effect both on CXCL10 and CCL2 chemokines in GD thyrocytes at levels comparable to those of controls. PPAR{alpha} activators inhibited the secretion of both chemokines (stimulated with IFN{gamma} and TNF{alpha}) at a level higher (for CXCL10, about 60-72%) than PPAR{gamma} agonists (about 25-35%), which were confirmed to inhibit CXCL10, but not CCL2. Our data show that CCL2 is modulated by IFN{gamma} and TNF{alpha} in GD and normal thyrocytes. Furthermore we first show that PPAR{alpha} activators inhibit the secretion of CXCL10 and CCL2 in thyrocytes, suggesting that PPAR{alpha} may be involved in the modulation of the immune response in the thyroid.

  17. Epstein-Barr Virus Lytic Reactivation Activates B Cells Polyclonally and Induces Activation-Induced Cytidine Deaminase Expression: A Mechanism Underlying Autoimmunity and Its Contribution to Graves' Disease.

    PubMed

    Nagata, Keiko; Kumata, Keisuke; Nakayama, Yuji; Satoh, Yukio; Sugihara, Hirotsugu; Hara, Sayuri; Matsushita, Michiko; Kuwamoto, Satoshi; Kato, Masako; Murakami, Ichiro; Hayashi, Kazuhiko

    2017-04-01

    Graves' disease is an autoimmune disease that results in and is the most common cause of hyperthyroidism, and the reactivation of persisting Epstein-Barr virus (EBV) in B lymphocytes induces the differentiation of host B cells into plasma cells. We previously reported that some EBV-infected B cells had thyrotropin receptor antibodies (TRAbs) as surface immunoglobulins (Igs), and EBV reactivation induced these TRAb+EBV+ cells to produce TRAbs. EBV reactivation induces Ig production from host B cells. The purpose of the present study was to examine total Ig productions from B cell culture fluids and to detect activation-induced cytidine deaminase (AID), nuclear factor kappa B (NF-κB), and EBV latent membrane protein (LMP) 1 in culture B cells during EBV reactivation induction and then we discussed the mechanisms of EBV reactivation-induced Ig production in relation to autoimmunity. We showed that the EBV reactivation induces the production of every isotype of Ig and suggested that the Ig production was catalyzed by AID through LMP1 and NF-κB. The results that the amount of IgM was significantly larger compared with IgG suggested the polyclonal B cell activation due to LMP1. We proposed the pathway of EBV reactivation induced Ig production; B cells newly infected with EBV are activated by polyclonal B cell activation and produce Igs through plasma cell differentiation induced by EBV reactivation. LMP1-induced AID enabled B cells to undergo class-switch recombination to produce every isotype of Ig. According to this mechanism, EBV rescues autoreactive B cells to produce autoantibodies, which contribute to the development and exacerbation of autoimmune diseases.

  18. Batteries, from Cradle to Grave

    ERIC Educational Resources Information Center

    Smith, Michael J.; Gray, Fiona M.

    2010-01-01

    As battery producers and vendors, legislators, and the consumer population become aware of the consequences of inappropriate disposal of batteries to landfill sites instead of responsible chemical neutralization and reuse, the topic of battery recycling has begun to appear on the environmental agenda. In the United Kingdom, estimates of annual…

  19. Chemicals from Cradle to Grave

    ERIC Educational Resources Information Center

    Science Scope, 2005

    2005-01-01

    About two years ago, an urban school district had planned for the disposal of some hazardous chemicals. It contracted with a chemical recycling company that was considered to be reputable. The school district, along with several other companies, was charged and fined by the Environmental Protection Agency for improperly releasing hazardous…

  20. Stratégie transfusionnelle des hémorragies graves du post-partum: étude rétrospective à propos de 47 cas

    PubMed Central

    Khouadja, Hosni; Rouissi, Wissem; Mahjoub, Mohamed; Sakhri, Jaballah; Beletaifa, Dhafer; Jazia, Khaled Ben

    2016-01-01

    Introduction L’hémorragie du post-partum est la principale cause de morbi-mortalité maternelle dans le monde. La prise en charge est multidisciplinaire. La stratégie transfusionnelle est capitale jouant un rôle majeur dans le pronostic maternel. L’objectif de ce travail a été de déterminer le rapport PFC/CGR lors de la prise en charge des hémorragies graves du post-partum. Méthodes Une étude Etude rétrospective sur une période de 4 ans (2009-2012) a été réalisée dans un centre de maternité de référence de niveau III du centre-Est tunisien. Elle a inclut les parturientes admises pour une hémorragie sévère du post-partum définit par la nécessité d’une transfusion de plus de 04 CGR durant les 3 premières heures ou de plus de 10 CGR durant les 24 premières heures de prise en charge. Résultats Notre étude a inclut 47 parturientes. Le diagnostic de l’HPP a été fait devant un saignement vaginal dans 28 cas et suite à une césarienne dans 19 cas. En préopératoire le taux d’Hb a été de 6.3 g/dl. Le rapport transfusionnel (PFC/CGR) a été de 1/0.7. Conclusion Au cours de notre prise en charge, le rapport transfusionnel a été plus élevé que les recommandations récentes de la littérature stipulant une administration précoce et massive de PFC avec un ratio PFC/CGR compris entre 1/2 et 1/1. L’administration du fibrinogène (Fbg) et de l’acide tranexamique doit être précoce. L’emploi du facteur VII activé recombinant (rFVIIa) doit rester une solution ultime de prise en charge. PMID:28292131

  1. A novel and major association of HLA-C in Graves' disease that eclipses the classical HLA-DRB1 effect.

    PubMed

    Simmonds, Matthew J; Howson, Joanna M M; Heward, Joanne M; Carr-Smith, Jackie; Franklyn, Jayne A; Todd, John A; Gough, Stephen C L

    2007-09-15

    Association of the major histocompatibility complex (MHC) class II-encoded HLA-DRB1-DQA1-DQB1 haplotype with Graves' disease (GD) has been known for several years. Recent evidence from other autoimmune diseases has suggested that the HLA class I encoded HLA-B/-C molecules could be conferring HLA-DRB1-DQA1-DQB1 independent effects on disease. The aim of this study was to determine the effect of HLA-B and HLA-C in GD in a white ethnic group of 806 patients with GD and 487 control subjects from the UK. Of the five loci (HLA-B, -C, -DRB1, -DQA1, -DQB1), HLA-C demonstrated the strongest association (P = 1.20 x 10(-20)) with HLA-C*07 predisposing [OR = 1.63, 95% CI (1.23-2.17)] and both HLA-C*03 [OR = 0.54, 95% CI (0.38-0.77)], HLA-C*16 [OR = 0.36, 95% CI (0.21-0.61)] protective. The other loci were then tested for HLA-C-independent associations. HLA-B was found to be associated independently of HLA-C (P = 1.54 x 10(-6)) with the other three loci, HLA-DRB1, HLA-DQB1 and HLA-DQA1, also improving the model but with less confidence (P > 10(-5)). This study has for the first time provided evidence of a primary association of HLA-C, and to a lesser extent HLA-B, with GD. Class II loci could still have effects on GD, but they appear smaller than the HLA-C association. A full investigation of the MHC region, including all class I and II loci is now required. Our results point to a primary role for class I-mediated responses in GD, a condition classically assumed to be a straightforward HLA-class II-restricted autoantibody response to the thyroid stimulating hormone receptor.

  2. Association of circulating antibodies against double-stranded and single-stranded DNA with thyroid autoantibodies in Graves' disease and Hashimoto's thyroiditis patients.

    PubMed

    Pedro, A B P; Romaldini, J H; Americo, C; Takei, K

    2006-01-01

    The occurrence of antinuclear antibody (ANA), rheumatoid factor (RF), antibodies to double-stranded DNA (anti-dsDNA) and to single-stranded DNA (anti-ssDNA) was investigated in 51 patients with autoimmune thyroid diseases (AITD), and in 25 matched control subjects. In comparison with controls, the prevalence of anti-dsDNA was 74.5% in AITD patients (p=0.0001), 82.0% in 39 hyperthyroid Graves' disease (GD) (p=0.0001), and 50.0% in 12 euthyroid Hashimoto's thyroiditis (HT) patients (p=0.0001). The prevalence of anti-ssDNA was 90.1% in AITD (94.8% in GD and 75% in HT; p=0.001). The concentration of both anti-dsDNA and anti-ssDNA were higher (p=0.002) in AITD, in GD (p=0.001), and in HT (p=0.01) patients than in controls. Two patients with AITD were identified as positive for ANA. RF was detected in 4 AITD patients. Positive correlation was noted between anti-dsDNA with T4 (p=0.001), T3 (p=0.002), thyroid peroxidase antibody (anti-TPO) (p=0.0001), and TSH (p=0.001) values but not with thyroglobulin antibody (anti-Tg). Serum anti-ssDNA values were also correlated with T3 (p=0.0001), TSH (p=0.003), and anti-TPO (p=0.0001). However, by using a multiple regression analysis only anti-TPO remained associated with anti-dsDNA and both anti-Tg and anti-TPO with anti-ssDNA values. The predisposition to develop systemic autoimmune disorders is not influenced by thyroid hormones. The elevated prevalence of serum anti-dsDNA and anti-ssDNA in AITD patients points out that we must be aware of the risk for predisposition for the development of other systemic autoimmune diseases.

  3. The Role of Glutamic or Aspartic Acid in Position Four of the Epitope Binding Motif and Thyrotropin Receptor-Extracellular Domain Epitope Selection in Graves' Disease

    PubMed Central

    Inaba, Hidefumi; Martin, William; Ardito, Matt; De Groot, Anne Searls; De Groot, Leslie J.

    2010-01-01

    Context: Development of Graves' disease (GD) is related to HLA-DRB1*0301 (DR3),and more specifically to arginine at position 74 of the DRB1 molecule. The extracellular domain (ECD) of human TSH receptor (hTSH-R) contains the target antigen. Objective and Design: We analyzed the relation between hTSH-R-ECD peptides and DR molecules to determine whether aspartic acid (D) or glutamic acid (E) at position four in the binding motif influenced selection of functional epitopes. Results: Peptide epitopes from TSH-R-ECD with D or E in position four (D/E+) had higher affinity for binding to DR3 than peptides without D/E (D/E−) (IC50 29.3 vs. 61.4, P = 0.0024). HLA-DR7, negatively correlated with GD, and DRB1*0302 (HLA-DR18), not associated with GD, had different profiles of epitope binding. Toxic GD patients who are DR3+ had higher responses to D/E+ peptides than D/E− peptides (stimulation index 1.42 vs. 1.22, P = 0.028). All DR3+ GD patients (toxic + euthyroid) had higher responses, with borderline significance (Sl; 1.32 vs. 1.18, P = 0.051). Splenocytes of DR3 transgenic mice immunized to TSH-R-ECD responded to D/E+ peptides more than D/E− peptides (stimulation index 1.95 vs. 1.69, P = 0.036). Seven of nine hTSH-R-ECD peptide epitopes reported to be reactive with GD patients' peripheral blood mononuclear cells contain binding motifs with D/E at position four. Conclusions: TSH-R-ECD epitopes with D/E in position four of the binding motif bind more strongly to DRB1*0301 than epitopes that are D/E− and are more stimulatory to GD patients' peripheral blood mononuclear cells and to splenocytes from mice immunized to hTSH-R. These epitopes appear important in immunogenicity to TSH-R due to their favored binding to HLA-DR3, thus increasing presentation to T cells. PMID:20392871

  4. Evaluation de la fonction hépatique au cours du paludisme grave chez les enfants de moins de cinq ans à Kinshasa en République Démocratique du Congo

    PubMed Central

    Kabamba, Arsène Tshikongo; Mukuku, Olivier; Shamashanga, Laurent Kwete; Kamunga, Daniel Badibanga; Bokanya, Alex Impele; Lukumwena, Zet Kalala; Longanga, Albert Otshudi

    2014-01-01

    Introduction Le paludisme est toujours compté parmi les problèmes de santé publique prioritaires en République Démocratique du Congo suite au nombre de malades et de décès qu'il provoque. Cette étude évalue l'atteinte de la fonction hépatique au cours du paludisme grave chez les enfants de moins de 5 ans. Méthodes Il s'agit d'une étude cas-témoins menée de janvier à juin 2013 à Kinshasa (République Démocratique du Congo) où le dosage des bilirubines totale, directe et indirecte et la mesure de l'activité enzymatique de la Glutamate Pyruvate Transaminase (GPT), de la Glutamate Oxaloacétate Transaminase (GOT) et du taux d'hémoglobine ont été faits chez 46 enfants âgés de moins de 5 ans atteints de paludisme grave (groupe I) et chez 46 autres considérés sains avec une goutte négative (groupe II). Les résultats obtenus ont été comparés dans les deux groupes et le seuil de signification a été fixé à p <0,05. Résultats Les analyses statistiques relèvent que les valeurs sont considérablement élevées en ce qui concerne les deux transaminases (GOT et GPT), la bilirubine directe, la bilirubine indirecte et la bilirubine totale chez les enfants atteints du paludisme grave. Ces analyses montrent une différence significative en défaveur de ces derniers (p < 0,001). Conclusion En effet, cette augmentation des taux plasmatiques des paramètres biologiques analysés observée chez les enfants gravement impaludés traduit ainsi une altération de la fonction hépatique au cours d'un paludisme grave chez l'enfant de moins de cinq ans. PMID:25870721

  5. Origin of felsic achondrites Graves Nunataks 06128 and 06129, and ultramafic brachinites and brachinite-like achondrites by partial melting of volatile-rich primitive parent bodies

    NASA Astrophysics Data System (ADS)

    Day, James M. D.; Walker, Richard J.; Ash, Richard D.; Liu, Yang; Rumble, Douglas; Irving, Anthony J.; Goodrich, Cyrena A.; Tait, Kimberly; McDonough, William F.; Taylor, Lawrence A.

    2012-03-01

    New major- and trace-element abundances, highly siderophile element (HSE: Os, Ir, Ru, Pt, Pd, Re) abundances, and oxygen and rhenium-osmium isotope data are reported for oligoclase-rich meteorites Graves Nunataks 06128 and 06129 (GRA 06128/9), six brachinites (Brachina; Elephant Morraine 99402/7; Northwest Africa (NWA) 1500; NWA 3151; NWA 4872; NWA 4882) and three olivine-rich achondrites, which are referred to here as brachinite-like achondrites (NWA 5400; NWA 6077; Zag (b)). GRA 06128/9 represent examples of felsic and highly-sodic melt products from an asteroid that may provide a differentiation complement to brachinites and/or brachinite-like achondrites. The new data, together with our petrological observations, are consistent with derivation of GRA 06128/9, brachinites and the three brachinite-like achondrites from nominally volatile-rich and oxidised 'chondritic' precursor sources within their respective parent bodies. Furthermore, the range of Δ17O values (˜0‰ to -0.3‰) among the meteorites indicates generation from isotopically heterogeneous sources that never completely melted, or isotopically homogenised. It is possible to generate major- and trace-element compositions similar to brachinites and the three studied brachinite-like achondrites as residues of moderate degrees (13-30%) of partial melting of primitive chondritic sources. This process was coupled with inefficient removal of silica-saturated, high Fe/Mg felsic melts with compositions similar to GRA 06128/9. Melting of the parent bodies of GRA 06128/9, brachinites and brachinite-like achondrites halted well before extensive differentiation, possibly due to the exhaustion of the short-lived radionuclide 26Al by felsic melt segregation. This mechanism provides a potential explanation for the cessation of run-away melting in asteroids to preserve achondrites such as GRA 06128/9, brachinites, brachinite-like achondrites, acapulcoite-lodranites, ureilites and aubrites. Moderate degrees of

  6. L'hemorragie grave du peripartum en milieu de reanimation dans un centre universitaire tunisien de niveau 3: épidémiologie et facteurs de risque de mortalité maternelle

    PubMed Central

    Nasr, Laidi Ben; Marzouk, Sofiene Ben; Kehila, Mehdi; Jabri, Hamed; Thamleoui, Saber; Maghrebi, Hayen

    2015-01-01

    L'hémorragie grave du péripartum demeure une des causes principales de mortalité maternelle. L'objectif de notre étude était de décrire le profil épidémiologique des patientes qui ont été prises en charge en milieu de réanimation suite à une hémorragie grave du péripartum et de rechercher d’éventuels facteurs de risque de mortalité. Notre étude est rétrospective descriptive et analytique. Nous avons inclus tous les cas d'hémorragie du péripartum ayant séjourné en unité de réanimation obstétricale du centre de maternité et de néonatologie de Tunis (CMNT) au cours de la période allant de janvier 2010 à Décembre 2013. Nous avons recueilli les paramètres démographiques, obstétricaux, ceux relatifs à la prise en charge chirurgicale et réanimatoire, les scores de gravité SAPS obstétrical et APACHEII, ainsi que la morbi-mortalité. Au total nous avons colligé 322 cas sur quatre ans. La répartition annuelle des patientes ainsi que les caractéristiques démographiques et obstétricales étaient comparables dans leur globalité sur les quatre années. Les pratiques thérapeutiques étaient également comparables. Le taux global de mortalité par hémorragie dans notre unité était à 4,7%, avec un taux annuel de mortalité stable. L'analyse des facteurs de risque de mortalité par hémorragie en milieu de réanimation a montré une association statistiquement significative entre la survenue du décès et les facteurs suivants: recours aux catécholamines, survenue de sepsis, œdème pulmonaire aigu, coagulation intravasculaire disséminée, insuffisance rénale aigue avec recours à l'hémodialyse, SDRA ou TRALI, atteinte neurologique grave, défaillance multiviscérale et arrêt cardiaque récupéré. PMID:26587127

  7. [Problem of exposure to direct danger of death or grave detriment to health of a child breast-fed by an alcohol-abusing mother in medico-legal opinions].

    PubMed

    Swiderski, Paweł; Zaba, Czesław; Tezyk, Artur; Wachowiak, Roman

    2011-01-01

    In the last few years, the authors have noted an increasing amount of cases submitted for analysis in the Chair and Department of Forensic Medicine, Poznan University of Medical Sciences, and addressing alcohol abuse by breast-feeding mothers. A question about the exposure to direct danger of death or grave detriment to health of a child by a breast-feeding mother under the influence of alcohol is posed by prosecution or the court, and the expectation is obtaining answers from forensic experts as to whether the situation fulfills the meaning of article 160 of the penal code, which would result in the mother bearing criminal liability. Difficulties that have arisen during the analysis of such cases have prompted the authors to analyze the problem of alcohol abuse by breast-feeding mothers in terms of medico-legal opinions.

  8. Why does the patient with Graves' disease remain euthyroid/mildly hyperthyroid following total thyroidectomy--the role of thyrotropin receptor antibodies (TRAb) and vestigial remnants of the thyroglossal tract.

    PubMed

    Cigrovski-Berković, Maja; Solter, Darko; Solter, Miljenko

    2008-09-01

    A young female patient suffering from Graves' disease is presented, who raised some diagnostic and therapeutic dilemmas after being diagnosed with subclinical hyperthyroidism following total thyroidectomy. This 20-year-old female patient, carrier of HLA B8 DR3 genes, was referred to our hospital for total thyroidectomy after developing severe leukopenia on both methimazole and propylthiouracil therapy. A high postoperative titer of thyrotropin receptor antibodies and positive scintigraphy finding of the pyramidal lobe and remnant thyroid tissue in the left thyroid lobe led to the administration of radioiodine. Despite further enlargement of the remnant thyroid tissue on post-radioiodine scintiscanning, the patient is currently euthyroid, with normal thyroid-stimulating hormone levels; however, her long-term prognosis remains uncertain.

  9. Frequencies of PD-1- positive T CD3+CD4+, T CD3+CD8+ and B CD19+ lymphocytes in female patients with Graves' disease and healthy controls- preliminary study.

    PubMed

    Pyzik, Aleksandra; Grywalska, Ewelina; Matyjaszek-Matuszek, Beata; Smoleń, Agata; Pyzik, Dawid; Roliński, Jacek

    2017-03-08

    PD-1 maintains tolerance and inhibits autoimmune responses. Graves' disease (GD) is one of the most frequent autoimmune diseases of unclear etiology. The aim of this study was to evaluate the percentage and absolute counts of PD-1 positive T and B cells in newly diagnosed, untreated patients with hyperthyroidism due to GD. The study group included 30 patients and the control group comprised of 20 age- and sex-matched healthy individuals. Results showed significantly higher frequencies and absolute counts of PD-1 positive CD3+CD4+ T cells, CD3+CD8+ T cells and CD19+B cells in patients with GD in comparison to the healthy volunteers. Moreover, higher mean fluorescence intensity of PD-1 was found on CD3+CD4+ T cells, CD3+CD8+ T cells and CD19+B cells in the study group than in the control group. These results suggest that PD-1 protein might involved in the pathogenesis of GD.

  10. Une intoxication peut en cacher une autre plus grave. Exemple d'une intoxication fatale à l'éthylène glycol masquée par une intoxication à un insecticide pyréthrinoïde

    PubMed Central

    Aissaoui, Younès; Kichna, Hicham; Boughalem, Mohammed; Kamili, Noureddine Drissi

    2013-01-01

    Les pyréthrinoïdes sont des insecticides largement utilisés du fait de leur efficacité et de leur relative sécurité chez l'homme. Les intoxications mortelles liées à ces agents restent exceptionnelles. Leur métabolisme hépatique rapide limite considérablement leur toxicité chez l'homme. Cette observation relate une intoxication grave à un pyréthrinoïde (la cyperméthrine) dont le solvant était l'éthylène glycol. Ce dernier est un toxique nettement plus dangereux pour l'homme. Le tableau clinique consistait en une atteinte multiviscérale avec prédominance de la défaillance cardiovasculaire et neurologique. Le faible potentiel toxique des pyréthrinoïdes suggère l'implication évidente de l'éthylène glycol dans la gravité de cette intoxication. La prise en charge thérapeutique, essentiellement symptomatique, n'a pas pris en compte la présence d'éthylène glycol dans la formulation de l'insecticide. L'évolution clinique était défavorable. Devant toute intoxication grave à un insecticide pyréthrinoïde une intoxication associée au solvant tel que l'éthylène glycol doit être recherchée et traitée. PMID:23734273

  11. Épidémiologie des accidents domestiques graves de l'enfant admis en réanimation pédiatrique polyvalente à l'hôpital d'enfants de Rabat-Maroc

    PubMed Central

    Rafai, Mostafa; Mekaoui, Nour; Chouaib, Naoufal; Bakkali, Hicham; Belyamani, Lahcen; El Koraichi, Alae; El Kettani, Salma Ech-Cherif

    2015-01-01

    Introduction Les accidents domestiques de l'enfant représentent un vrai problème de santé publique dans les pays industrialisés. Au Maroc, la priorité en santé publique est toujours donnée aux pathologies infectieuses, et bien qu'elle soit très peu décrite, la pathologie accidentelle de l'enfant devient de plus en plus fréquente dans notre pays avec une mortalité importante. L'objectif est de mettre le point sur la prévalence, la gravité, les aspects étiologiques, les facteurs de risque et les circonstances de survenue de ces accidents, ainsi que les moyens de prévention active et passive. Méthodes Enquête rétrospective descriptive sur une période de douze mois portant sur tous les enfants pris en charge pour accident domestique grave au service de réanimation pédiatrique polyvalente de l'hôpital universitaire d'enfants de Rabat. Résultats Parmi 698 admissions, 108 cas d'accidents domestiques graves ont étaient colligés (soit 15,5%), L’âge moyen des enfants était de 04ans tout accident confondu, avec un sex-ratio de 1,08 en faveur des garçons. L’évolution générale était marquée par le décès de 16 enfants (soit 14,8%) parmi 164 décès toute pathologie confondue au cours de la même période d’étude (soit 9,75% des décès) avec une durée moyenne d'hospitalisation de 04jours. les brûlures constituaient le premier accident dans notre série par 37cas, et elles étaient la première cause de mortalité par huit cas; par ailleurs, la population la plus à risque de brûlure était les nourrissons (67,6%). L'inhalation intrabronchique d’épingle à foulard (accident particulier dans notre contexte islamique) à été retrouvée chez six cas. Conclusion Les accidents domestiques de l'enfant constituent rarement une préoccupation de premier plan dans la population alors qu'ils sont parfois très graves et source d'une mortalité importante. Le meilleur traitement reste la prévention active et passive. PMID:26015848

  12. Les formes graves de la grippe A(H1N1) 2009 chez la femme enceinte: expérience du centre hospitalier universitaire de Fès, Maroc et revue de la littérature

    PubMed Central

    Adnane Berdai, Mohamed; Labib, Smael; Harandou, Mustapha

    2012-01-01

    Introduction Le but de cette étude est de décrire les caractéristiques épidémiologiques, cliniques, paracliniques ainsi que l’évolution des femmes enceintes ou en post partum atteintes de formes graves de Grippe A(H1N1) 2009. Méthodes C’est une étude prospective observationnelle monocentrique, menée au sein de notre service de réanimation mère et enfant au centre hospitalier universitaire Hassan II à Fès, sur une période de 3 mois, allant de novembre 2009 à janvier 2010. Résultats L’âge moyen était de 28 ans, dans 85% des cas la grossesse se situaient au troisième trimestre, le syndrome grippal était constant, la SpO2 initiale était en moyenne de 86%. A la radiographie thoracique, un syndrome alvéolaire bilatéral était toujours présent. L’infection virale était confirmée dans tous les cas par la polymerase chain reaction. Chez 3 patientes la PaO2/FiO2 était inférieure à 300. L’Oseltamivir était l’antiviral utilisé chez toutes les parturientes. Un syndrome de détresse respiratoire aigu a été développé chez 28% des parturientes, elles ont été ventilées artificiellement avec des niveaux de pressions expiratoires positives à 14 +/- 1 cmH2O. L’évolution était favorable dans 71% des cas, cependant, 2 décès ont été déplorés. Conclusion Les résultats rejoignent les données de la littérature, à savoir, un risque accru pour la femme enceinte de développer une forme grave, une présentation clinique similaire au reste de la population, l’intérêt de la vaccination et d’un traitement antiviral précoce et le rôle de l’ECMO dans le traitement des hypoxémies réfractaires. PMID:22514770

  13. Cradle-to-Grave Lifecycle Analysis of U.S. Light Duty Vehicle-Fuel Pathways: A Greenhouse Gas Emissions and Economic Assessment of Current (2015) and Future (2025-2030) Technologies

    SciTech Connect

    Elgowainy, Amgad; Han, Jeongwoo; Ward, Jacob; Joseck, Fred; Gohlke, David; Lindauer, Alicia; Ramsden, Todd; Biddy, Mary; Alexander, Marcus; Barnhart, Steven; Sutherland, Ian; Verduzco, Laura; Wallington, Timothy

    2016-06-01

    This study provides a comprehensive lifecycle analysis (LCA), or cradle-to-grave (C2G) analysis, of the cost and greenhouse gas (GHG) emissions of a variety of vehicle-fuel pathways, as well as the levelized cost of driving (LCD) and cost of avoided GHG emissions. This study also estimates the technology readiness levels (TRLs) of key fuel and vehicle technologies along the pathways. The C2G analysis spans a full portfolio of midsize light-duty vehicles (LDVs), including conventional internal combustion engine vehicles (ICEVs), flexible fuel vehicles (FFVs), hybrid electric vehicles (HEVs), plug-in hybrid electric vehicles (PHEVs), battery electric vehicles (BEVs), and fuel cell electric vehicles (FCEVs). In evaluating the vehicle-fuel combinations, this study considers both low-volume and high-volume “CURRENT TECHNOLOGY” cases (nominally 2015) and a high-volume “FUTURE TECHNOLOGY” lower-carbon case (nominally 2025–2030). For the CURRENT TECHNOLOGY case, low-volume vehicle and fuel production pathways are examined to determine costs in the near term.

  14. Cradle-to-Grave Lifecycle Analysis of U.S. Light-Duty Vehicle-Fuel Pathways: A Greenhouse Gas Emissions and Economic Assessment of Current (2015) and Future (2025–2030) Technologies

    SciTech Connect

    Elgowainy, Amgad; Han, Jeongwoo; Ward, Jacob; Joseck, Fred; Gohlke, David; Lindauer, Alicia; Ramsden, Todd; Biddy, Mary; Alexander, Marcus; Barnhart, Steven; Sutherland, Ian; Verduzco, Laura; Wallington, Timothy J.

    2016-09-01

    This study provides a comprehensive life-cycle analysis (LCA), or cradle-to-grave (C2G) analysis, of the cost and greenhouse gas (GHG) emissions of a variety of vehicle-fuel pathways, as well as the levelized cost of driving (LCD) and cost of avoided GHG emissions. This study also estimates the technology readiness levels (TRLs) of key fuel and vehicle technologies along the pathways. The C2G analysis spans a full portfolio of midsize light-duty vehicles (LDVs), including conventional internal combustion engine vehicles (ICEVs), flexible fuel vehicles (FFVs), hybrid electric vehicles (HEVs), plug-in hybrid electric vehicles (PHEVs), battery electric vehicles (BEVs), and fuel cell electric vehicles (FCEVs). In evaluating the vehicle-fuel combinations, this study considers both low-volume and high-volume “CURRENT TECHNOLOGY” cases (nominally 2015) and a high-volume “FUTURE TECHNOLOGY” lower-carbon case (nominally 2025–2030). For the CURRENT TECHNOLOGY case, low-volume vehicle and fuel production pathways are examined to determine costs in the near term.

  15. Graving Drydocks. Design Manual 29.1

    DTIC Science & Technology

    1982-05-01

    plate construction, with reactions carried to the walls by girders and to the floor by beams . ’iese gates are extensively used for small docks. Since...moments in individual frames and girders , stiffeners, and plating. b. Framing. Main framing should consist of a series of vertical -* .. " trusses or...29.1-80 c. Cellular Sheet Pile Cofferdam. ........... 29.1-80 d. Internally Braced Sheet Pile Cofferdam .. ...... 29.1-81 5

  16. Insights on influenza pathogenesis from the grave.

    PubMed

    Taubenberger, Jeffery K; Kash, John C

    2011-12-01

    The 1918-1919 'Spanish' influenza virus caused the worst pandemic in recorded history and resulted in approximately 50 million deaths worldwide. Efforts to understand what happened and to use these insights to prevent a future similar pandemic have been ongoing since 1918. In 2005 the genome of the 1918 influenza virus was completely determined by sequencing fragments of viral RNA preserved in autopsy tissues of 1918 victims, and using reverse genetics, infectious viruses bearing some or all the 1918 virus gene segments were reconstructed. These studies have yielded much information about the origin and pathogenicity of the 1918 virus, but many questions still remain.

  17. From the Cradle to the Grave.

    ERIC Educational Resources Information Center

    Hill, Jim, Ed.

    1994-01-01

    Examines the emerging discipline known as life-cycle assessment (LCA) used to evaluate the true environmental impacts of products, materials, or activities from the time raw materials leave the earth until those materials return to their final resting place. (LZ)

  18. QT Prolongation due to Graves' Disease

    PubMed Central

    Deol, Nisha; Tolly, Renee; Manocha, Rohan; Naseer, Maliha

    2017-01-01

    Hyperthyroidism is a highly prevalent disease affecting over 4 million people in the US. The disease is associated with many cardiac complications including atrial fibrillation and also less commonly with ventricular tachycardia and fibrillation. Many cardiac pathologies have been extensively studied; however, the relationship between hyperthyroidism and rate of ventricular repolarization manifesting as a prolonged QTc interval is not well known. Prolonged QTc interval regardless of thyroid status is a risk factor for cardiovascular mortality and life-threatening ventricular arrhythmia. The mechanism regarding the prolongation of the QT interval in a hyperthyroid patient has not been extensively investigated although its clinical implications are relevant. Herein, we describe a case of prolonged QTc in a patient who presented with signs of hyperthyroidism that was corrected with return to euthyroid status. PMID:28154763

  19. Ampleur et impact des évènements indésirables graves liés aux soins: étude d'incidence dans un hôpital du Centre-Est tunisien

    PubMed Central

    Bouafia, Nabiha; Bougmiza, Iheb; Bahri, Fathi; Letaief, Mondher; Astagneau, Pascal; Njah, Mansour

    2013-01-01

    Introduction La prévention des événements indésirables représente une priorité de santé du fait de leur fréquence et de leur gravité potentielle. Ce travail a été mené afin d'avoir un diagnostic de la situation épidémiologique relative aux événements indésirables survenant dans notre hôpital. Méthodes Une étude prospective a été menée auprès de tous les patients qui ont été hospitalisés au CHU Farhat Hached - Sousse (Tunisie) sur une période d'un mois dans quatorze services de l'hôpital. La détection d'évènement indésirable grave (EIG) était basée sur les critères adoptés dans différentes études. Les tests T et Chi 2 ont été utilisés pour identifier les facteurs contribuant à l'apparition d'évènements indésirables. Résultats Au total, 162 EIG ont été identifiés pendant la période. 45% de ces évènements étaient des infections nosocomiales. Ces EIG ont eu comme conséquences un décès chez 9,2% des patients, la mise en jeu du pronostic vital de 26% des patients et la prolongation de la durée de séjour chez 61,7% d'entre eux. L'admission dans des circonstances particulières et l'exposition à des soins invasifs étaient identifiés comme des facteurs de risque potentiels EIG. Conclusion Le renforcement de la stratégie de gestion des risques sanitaires en ciblant préférentiellement le risque infectieux constitue une étape fondamentale dans l'amélioration de la sécurité des patients au sein de notre établissement de santé. PMID:24711868

  20. Assistance circulatoire extracorporelle percutanée dans les défaillances hémodynamiques aiguës graves : Expérience monocentrique chez 100 patients consécutifs

    PubMed Central

    Vanzetto, Gerald; Akret, Chrystelle; Bach, Vincent; Barone, Gilles; Durand, Michel; Chavanon, Olivier; Hacini, Rachid; Bouvaist, Hélène; Machecourt, Jacques; Blin, Dominique

    2009-01-01

    CONTEXTE : L’ECLS (extracorporeal life support) est une assistance circulatoire de plus en plus fréquemment employée chez l’adulte dans le cadre des arrêts cardiorespiratoires (ACR) et des défaillances hémodynamiques ne répondant pas aux traitements classiques. OBJECTIFS : Le but était d’évaluer la faisabilité et les résultats de 100 procédures consécutives d’ECLS artérioveineuses percutanées au Centre Hospitalier Universitaire de Grenoble (France) entre janvier 2002 et septembre 2007. MÉTHODES : Registre monocentrique descriptif avec suivi prospectif à 1 an. RÉSULTATS : L’ECLS a été posée avec succès chez 93 % des patients. Son indication était un choc cardiogénique dans 50 % des cas, un ACR dans 38 % des cas et un échec de sevrage de circulation extracorporelle (CEC) en fin d’intervention de chirurgie cardiothoracique dans 12 % des cas. Des complications directement liées à l’ECLS ont été notées chez 56 % des patients, les plus fréquentes étant une hémorragie au niveau des points de ponctions avec transfusion de culots globulaires (26 %) et une ischémie des membres inférieurs (19 %). Le sevrage de l’assistance a pu être effectué chez 33 patients (44 % des chocs cardiogéniques, 13 % des ACR, 50 % des échecs de sevrage de CEC) et 20 patients sont sortis de l’hôpital (26 % des chocs cardiogéniques, 10,5 % des ACR et 25 % des échecs de sevrage de CEC). Tous sont vivants à distance sans séquelles graves (suivi moyen : 16,8 mois). CONCLUSION : L’emploi de l’ECLS chez les patients en ACR et surtout en choc cardiogénique est faisable, avec un taux de survie satisfaisant vu la gravité initiale extrême de leur état. PMID:19536387

  1. [An international medical expert committee's participation in uncovering the truth on the liquidation of Polish officers found in mass graves at Katyn in the spring of 1943 and the biography of a Danish participant, Helge Tramsen (1910-1979)].

    PubMed

    Rosdahl, Nils

    2008-01-01

    The article is based on a paper read as a invited speaker at a conference, entitled "Medical experts and expertise in cases of humanitarian crises "convened by the University of Geneva and the Committee of the International Red Cross in April 2007. The article starts with an overview of Polish history from the end of World War I up to the disclosure of the mass graves in the spring of 1943, but is otherwise a translation of the original English lecture with some additions from new findings.in archives. Helge tramsen was born into a bourgois family in Copenhagen. After graduation in medicine from the University of Copenhegen in 1936 he married a British woman and joined the naval medical corps and also embarked on a surgical career.. From 1940 to 1943 he was prosector at the Institute of Forensic Medicine at the University of Copenhagen. After the finding of the mass graves at Katyn, Germany requested from a number of European countries under German control forensic experts to join an international commission to investigate the findings. As the professor of forensic medicine declined perobably due to health reasons Tramsen was sent. During the German occupation of Denmark 1940 to 1945 Tramsen according to family tradition participated in the resistance movement and he consulted with members of the more conservative part of it and was recommended to go to Germany with an added purpose of being able to transport material out of Germany. He went with special plane from Copenhagen to Berlin, where he joined the international group, which later flew to Smolensk via Warszawa. He conducted a post mortem on the body of a Polish officer, selected by himself. Following that he attended in the discussion on the final report, which later in Berlin was handed over to the German minister of health, and which later formed an important part of the official German material accusing the USSR for the killing. During his stay in Berlin he claimed to have collected material, which in

  2. Décision d'amputation dans la prise en charge initiale d'une luxation ouverte grave de la cheville à propos d'un cas observé à l'Hôpital Laquintinie de Douala suite à un accident par moto-taxi

    PubMed Central

    Tsatedem, Faustin Atemkeng; Tsiagadigui, Jean Gustave; Ndando, Richard Polle; Arabo, Mohamadou Saidou; Bayiha, Alphonse; Kenfack, Bruno

    2012-01-01

    La décision d'amputation pour traumatisme grave de membre n'est pas toujours facile à prendre. Les auteurs rapportent le cas d'un traumatisme ouvert de la cheville gauche avec luxation tibiotalienne complète, référé pour amputation. Il s'agit d'une passagère d'une moto-taxi percutée par une voiture. A l'admission, le pouls tibial postérieur était présent et le score dit MESS (Mangled Extremity Severity Score) côté à 5, ce qui a permis et d'éviter l'amputation. Après débridement et réduction, une broche transplantaire a permis d'immobiliser la cheville et de faire les pansements. L'amputation a été évitée. La cicatrisation dirigée de la peau a été suivie par la kinésithérapie. La mobilité de la cheville autorise une marche avec cannes au quatrième mois post-opératoire. Les auteurs recommandent l'utilisation du MESS dans la décision d'amputation après traumatisme grave de membre. PMID:23396997

  3. [Extrinsic allergic alveolitis. Clinical experience at the Instituto National de Enfermedades Respiratorias (INER)].

    PubMed

    Chapela-Mendoza, R; Selman-Lama, M

    1999-01-01

    Extrinsic allergic alveolitis is an interstitial lung disease caused by exposure to a variety of inhaled antigens. In Mexico, the most frequent form is due to the inhalation of avian antigens, markedly pigeon proteins. Depending on type and time exposure, the disease presents different clinical forms usually characterized by progressive dyspnea, ground glass or reticulonodular images on chest x rays, a restrictive functional pattern, rest hypoxemia worsening with exercise, and increase of T lymphocytes in bronchoalveolar lavage with an inversion in the helper/suppressor ratio. In this paper, we discuss a 15-year experience with this pathological problem in Mexico, emphasizing the differences with this disorder in Caucasian populations. Generally, our patients display a chronic form of the disease, which evolves to fibrosis in about one-half of the patients. In this sense, the diagnostic, prognostic, and therapeutic focusing exhibit different elements, and thus the development of clinical and basic research is strongly required.

  4. [Study of death with secondary diagnosis of malnutrition in a third level hospital].

    PubMed

    Fernández Valdivia, Antonia; Lobo Támer, Gabriela; Martínez Cirre, Ma Carmen; Valero Aguilera, Beatriz; Peña Taveras, Manuel del Carmen; Rodríguez Rodríguez, José María; Martínez Tapias, Jesús; Pérez de la Cruz, Antonio Jesús

    2013-01-01

    Introducción: La desnutrición constituye uno de los principales problemas de Salud Pública, según datos de la OMS, es la primera causa de mortalidad, cuando la misma afecta al colectivo de los sujetos hospitalizados, toma entidad propia denominándose “desnutrición hospitalaria”. Objetivos: El objetivo general es cuantificar los diagnósticos principales de alta más frecuentes, que causan exitus, con el diagnóstico secundario de desnutrición. Métodos: Se trata de un estudio transversal y descriptivo, en el que se han incluido todas las altas hospitalarias del año 2011 y primer semestre de 2012, que han sido exitus y que tienen como diagnóstico secundario la desnutrición, siendo el total de 33. Se ha realizado un análisis estadístico descriptivo, efectuándose el test de Mann-Whitney para pruebas no paramétricas (p < 0,05). Resultados: Los diagnósticos principales más frecuentes entre las 33 altas analizadas son la sepsis (12,1%), metástasis hepáticas (9,1%), neumonía (6,1%), insuficiencia respiratoria aguda (6,1%) e insuficiencia renal aguda (6,1%). Conclusiones: Aunque el diagnóstico principal más frecuente es la sepsis, al agrupar los diagnósticos, el GRD más frecuente es de patología respiratoria, por lo que se ha de hacer codificación exhaustiva y de calidad para ajustar el peso relativo de los mismos a la realidad. Es fundamental especificar en la fuente de información clínica utilizada para la codificación, el grado de desnutrición, para obtener mayor especificidad en los datos.

  5. PubMed

    Goñi Esarte, S; Zozaya Urmeneta, J M; Goñi Esarte, M; Uriz Otano, J I; Idoate Santesteban, I; Beunza Puyol, M T

    2016-12-30

    La hepatitis isquémica es una entidad poco frecuente. Se asocia a una hipoperfusión hepática debida en primer lugar a un bajo gasto cardíaco (insuficiencia cardiaca congestiva, infarto agudo de miocardio o miocardiopatía dilatada). De forma menos frecuente puede ser secundaria a una insuficiencia respiratoria o al aumento de las necesidades de oxígeno en el contexto de una sepsis.Paciente varón de 49 años que acude al servicio de Urgencias por disnea progresiva e hipotensión, objetivándose una importante elevación de transaminasas (aspartato aminotransferasa de 5.550 U/L, alanina aminotransferasa de 3.826 U/L) y de LDH (10.375 U/L). La ecografía Doppler hepática fue normal. El ecocardiograma confirmó la sospecha diagnóstica, visualizándose la presencia de un derrame pericárdico masivo. El taponamiento cardíaco es una causa excepcional de este cuadro clínico. En el caso de nuestro paciente, el rápido diagnóstico y una pericardiocentesis realizada de forma urgente le llevaron a su pronta recuperación.

  6. Graves' disease presenting as pyrexia of unknown origin.

    PubMed Central

    Shaked, Y.; Samra, Y.; Zwas, S. T.

    1988-01-01

    Fever is a common clinical manifestation of inflammatory processes of the thyroid and thyroid crisis. On the other hand, fever alone as a presenting symptom of thyrotoxicosis, without other manifestations, is extremely rare. A female patient is described in whom fever persisted for two months prior to hospitalization, but without clinical symptoms or signs to lead to suspicion of thyroid disease. After exhaustive investigation it was found that the patient was suffering from hyperthyroidism. Fever disappeared gradually on antithyroid therapy, recurred when the drugs were withdrawn for a rechallenge trial, and cleared up again after renewal. Four other cases of persistent fever as a presenting symptom of hyperthyroidism were found on a review of previous publications. Thyrotoxicosis should, therefore, be included in the differential diagnosis of pyrexia of unknown origin. Images Figure 1 PMID:3050943

  7. Xylem development - from the cradle to the grave.

    PubMed

    Růžička, Kamil; Ursache, Robertas; Hejátko, Jan; Helariutta, Ykä

    2015-08-01

    The development and growth of plants, as well as their successful adaptation to a variety of environments, is highly dependent on the conduction of water, nutrients and other important molecules throughout the plant body. Xylem is a specialized vascular tissue that serves as a conduit of water and minerals and provides mechanical support for upright growth. Wood, also known as secondary xylem, constitutes the major part of mature woody stems and roots. In the past two decades, a number of key factors including hormones, signal transducers and (post)transcriptional regulators have been shown to control xylem formation. We outline the main mechanisms shown to be essential for xylem development in various plant species, with an emphasis on Arabidopsis thaliana, as well as several tree species where xylem has a long history of investigation. We also summarize the processes which have been shown to be instrumental during xylem maturation. This includes mechanisms of cell wall formation and cell death which collectively complete xylem cell fate.

  8. Experimental Study on the Intelligibility of Grave, Bisyllabic Spanish Words.

    ERIC Educational Resources Information Center

    Tosi, Oscar

    1969-01-01

    The present study, conducted at the Department of Audiology and Sciences, Michigan State University, consisted of determining the intelligibility of 648 Spanish stimulus-words arranged in a multiple-choice test of the two forms, A and B, each including 12 lists of approximately the same degree of difficulty. (Appendix.) This multiple-choice test…

  9. Organic Carbon Inclusions in CR2 Chondrite Graves Nunataks 95229

    NASA Astrophysics Data System (ADS)

    Peeters, Z.; Changela, H.; Stroud, R. H.; Alexander, C. M. O'D.; Nittler, L. R.

    2012-09-01

    We report coordinated XANES, TEM, and nanoSIMS analysis of two large, carbon-rich veins in CR2 chondrite GRA 95229. The variability in morphological, isotopic, and chemical properties is compared to previous results on C-rich veins in CR3 QUE 99177.

  10. White dwarf evolution - Cradle-to-grave constraints via pulsation

    NASA Technical Reports Server (NTRS)

    Kawaler, Steven D.

    1990-01-01

    White dwarf evolution, particularly in the early phases, is not very strongly constrained by observation. Fortunately, white dwarfs undergo nonradial pulsation in three distinct regions of the H-R diagram. These pulsations provide accurate masses, surface compositional structure and rotation velocities, and help constrain other important physical properties. We demonstrate the application of the tools of stellar seismology to white dwarf evolution using the hot white dwarf star PG 1159-035 and the cool DAV (or ZZ Ceti) stars as examples. From pulsation studies, significant challenges to the theory of white dwarf evolution emerge.

  11. Two grave issues concerning the expected Tokai Earthquake

    NASA Astrophysics Data System (ADS)

    Mogi, K.

    2004-08-01

    The possibility of a great shallow earthquake (M 8) in the Tokai region, central Honshu, in the near future was pointed out by Mogi in 1969 and by the Coordinating Committee for Earthquake Prediction (CCEP), Japan (1970). In 1978, the government enacted the Large-Scale Earthquake Countermeasures Law and began to set up intensified observations in this region for short-term prediction of the expected Tokai earthquake. In this paper, two serious issues are pointed out, which may contribute to catastrophic effects in connection with the Tokai earthquake: 1. The danger of black-and-white predictions: According to the scenario based on the Large-Scale Earthquake Countermeasures Law, if abnormal crustal changes are observed, the Earthquake Assessment Committee (EAC) will determine whether or not there is an imminent danger. The findings are reported to the Prime Minister who decides whether to issue an official warning statement. Administrative policy clearly stipulates the measures to be taken in response to such a warning, and because the law presupposes the ability to predict a large earthquake accurately, there are drastic measures appropriate to the situation. The Tokai region is a densely populated region with high social and economic activity, and it is traversed by several vital transportation arteries. When a warning statement is issued, all transportation is to be halted. The Tokyo capital region would be cut off from the Nagoya and Osaka regions, and there would be a great impact on all of Japan. I (the former chairman of EAC) maintained that in view of the variety and complexity of precursory phenomena, it was inadvisable to attempt a black-and-white judgment as the basis for a "warning statement". I urged that the government adopt a "soft warning" system that acknowledges the uncertainty factor and that countermeasures be designed with that uncertainty in mind. 2. The danger of nuclear power plants in the focal region: Although the possibility of the occurrence of a great shallow earthquake in the Tokai region was pointed out by CCEP in 1970, soon after, plans for construction of a nuclear power plant started in this region. Since 1976, Hamaoka nuclear power plants (Units 1˜4) have been operating near the center of the expected focal region of the great Tokai earthquake, and Unit 5 is under construction. This is quite a dangerous situation.

  12. Waste minimization: The planned-parenthood-to-grave'' philosophy

    SciTech Connect

    Cash, K.M. ); Ostergaard, A.P. Corp. )

    1992-02-11

    Until 1985, the Y-12 Plant, a DOE facility, had concentrated waste minimization efforts on select large waste streams. However, during the past seven years, Y-12 has been faced with the challenge of complying with all of these requirements as well as striving to develop and implement a comprehensive proactive program to reduce waste. Thus, the Y-12 Plant Waste Minimization Program has gradually developed toward an all encompassing program. The overall strategy and structure of the Y-12 program is centered around four basic elements: Waste Minimization Process Waste Assessments (PWAs), Opportunities, and Projects; Waste Minimization and Pollution Prevention Promotional Campaign; Waste Tracking; and Information Exchange and Technology Transfer. Activities within each of these elements are described in this report.

  13. Waste minimization: The ``planned-parenthood-to-grave`` philosophy

    SciTech Connect

    Cash, K.M.; Ostergaard, A.P.

    1992-02-11

    Until 1985, the Y-12 Plant, a DOE facility, had concentrated waste minimization efforts on select large waste streams. However, during the past seven years, Y-12 has been faced with the challenge of complying with all of these requirements as well as striving to develop and implement a comprehensive proactive program to reduce waste. Thus, the Y-12 Plant Waste Minimization Program has gradually developed toward an all encompassing program. The overall strategy and structure of the Y-12 program is centered around four basic elements: Waste Minimization Process Waste Assessments (PWAs), Opportunities, and Projects; Waste Minimization and Pollution Prevention Promotional Campaign; Waste Tracking; and Information Exchange and Technology Transfer. Activities within each of these elements are described in this report.

  14. Grave New World? Workplace Skills for Today's College Graduates

    ERIC Educational Resources Information Center

    Eisner, Susan

    2010-01-01

    Today's college graduates face an uncertain and demanding job market in which they are likely to encounter evolving skill needs, reduced hiring, and heightened competition from experienced laid off workers and globally available labor. These realities underscore the importance expressed by educators and practitioners of identifying attributes new…

  15. Thyroglobulin autoantibodies switch to immunoglobulin (Ig)G1 and IgG3 subclasses and preserve their restricted epitope pattern after 131I treatment for Graves' hyperthyroidism: the activity of autoimmune disease influences subclass distribution but not epitope pattern of autoantibodies.

    PubMed

    Latrofa, F; Ricci, D; Montanelli, L; Piaggi, P; Mazzi, B; Bianchi, F; Brozzi, F; Santini, P; Fiore, E; Marinò, M; Tonacchera, M; Vitti, P

    2014-12-01

    The subclass distribution of thyroglobulin autoantibodies (TgAb) is debated, whereas their epitope pattern is restricted. Radioidine ((131)I) treatment for Graves' disease (GD) induces a rise in TgAb levels, but it is unknown whether it modifies subclass distribution and epitope pattern of TgAb as well. We collected sera from GD patients before (131) I treatment and 3 and 6 months thereafter. We measured total TgAb, TgAb light chains and TgAb subclasses by enzyme-linked immunosorbent assay (ELISA) in 25 patients. We characterized the TgAb epitope pattern in 30 patients by inhibiting their binding to (125-) (I) Tg by a pool of four TgAb-Fab (recognizing Tg epitope regions A, B, C and D) and to Tg in ELISA by each TgAb-Fab. Total TgAb immunoglobulin (Ig)G rose significantly (P = 0.024). TgAb κ chains did not change (P = 0.052), whereas TgAb λ chains increased significantly (P = 0.001) and persistently. We observed a significant rise in IgG1 and IgG3 levels after (131)I (P = 0.008 and P = 0.006, respectively), while IgG2 and IgG4 levels did not change. The rise of IgG1 was persistent, that of IgG3 transient. The levels of inhibition of TgAb binding to Tg by the TgAb-Fab pool were comparable. A slight, non-significant reduction of the inhibition by the immune-dominant TgAb-Fab A was observed 3 and 6 months after (131)I. We conclude that (131)I treatment for GD increases the levels of the complement-activating IgG1 and IgG3 subclasses and does not influence significantly the epitope pattern of TgAb. In autoimmune thyroid disease subclass distribution of autoantibodies is dynamic in spite of a stable epitope pattern.

  16. Thyroglobulin autoantibodies switch to immunoglobulin (Ig)G1 and IgG3 subclasses and preserve their restricted epitope pattern after 131I treatment for Graves' hyperthyroidism: the activity of autoimmune disease influences subclass distribution but not epitope pattern of autoantibodies

    PubMed Central

    Latrofa, F; Ricci, D; Montanelli, L; Piaggi, P; Mazzi, B; Bianchi, F; Brozzi, F; Santini, P; Fiore, E; Marinò, M; Tonacchera, M; Vitti, P

    2014-01-01

    The subclass distribution of thyroglobulin autoantibodies (TgAb) is debated, whereas their epitope pattern is restricted. Radioidine (131I) treatment for Graves' disease (GD) induces a rise in TgAb levels, but it is unknown whether it modifies subclass distribution and epitope pattern of TgAb as well. We collected sera from GD patients before 131I treatment and 3 and 6 months thereafter. We measured total TgAb, TgAb light chains and TgAb subclasses by enzyme-linked immunosorbent assay (ELISA) in 25 patients. We characterized the TgAb epitope pattern in 30 patients by inhibiting their binding to 125-ITg by a pool of four TgAb-Fab (recognizing Tg epitope regions A, B, C and D) and to Tg in ELISA by each TgAb-Fab. Total TgAb immunoglobulin (Ig)G rose significantly (P = 0·024). TgAb κ chains did not change (P = 0·052), whereas TgAb λ chains increased significantly (P = 0·001) and persistently. We observed a significant rise in IgG1 and IgG3 levels after 131I (P = 0·008 and P = 0·006, respectively), while IgG2 and IgG4 levels did not change. The rise of IgG1 was persistent, that of IgG3 transient. The levels of inhibition of TgAb binding to Tg by the TgAb-Fab pool were comparable. A slight, non-significant reduction of the inhibition by the immune-dominant TgAb-Fab A was observed 3 and 6 months after 131I. We conclude that 131I treatment for GD increases the levels of the complement-activating IgG1 and IgG3 subclasses and does not influence significantly the epitope pattern of TgAb. In autoimmune thyroid disease subclass distribution of autoantibodies is dynamic in spite of a stable epitope pattern. PMID:25134846

  17. Randomised trial of low-dose amiodarone in severe congestive heart failure. Grupo de Estudio de la Sobrevida en la Insuficiencia Cardiaca en Argentina (GESICA)

    PubMed

    Doval, H C; Nul, D R; Grancelli, H O; Perrone, S V; Bortman, G R; Curiel, R

    1994-08-20

    In severe heart failure many deaths are sudden and are presumed to be due to ventricular arrhythmias. The GESICA trial evaluated the effect of low-dose amiodarone on two-year mortality in patients with severe heart failure. Our prospective multicentre trial included 516 patients on optimal standard treatment for heart failure. Patients were randomised to 300 mg/day amiodarone (260) or to standard treatment (256). Intention-to-treat analysis showed 87 deaths in the amiodarone group (33.5%) compared with 106 in the control group (41.4%) (risk reduction 28%; 95% CI 4%-45%; log rank test p = 0.024). There were reductions in both sudden death (risk reduction 27%; p = 0.16) and death due to progressive heart failure (risk reduction 23%; p = 0.16). Fewer patients in the amiodarone group died or were admitted to hospital due to worsening heart failure (119 versus 149 in the control group; risk reduction 31%; 95% CI 13-46%; p = 0.0024). The decrease in mortality and hospital admission was present in all subgroups examined and independent of the presence of non-sustained ventricular tachycardia. Side-effects were reported in 17 patients (6.1%); amiodarone was withdrawn in 12. Low-dose amiodarone proved to be an effective and reliable treatment, reducing mortality and hospital admission in patients with severe heart failure independently of the presence of complex ventricular arrhythmias.

  18. Collective secondary cremation in a pit grave: a unique funerary context in Portuguese Chalcolithic burial practices.

    PubMed

    Silva, A M; Leandro, I; Pereira, D; Costa, C; Valera, A C

    2015-02-01

    Perdigões is a large site with a set of ditched enclosures located at Reguengos de Monsaraz, Alentejo, South Portugal. Recently at the central area of this site burnt human remains were found in a pit (#16). This structure had inside human remains, animal bones (namely pig, sheep or goat, cattle, dog, deer and rabbit), shards, ivory idols and arrowheads. All have been subjected to fire and later deposited in that pit, resulting in a secondary disposal of human bones. The recovered fragmented human bones (4845.18 g) correspond to a minimal number of 9 individuals: 6 adults and 3 sub-adults. The aim of this work is to document and interpret this funerary context based on the study of the recovered human remains. For that purpose, observations of all alterations due to fire, such as colour change and type of bone distortion, as well as anthropological data were collected. The data obtained suggest that these human remains were probably intentionally cremated, carefully collected and finally deposited in this pit. The cremation was conducted on probably complete corpses, some of them still fairly fresh and fleshed, as some bones presented thumbnail fractures. The collective cremation of the pit 16 represents an unprecedented funerary context for Portuguese, and Iberian Peninsula, Chalcolithic burial practices. Moreover, it is an example of the increasing diversity of mortuary practices of Chalcolithic human populations described in present Portuguese territory, as well as, in the Iberian Peninsula.

  19. 77 FR 65407 - Native American Graves Protection and Repatriation Review Committee: Notice of Nomination...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-26

    ... nominations submitted by national museum organizations and national scientific organizations. Nominations must... nominator is so authorized on behalf of the identified national museum or scientific organization. 2. A... NAGPRA experience and ability to work effectively as a member of an advisory board. DATES:...

  20. 78 FR 27078 - Native American Graves Protection and Repatriation Act Regulations

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-09

    ... through a commitment to consultation with Indian Tribes and recognition of their right to self-governance.... National Environmental Policy Act This rule does not constitute a major Federal action significantly affecting the quality of the human environment. A detailed statement under the National Environmental...

  1. Graves Disease Induced by Radioiodine Therapy for Toxic Nodular Goiter: A Case Report

    PubMed Central

    Yürekli, Yakup; Cengiz, Arzu; Güney, Engin

    2015-01-01

    Graves’ disease (GD) may be observed as an infrequent adverse effect after radioiodine therapy (RAIT) for toxic thyroid adenoma (TA) and toxic multi nodular goiter (MNG). We present a case of a 55-year-old male with a toxic nodule who was treated with RAI. After therapy, the patient’s serum free triiodothyronine (fT3) and free thyroxine (fT4) levels gradually increased. Antithyroid peroxidase (TPOAb), antithyroglobulin (TgAb) and TSH-receptor antibodies (TRAb) were also positive. Thyroid scintigraphy revealed diffuse intense uptake after four months of RAIT. Radiation-induced GD should be considered in patients with aggravated hyperthyroidism 3-4 months after therapy. PMID:27529890

  2. Role of color Doppler in differentiation of Graves' disease and thyroiditis in thyrotoxicosis

    PubMed Central

    Donkol, Ragab Hani; Nada, Aml Mohamed; Boughattas, Sami

    2013-01-01

    AIM: To evaluate the role of thyroid blood flow assessment by color-flow Doppler ultrasonography in the differential diagnosis of thyrotoxicosis and compare it to technetium pertechnetate thyroid scanning. METHODS: Twenty-six patients with thyrotoxicosis were included in the study. Clinical history was taken and physical examination and thyroid function tests were performed for all patients. Thyroid autoantibodies were measured. The thyroid glands of all patients were evaluated by gray scale ultrasonography for size, shape and echotexture. Color-flow Doppler ultrasonography of the thyroid tissue was performed and spectral flow analysis of both inferior thyroid arteries was assessed. Technetium99 pertechnetate scanning of the thyroid gland was done for all patients. According to thyroid scintigraphy, the patients were divided into two groups: 18 cases with Graves’ disease and 8 cases with Hashimoto’s thyroiditis. All patients had suppressed thyrotropin. The diagnosis of Graves’ disease and Hashimoto’s thyroiditis was supported by the clinical picture and follow up of patients. RESULTS: Peak systolic velocities of the inferior thyroid arteries were significantly higher in patients with Graves’ disease than in patients with thyroiditis (P = 0.004 in the right inferior thyroid artery and P = 0.001 in left inferior thyroid artery). Color-flow Doppler ultrasonography parameters demonstrated a sensitivity of 88.9% and a specificity of 87.5% in the differential diagnosis of thyrotoxicosis. CONCLUSION: Color Doppler flow of the inferior thyroid artery can be used in the differential diagnosis of thyrotoxicosis, especially when there is a contraindication of thyroid scintigraphy by radioactive material in some patients. PMID:23671754

  3. Fluid Simulation in the Movies: Navier and Stokes Must Be Circulating in Their Graves

    NASA Astrophysics Data System (ADS)

    Tessendorf, Jerry

    2010-11-01

    Fluid simulations based on the Incompressible Navier-Stokes equations are commonplace computer graphics tools in the visual effects industry. These simulations mostly come from custom C++ code written by the visual effects companies. Their significant impact in films was recognized in 2008 with Academy Awards to four visual effects companies for their technical achievement. However artists are not fluid dynamicists, and fluid dynamics simulations are expensive to use in a deadline-driven production environment. As a result, the simulation algorithms are modified to limit the computational resources, adapt them to production workflow, and to respect the client's vision of the film plot. Eulerian solvers on fixed rectangular grids use a mix of momentum solvers, including Semi-Lagrangian, FLIP, and QUICK. Incompressibility is enforced with FFT, Conjugate Gradient, and Multigrid methods. For liquids, a levelset field tracks the free surface. Smooth Particle Hydrodynamics is also used, and is part of a hybrid Eulerian-SPH liquid simulator. Artists use all of them in a mix and match fashion to control the appearance of the simulation. Specially designed forces and boundary conditions control the flow. The simulation can be an input to artistically driven procedural particle simulations that enhance the flow with more detail and drama. Post-simulation processing increases the visual detail beyond the grid resolution. Ultimately, iterative simulation methods that fit naturally in the production workflow are extremely desirable but not yet successful. Results from some efforts for iterative methods are shown, and other approaches motivated by the history of production are proposed.

  4. 78 FR 22292 - Native American Graves Protection and Repatriation Review Committee: Notice of Nomination...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-15

    ... religious leaders. The nominee need not be a traditional Indian religious leader. Nominations must include the following information: 1. Nominations by traditional religious leaders: Nominations must be... that he or she is a traditional religious leader. 2. Nominations by Indian tribes or Native...

  5. 77 FR 65406 - Native American Graves Protection and Repatriation Review Committee: Notice of Nomination...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-26

    ... religious leaders. The nominee must be a traditional Indian religious leader. Nominations must include the following information: 1. Nominations by traditional religious leaders: Nominations must be submitted with... she meets the definition of traditional religious leader. 2. Nominations by Indian tribes or...

  6. A Cradle-to-Grave Integrated Approach to Using UNIFORMAT II

    ERIC Educational Resources Information Center

    Schneider, Richard C.; Cain, David A.

    2009-01-01

    The ASTM E1557/UNIFORMAT II standard is a three-level, function-oriented classification which links the schematic phase Preliminary Project Descriptions (PPD), based on Construction Standard Institute (CSI) Practice FF/180, to elemental cost estimates based on R.S. Means Cost Data. With the UNIFORMAT II Standard Classification for Building…

  7. Approach to the Pediatric Patient with Graves’ Disease: When Is Definitive Therapy Warranted?

    DTIC Science & Technology

    2011-03-01

    disease (AITD; GD and autoimmune hypothyroid - ism) has provided evidence for involvement of several loci, including the human leukocyte antigen (HLA...Fluctuating levels of the stimula- tory and inhibitory antibodies can result in an alternating clinical presentation between hyper- and hypothyroidism ...Hepatitis Joint pain Arthralgia J Clin Endocrinol Metab, March 2011, 96(3):580–588 jcem.endojournals.org 583 hypothyroidism . The limiting factor for

  8. Mapping Soil Carbon from Cradle to Grave: 'Omic and Isotope Based Measurements of Root C Transformations

    NASA Astrophysics Data System (ADS)

    Pett-Ridge, J.; Nuccio, E. E.; Shi, S.; Neurath, R.; Brodie, E.; Zhou, J.; Lipton, M. S.; Herman, D.; Firestone, M.

    2014-12-01

    Carbon cycling in the rhizosphere is a nexus of biophysical interactions between plant roots, microorganisms, and the soil organo-mineral matrix. Plant roots are the primary inputs of soil organic C; the presence of roots significantly alters rates of organic matter mineralization by soil microbes. Our research on how roots influence decomposition of soil organic matter in both simplified and complex microcosms uses geochemical characterization, molecular microbiology, isotope tracing, 'omics and novel imaging approaches ('ChipSIP' and 'STXM-SIMS') to trace the fate of isotopically labelled root exudates and plant tissues. Our work seeks to understand the genomic basis for how organic C transformation and decomposition in soil is altered by interactions between plant roots and the soil microbial community (bacteria, archaea, fungi, microfauna). We hypothesize that root-exudate stimulation of soil microbial populations results in the altered expression of transcripts and proteins involved in decomposition of macromolecular C compounds. Using an isotope array that allows us to follow root C into bacterial, fungal, and microfaunal communities, we have tracked movement of 13C from labeled exudates and 15N from labeled root litter into the soil microbial community, and linked this data to 16S profiles and community gene transcripts. By integrating stable isotopes as tracers of natural resource utilization (i.e. root litter), and analysis of the functional properties of the communities that respond to those resources, we can identify the molecular pathways that are stimulated in the soil microbiome in response to root litter, living roots, and their interfaces.

  9. Abrupt onset of muscle dysfunction after treatment for Grave's disease: a case report.

    PubMed

    Hernán Martínez, José; Sánchez, Alfredo; Torres, Oberto; Palermo, Coromoto; Santiago, Mónica; Figueroa, Carlos; Trinidad, Rafael; Mangual, Michelle; Gutierrez, Madeleine; González, Eva; Miranda, María de Lourdes

    2014-01-01

    Myopathy is a known complication of hypothyroidism, commonly characterized by an elevation in Creatine Kinase (CPK) due to increase capillary permeability proportional to the hypothyroid state. Thyroid hormone is important for the expression of fast myofibrillar proteins in the muscle. In hypothyroidism the expression of these proteins are deficient and there is an increase accumulation of slow myofibrillar proteins. A rapid or abrupt descend in thyroid hormones caused by radioiodine therapy after prolonged hyperthyroidism can lead to local hypothyroid state within the muscle tissue, resulting in CPK elevation and hypothyroid myopathy. Hormone replacement leads to resolution of symptoms and normalization of muscle enzymes serum levels.

  10. Pharmacokinetics of methimazole in children and adolescents with Graves' disease. Studies on plasma and intrathyroidal concentrations.

    PubMed

    Okuno, A; Yano, K; Inyaku, F; Suzuki, Y; Sanae, N; Kumai, M; Naitoh, Y

    1987-05-01

    Methimazole concentrations in plasma and in the thyroid glands were measured by means of high-performance liquid chromatography. Pharmacokinetics of methimazole were studied after a single oral dose (175 mumol/m2) in nine children and adolescent who were in the thyrotoxic state. Plasma levels of methimazole showed peak concentrations of 4.4 to 12.6 (median 9.2) mumol/l at 0.5 to 4 h after drug administration. Plasma half-life, area under the curve, and distribution volume ranged from 2.73 to 6.04 h, 32.8 to 77.9 mumol X l-1 X h-1, and 0.516 to 0.913 l/kg, respectively. These pharmacokinetic parameters showed a wide variation among the patients, but were quite reproducible in the same subject. Intrathyroidal concentrations of methimazole were measured in another nine subjects including four adolescents and five adults who underwent thyroidectomy. The drug concentrations in the thyroid glands ranged between 3.5 and 23.8 mumol/kg tissue and were far higher than those in the plasma obtained at the time of surgery. In this series of experiments, the dose of the drug varied from 76 to 319 mumol/m2, time after the last dose to surgery from 5 to 24 h, and the mode of drug administration from a single to three divided doses. Among these variable factors, only the daily dose of methimazole corrected by body surface area showed significant correlation with the intrathyroidal concentration, whereas the time after the last dose of the drug and the mode of drug administration did not.(ABSTRACT TRUNCATED AT 250 WORDS)

  11. L'Equin du Pied dans un Contexte de Brulure Grave - Interet du Bilan Photographique

    PubMed Central

    Girbon, J.P.; Maligot, B.; Coiffier, E.; Gonzalez-Gutierrez, L.; Gaussorgues, C.; Lacroix, P.; Braye, F.

    2008-01-01

    Summary The incorrect position of the foot in talipes equinus is common in the framework of prolonged confinement to bed in a patient in deep sedation. In the context of severe burns, this incorrect position is difficult to prevent and its fixation by cutaneous shrinkage, which is often associated with a musculotendinous fibrosis, constitutes an important functional after-effect. The onset of talipes equinus is insidious and progressive, and it is therefore important to be watchful both in detection and in prevention. Regular photographic assessment makes it possible to predict its appearance and to take appropriate preventive or curative action. PMID:21991119

  12. 77 FR 23196 - Native American Graves Protection and Repatriation Act Regulations

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-18

    ... or brought to the attention of the Department. These proposed amendments revise the rules... inconsistencies in 43 CFR Part 10 have been identified by or brought to the attention of the Department....

  13. Increasing the quality of life from womb to grave: the importance of pregnancy and birth cohorts.

    PubMed

    Kaplan, Bonnie J; Leung, Brenda M; Giesbrecht, Gerald F; Field, Catherine J; Bernier, Francois P; Tough, Suzanne; Cui, Xinjie; Dewey, Deborah

    2013-01-01

    Epigenetics is revealing how "nature is nurtured", with environmental factors such as nutrition, environmental neurotoxicants, and psychological stress influencing DNA expression. In this current opinion paper, we argue that understanding the dynamic interplay between the genome acquired at conception and environmental exposures throughout life requires pregnancy and birth cohorts, and that greater Canadian national commitment to the infrastructure needed for sustaining such cohorts is warranted. We present a framework that is now being implemented in Alberta.

  14. Graves' disease radioiodine-therapy: Choosing target absorbed doses for therapy planning

    SciTech Connect

    Willegaignon, J. Sapienza, M. T.; Coura-Filho, G. B.; Buchpiguel, C. A.; Watanabe, T.; Traino, A. C.

    2014-01-15

    Purpose: The precise determination of organ mass (m{sub th}) and total number of disintegrations within the thyroid gland (A{sup ~}) are essential for thyroid absorbed-dose calculations for radioiodine therapy. Nevertheless, these parameters may vary according to the method employed for their estimation, thus introducing uncertainty in the estimated thyroid absorbed dose and in any dose–response relationship derived using such estimates. In consideration of these points, thyroid absorbed doses for Graves’ disease (GD) treatment planning were calculated using different approaches to estimating the m{sub th} and the A{sup ~}. Methods: Fifty patients were included in the study. Thyroid{sup 131}I uptake measurements were performed at 2, 6, 24, 48, 96, and 220 h postadministration of a tracer activity in order to estimate the effective half-time (T{sub eff}) of {sup 131}I in the thyroid; the thyroid cumulated activity was then estimated using the T{sub eff} thus determined or, alternatively, calculated by numeric integration of the measured time-activity data. Thyroid mass was estimated by ultrasonography (USG) and scintigraphy (SCTG). Absorbed doses were calculated with the OLINDA/EXM software. The relationships between thyroid absorbed dose and therapy response were evaluated at 3 months and 1 year after therapy. Results: The average ratio (±1 standard deviation) betweenm{sub th} estimated by SCTG and USG was 1.74 (±0.64) and that between A{sup ~} obtained by T{sub eff} and the integration of measured activity in the gland was 1.71 (±0.14). These differences affect the calculated absorbed dose. Overall, therapeutic success, corresponding to induction of durable hypothyroidism or euthyroidism, was achieved in 72% of all patients at 3 months and in 90% at 1 year. A therapeutic success rate of at least 95% was found in the group of patients receiving doses of 200 Gy (p = 0.0483) and 330 Gy (p = 0.0131) when m{sub th} was measured by either USG or SCTG and A{sup ~} was determined by the integration of measured {sup 131}I activity in the thyroid gland and based on T{sub eff}, respectively. No statistically significant relationship was found between therapeutic response and patients’ age, administered {sup 131}I activity (MBq), 24-h thyroid {sup 131}I uptake (%) or T{sub eff} (p ≥ 0.064); nonetheless, a good relationship was found between the therapeutic response and m{sub th} (p ≤ 0.035). Conclusions: According to the results of this study, the most effective thyroid absorbed dose to be targeted in GD therapy should not be based on a fixed dose but rather should be individualized based on the patient'sm{sub th} and A{sup ~}. To achieve a therapeutic success (i.e., durable euthyroidism or hypothyroidism) rate of at least 95%, a thyroid absorbed dose of 200 or 330 Gy is required depending on the methodology used for estimating m{sub th} and A{sup ~}.

  15. Taking it to the grave: gender, cultural capital, and ethnicity in Turkish death announcements.

    PubMed

    Ergin, Murat

    Popularly considered a great equalizer, death and the rituals around it nevertheless accentuate social distinctions. The present study focuses on a sample (N = 2554) of death announcements in a major Turkish daily newspaper (Hürriyet) from 1970 to 2006. Out of the liminal position of Turkish death announcements between obituaries and death notices emerges a large decentralized collection of private decisions responding to death, reflecting attitudes toward gender, ethnic/religious minority status and cultural capital, and echoing the aggregate efforts of privileged groups to maintain a particular self-image. Class closures lead to openings for traditionally under-represented minorities, such as Jewish Turkish citizens and citizens of Greek or Armenian origin. Results reveal that signs of status and power in announcements are largely monopolized by men of Turkish-Muslim origins. Although the changes in the genre-characteristics of death announcements are slow, they correspond to major turning points in Turkish social history.

  16. 75 FR 62320 - Safety Zone; Fireworks for USS GRAVELY Commissioning Ceremony, Cape Fear River, Wilmington, NC

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-08

    ... Fear River, Wilmington, NC AGENCY: Coast Guard, DHS. ACTION: Temporary final rule. SUMMARY: The Coast Guard is establishing a safety zone on the navigable waters of Cape Fear River in Wilmington, NC in... fireworks display on the western shore of the Cape Fear River at Battleship Park. The fireworks...

  17. 77 FR 53228 - Native American Graves Protection and Repatriation Review Committee: Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-31

    ...)(3), for review and findings of fact related to the identity or cultural affiliation of human remains..., pursuant to 25 U.S.C. 3006 (c)(3), for review and findings of fact related to the identity or cultural...), for review and findings of fact related to the identity or cultural affiliation of human remains...

  18. Letter from Thomas J Graves on Concerns about National Public Awareness Campaign on Childhood Lead Poisoning

    EPA Pesticide Factsheets

    Request for correction of information by EPA withdrawal from sponsorship and participation in the print and video depictions used in the childhood lead poisoning PSAs are misleading and misrepresent the paint industry

  19. 77 FR 12875 - Proposed Information Collection; Native American Graves Protection and Repatriation Regulations

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-02

    ... remains and NAGPRA cultural items. $ Value of Information collections Annual Annual Avg. time/ Total... personal identifying information in your comment, you should be aware that your entire comment, including your personal identifying information, may be made publicly available at any time. While you can ask...

  20. From cradle to grave: the multiple roles of fibroblast growth factors in neural development.

    PubMed

    Guillemot, François; Zimmer, Céline

    2011-08-25

    The generation of a functional nervous system involves a multitude of steps that are controlled by just a few families of extracellular signaling molecules. Among these, the fibroblast growth factor (FGF) family is particularly prominent for the remarkable diversity of its functions. FGFs are best known for their roles in the early steps of patterning of the neural primordium and proliferation of neural progenitors. However, other equally important functions have emerged more recently, including in the later steps of neuronal migration, axon navigation, and synaptogenesis. We review here these diverse functions and discuss the mechanisms that account for this unusual range of activities. FGFs are essential components of most protocols devised to generate therapeutically important neuronal populations in vitro or to stimulate neuronal repair in vivo. How FGFs promote the development of the nervous system and maintain its integrity will thus remain an important focus of research in the future.

  1. 75 FR 12377 - Native American Graves Protection and Repatriation Act Regulations-Disposition of Culturally...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-15

    ... Culturally Unidentifiable Human Remains; Final Rule #0;#0;Federal Register / Vol. 75 , No. 49 / Monday, March... of Culturally Unidentifiable Human Remains AGENCY: Office of the Secretary, Interior. ACTION: Final... American human remains in the possession or control of museums or Federal agencies. This rule also...

  2. 77 FR 39406 - Safety Zone; Tom Graves Memorial Fireworks, Port Bay, Wolcott, NY

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-03

    .... Coast Guard Sector Buffalo; telephone 716- 843-9343, email SectorBuffaloMarineSafety@uscg.mil . If you... display will be held on Port Bay near Wolcott, NY. The Captain of the Port Buffalo has determined that... Buffalo has determined that this temporary safety zone is necessary to ensure the safety of spectators...

  3. Searching for graves using geophysical technology: field tests with ground penetrating radar, magnetometry, and electrical resistivity.

    PubMed

    Buck, Sabrina C

    2003-01-01

    Field experiments were conducted using three types of geophysical equipment in a variety of situations. The goal of the study was to ascertain the relative utility of this technology for non-geophysical expert forensic professionals searching for buried human remains. The study concludes that the equipment should be used with caution after a critical evaluation of specific field conditions, and more refinement of technical methods and skills should be developed.

  4. "My Grandfather Would Roll over in His Grave": Family Farming and Tree Plantations on Farmland

    ERIC Educational Resources Information Center

    Neumann, Pamela D.; Krahn, Harvey J.; Krogman, Naomi T.; Thomas, Barb R.

    2007-01-01

    In this paper we hypothesize that farmers with a stronger valuation of family farming will be more resistant to converting farmland to tree plantations. Our survey data analysis from 106 farmers in northern Alberta reveals that general opposition to trees on farmland is the strongest predictor of farmers' resistance to the establishment of poplar…

  5. Out of the "Graves of the Polluted Debauches": The Boys of the Cherokee Male Seminary.

    ERIC Educational Resources Information Center

    Mihesuah, Devon

    1991-01-01

    Opened in 1851, the Cherokee Male Seminary was the first nonsectarian secondary school west of the Mississippi River. It fulfilled the goals of the Cherokee national council to prepare students for higher education, promote the Cherokee economy, and expose children to white values and lifestyle. (SV)

  6. 75 FR 17953 - Native American Graves Protection and Repatriation Review Committee Findings Related to the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-08

    ... to the Identity of Cultural Items in the Possession of the American Museum of Natural History, New... American Museum of Natural History. The San Carlos Apache Tribe requested the repatriation of 29 items, and... response, the American Museum of Natural History agreed that the repatriation request satisfied......

  7. Tales from the grave: Opposing autopsy reports from a body exhumed.

    PubMed

    Gunasekera, R S; Brown, A B; Costas, E H

    2012-07-01

    We report an autopsy case of a 42-year-old woman who, when discovered, had been dead in her apartment for approximately 1 week under circumstances involving treachery, assault and possible drug overdose. This case is unique as it involved two autopsies of the deceased by two different medical examiners who reached opposing conclusions. The first autopsy was performed about 10 days after death. The second autopsy was performed after an exhumation approximately 2 years after burial. Evidence collected at the crime scene included blood samples from which DNA was extracted and analysed, fingerprints and clothing containing dried body fluids. The conclusion of the first autopsy was accidental death due to cocaine toxicity; the conclusion of the second autopsy was death due to homicide given the totality of evidence. Suspects 1 and 2 were linked to the death of the victim by physical evidence and suspect 3 was linked by testimony. Suspect 1 received life in prison, and suspects 2 and 3 received 45 and 20 years in prison, respectively. This case indicates that cocaine toxicity is difficult to determine in putrefied tissue and that exhumations can be important in collecting forensic information. It further reveals that the combined findings of medical examiners, even though contradictory, are useful in determining the circumstances leading to death in criminal justice. Thus, this report demonstrates that such criminal circumstances require comparative forensic review and, in such cases, scientific conclusions can be difficult.

  8. From the Cradle to the Grave: The Role of Macrophages in Erythropoiesis and Erythrophagocytosis

    PubMed Central

    Klei, Thomas R. L.; Meinderts, Sanne M.; van den Berg, Timo K.; van Bruggen, Robin

    2017-01-01

    Erythropoiesis is a highly regulated process where sequential events ensure the proper differentiation of hematopoietic stem cells into, ultimately, red blood cells (RBCs). Macrophages in the bone marrow play an important role in hematopoiesis by providing signals that induce differentiation and proliferation of the earliest committed erythroid progenitors. Subsequent differentiation toward the erythroblast stage is accompanied by the formation of so-called erythroblastic islands where a central macrophage provides further cues to induce erythroblast differentiation, expansion, and hemoglobinization. Finally, erythroblasts extrude their nuclei that are phagocytosed by macrophages whereas the reticulocytes are released into the circulation. While in circulation, RBCs slowly accumulate damage that is repaired by macrophages of the spleen. Finally, after 120 days of circulation, senescent RBCs are removed from the circulation by splenic and liver macrophages. Macrophages are thus important for RBCs throughout their lifespan. Finally, in a range of diseases, the delicate interplay between macrophages and both developing and mature RBCs is disturbed. Here, we review the current knowledge on the contribution of macrophages to erythropoiesis and erythrophagocytosis in health and disease. PMID:28210260

  9. 77 FR 74875 - Native American Graves Protection and Repatriation Review Committee Findings Related to the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-18

    ... deriving from the Snail House and one catalogued object deriving from the Eagle's Nest House that are in... ). SUPPLEMENTARY INFORMATION: Since 1924, thirty-eight cataloged objects deriving from the T x Hit, or Snail House (Snail House), of the T'akdeintaan Clan of Tlingit Indians from Hoonah, Alaska have been in...

  10. Mapping Soil Carbon from Cradle to Grave: C Transformations of Root Exudates and Plant Litter

    NASA Astrophysics Data System (ADS)

    Pett-Ridge, J.; Keiluweit, M.; Nuccio, E.; Bougoure, J.; Weber, P. K.; Brodie, E.; Mayali, X.; Shi, S.; Hwang, M.; Thelen, M.; Firestone, M.; Kleber, M.; Nico, P. S.

    2013-12-01

    Carbon cycling in the rhizosphere is a nexus of biophysical interactions between plant roots, microorganisms, and the soil organo-mineral matrix. Plant roots provide 30-40% of soil organic C inputs, accelerate the rate of organic matter mineralization by ~10X, and support an active microhabitat for microbial transformation of soil C. Our research on how roots influence decomposition of soil organic matter in both simplified and complex microcosms uses geochemical characterization, molecular microbiology, isotope tracing, metabolomics and novel imaging approaches (';ChipSIP' and ';STXM-SIMS') to trace the fate of isotopically labelled root exudates and plant tissues. Our previous work suggests root exudates drive O2 limitation, alter metal chemistry and mineralogy, and influence the availability of SOM. Our most recent experiments using synthetic rhizospheres were designed to identify the role of root exudates on ligno-cellulose decomposition in soils. Cultures of 13C/15N-labeled single plant cells (lignin-rich tracheary elements) were added to rhizosphere microcosm soils, and their decomposition followed under the influence of different root exudates using the dual imaging approach ';STXM-SIMS'. Using this combination of X-ray spectromicroscopy and NanoSIMS, we imaged the deconstruction of 13C/15N-labeled ligno-cellulose in situ, and mapped associations of plant cell-derived decomposition products with specific soil minerals. We've also looked at microbial community function in the more complex rhizospheres surrounding roots of the annual grass Avena fatua. Using an isotope array that allows us to follow root C into bacterial, fungal, and microfaunal communities, we tracked the movement of 13C from labeled exudates and 15N from labeled root litter into the soil microbial community. Our results indicate that the microbial communities involved in litter decomposition differ in rhizosphere versus bulk soils, which may have implications for carbon stabilization in soil.

  11. Lamarck rises from his grave: parental environment-induced epigenetic inheritance in model organisms and humans.

    PubMed

    Wang, Yan; Liu, Huijie; Sun, Zhongsheng

    2017-02-20

    Organisms can change their physiological/behavioural traits to adapt and survive in changed environments. However, whether these acquired traits can be inherited across generations through non-genetic alterations has been a topic of debate for over a century. Emerging evidence indicates that both ancestral and parental experiences, including nutrition, environmental toxins, nurturing behaviour, and social stress, can have powerful effects on the physiological, metabolic and cellular functions in an organism. In certain circumstances, these effects can be transmitted across several generations through epigenetic (i.e. non-DNA sequence-based rather than mutational) modifications. In this review, we summarize recent evidence on epigenetic inheritance from parental environment-induced developmental and physiological alterations in nematodes, fruit flies, zebrafish, rodents, and humans. The epigenetic modifications demonstrated to be both susceptible to modulation by environmental cues and heritable, including DNA methylation, histone modification, and small non-coding RNAs, are also summarized. We particularly focus on evidence that parental environment-induced epigenetic alterations are transmitted through both the maternal and paternal germlines and exert sex-specific effects. The thought-provoking data presented here raise fundamental questions about the mechanisms responsible for these phenomena. In particular, the means that define the specificity of the response to parental experience in the gamete epigenome and that direct the establishment of the specific epigenetic change in the developing embryos, as well as in specific tissues in the descendants, remain obscure and require elucidation. More precise epigenetic assessment at both the genome-wide level and single-cell resolution as well as strategies for breeding at relatively sensitive periods of development and manipulation aimed at specific epigenetic modification are imperative for identifying parental environment-induced epigenetic marks across generations. Considering their diverse epigenetic architectures, the conservation and prevalence of the mechanisms underlying epigenetic inheritance in non-mammals require further investigation in mammals. Interpretation of the consequences arising from epigenetic inheritance on organisms and a better understanding of the underlying mechanisms will provide insight into how gene-environment interactions shape developmental processes and physiological functions, which in turn may have wide-ranging implications for human health, and understanding biological adaptation and evolution.

  12. 78 FR 5205 - Native American Graves Protection and Repatriation Review Committee Findings Related to the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-24

    ...@nps.gov ). SUPPLEMENTARY INFORMATION: Since 1969, a Tlingit Teeyh ttaan Clan Y il aan Kaawu Naa s'aaxw... from the Tlingit Teeyh ttaan Clan, the transferor consented to transfer possession, the...

  13. Turning in Their Graves? A Tale of Two Coalitions--and What Happened in Between

    ERIC Educational Resources Information Center

    Gillard, Derek

    2013-01-01

    Amid the horrors of the Second World War, a group of Board of Education officials met to plan a new public education system which would be fair to and free for all. In the seventy years since then, successive governments have not only failed to live up to their vision but have increasingly sought to interfere with the teaching and learning process…

  14. From Cradle To Grave: Chandra Discovers The History Of Black Hole X-Ray Jets

    NASA Astrophysics Data System (ADS)

    2002-10-01

    For the first time, astronomers have tracked the life cycle of X-ray jets from a black hole. A series of images from NASA's Chandra X-ray Observatory has revealed that as the jets evolved, they traveled at near light speed for several years before slowing down and fading. "Watching these jets slow down and disappear is like watching a time-lapse movie of the rise and fall of the Bronze Age," said Stephane Corbel of the University of Paris VII and the French Atomic Energy Commission in Saclay, lead author of a paper in the October 4th issue of the journal Science. "Since the jets came from a stellar black hole in our galaxy, we watched in a few years developments that would have taken thousands of years to occur around a supermassive black hole in a distant galaxy." Astronomers have been using Chandra and radio telescopes to observe two opposing jets of high-energy particles emitted following an outburst, first detected in 1998 by NASA's Rossi X-ray Timing Explorer, from the double-star system XTE J1550-564. The X-ray jets, which require a continuous source of trillion-volt electrons to remain bright, were observed moving at about half the speed of light. Four years later, they are now more than three light years apart and slowing down. One of the jets has recently been observed to fade. XTE J1550-564 Time-Lapse Movie XTE J1550-564 Time-Lapse Movie "The ejection of jets from stellar and supermassive black holes is a common occurrence in the universe, so it is extremely important to understand the process," said John Tomsick of the University of California, San Diego, and author of an Astrophysical Journal paper scheduled for January 2003 publication describing the research. "For the first time, we have observed a jet from the initial explosion until it slowed and faded." The observations indicate that one jet, the eastern jet, is moving along a line tilted toward the Earth whereas the western jet is pointed away from the Earth. This alignment explains why the eastern jet appears to have traveled farther from the black hole than the western one. However, with this alignment, the eastern jet should be brighter than the western one, while the western jet was actually three times brighter. "This poses a puzzle. The simple model for jets doesn't explain what we are seeing," said Philip Kaaret of the Harvard-Smithsonian Center for Astrophysics in Cambridge, Mass., and lead author of another upcoming Astrophysical Journal paper on XTE J1550-564. "Either the black hole may somehow be feeding more energy into the western jet, or that jet has run into a dense cloud." XTE J1550-564 Animations Animation of an X-ray Binary System As jets plow through the interstellar gas, the resistance of the gas slows them down like air resistance slows down moving objects on Earth. Although all jets are believed to decelerate in this way, the observations of XTE J1550-564 mark the first time jets have been caught in the act of slowing down. The observed deceleration underscores the value of small, stellar black holes in our galaxy for studying similar processes that occur in distant quasars and active galactic nuclei. XTE J1550-564, which is about 17,000 light years from Earth, was observed with Chandra's Advanced CCD Imaging Spectrometer and the High Energy Transmission Grating instruments. Radio data used in this study were obtained by the Australia Telescope Compact Array. NASA's Marshall Space Flight Center in Huntsville, Ala., manages the Chandra program for the Office of Space Science, Washington, and TRW, Inc., Redondo Beach, Calif., is the prime contractor. The Smithsonian's Chandra X-ray Center controls science and flight operations from Cambridge, Mass.

  15. Anticonvulsants: choices and costs. Based on a presentation by Nina Graves, PharmD, FCCP.

    PubMed

    1998-09-01

    Epilepsy is not a single disease but a constellation of different syndromes and different seizure types. Consequently, establishing a diagnosis on which to base therapy can be complicated. The most commonly used antiepileptic drugs (AEDs) fall into two broad categories: the older AEDs introduced between 1912 and 1973 and the newer AEDs introduced since 1993. The older AEDs have many off-label uses, whereas the newer AEDs, with the exception of gabapentin and lamotrigine, are used exclusively for the treatment of epilepsy. All AEDs are associated to varying degrees with adverse effects on the central nervous system, gastrointestinal tract, blood, liver, and skin. The older AEDs are less expensive than the newer AEDs, but because the newer agents are available in both titration and maintenance-dose strengths, cost savings are possible. Use of the high-strength dose of a newer AED represents a huge cost saving per day compared with using the low-strength dose. Further savings can be realized in the managed care arena if pharmacists are involved in getting patients onto high-strength tablets as quickly as possible.

  16. Towards Image Documentation of Grave Coverings and Epitaphs for Exhibition Purposes

    NASA Astrophysics Data System (ADS)

    Pomaska, G.; Dementiev, N.

    2015-08-01

    Epitaphs and memorials as immovable items in sacred spaces provide with their inscriptions valuable documents of history. Today not only photography or photos are suitable as presentation material for cultural assets in museums. Computer vision and photogrammetry provide methods for recording, 3D modelling, rendering under artificial light conditions as well as further options for analysis and investigation of artistry. For exhibition purposes epitaphs have been recorded by the structure from motion method. A comparison of different kinds of SFM software distributions could be worked out. The suitability of open source software in the mesh processing chain from modelling up to displaying on computer monitors should be answered. Raspberry Pi, a computer in SoC technology works as a media server under Linux applying Python scripts. Will the little computer meet the requirements for a museum and is the handling comfortable enough for staff and visitors? This contribution reports about the case study.

  17. 76 FR 12132 - Native American Graves Protection and Repatriation Review Committee: Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-04

    ..., pursuant to 25 U.S.C. 3006(c)(3), for review and findings of fact related to the identity or cultural... consider requests, pursuant to 25 U.S.C. 3006(c)(3), for review and findings of fact related to the..., where consensus among affected parties is unclear or uncertain. A request for findings of fact...

  18. Danish Passage Graves, "Spring/Summer/Fall full Moons" and Lunar Standstills

    NASA Astrophysics Data System (ADS)

    Clausen, Claus Jørgen

    2015-05-01

    The author proposes and discusses a model for azimuth distribution which involves the criterion of a 'spring full moon' (or a 'fall full moon') proposed by Marciano Da Silva (Da Silva 2004). The model is based on elements of the rising pattern of the summer full moon combined with directions pointing towards full moonrises which occur immediately prior to lunar standstill eclipses and directions aimed at the points at which these eclipses begin. An observed sample of 153 directions has been compared with the proposed model, which has been named the lunar 'season pointer'. Statistical tests show that the model fits well with the observed sample within the azimuth interval of 54.5° to 156.5°. The conclusion made is that at least the 'season pointer' section of the model used could very well explain the observed distribution.

  19. 75 FR 70028 - Native American Graves Protection and Repatriation Review Committee: Meeting 2253-665

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-16

    ... and findings of fact related to the identity or cultural affiliation of human remains or other.... 3006 (c)(3), for review and findings of fact related to the identity or cultural affiliation of human... identity or cultural affiliation of human remains or other cultural items, or the return of such items....

  20. [Risk prescription associated to treatment at home of the elderly patient when admitted to the hospital].

    PubMed

    Iniesta-Navalón, C; Urbieta-Sanz, E; Gascón-Cánovas, J J; Rentero-Redondo, L; Cabello Muriel, A; García-Molina, C

    2013-01-01

    Objetivo: Determinar la prevalencia, la incidencia de error y el daño potencial asociado a determinadas prescripciones señaladas como de riesgo de error de medicación en el tratamiento domiciliario de pacientes ancianos que ingresan en el hospital, así como los factores asociados a su aparición. Material y métodos: Estudio transversal descriptivo. Se incluyeron los pacientes de edad igual o mayor a 65 años que ingresaron en el hospital desde el servicio de urgencias durante el último trimestre de 2009.Para el análisis estadístico se utilizó el programa SPSSv15.0. Resultados: Se incluyeron en el estudio 324 pacientes. Se identificaron 1176 (47%) prescripciones de riesgo en el 91% de los pacientes. La prescripción de riesgo más relevante fue la prescripción de medicamentos de alto riesgo (51.5% pacientes) que presentó una incidencia de error de 88/100 pacientes con medicamentos de alto riesgo, de los cuales en 68 pacientes fue grave. Los factores asociados a la presencia de error grave/moderado ocasionado por prescripciones de riesgo fueron tener enfermedad respiratoria crónica o diabetes y la polimedicación. Conclusiones: Se deben priorizar actuaciones dirigidas a disminuir errores por medicamentos de alto riesgo.

  1. [Hematopoietic stem cells transplant in patients with common variable immunodeficiency. Is a therapeutic option?

    PubMed

    Cambray-Gutiérrez, Julio César; Herrera-Sánchez, Diana Andrea; López-Pérez, Patricia; Chávez-García, Aurora; Yamazaki-Nakashimada, Marco Antonio

    2017-01-01

    Antecedentes: Los pacientes con inmunodeficiencia común variable presentan mayor incidencia de infecciones sinopulmonares y gastrointestinales, así como de enfermedades linfoproliferativas y autoinmunes. El tratamiento de elección es el reemplazo con gammaglobulina humana. El trasplante de células progenitoras hematopoyéticas es una modalidad terapéutica no convencional. Caso clínico: Mujer de 26 años de edad sin antecedentes heredofamiliares de inmunodeficiencias primarias ni consanguinidad, con procesos repetidos de otitis, sinusitis, gastroenteritis y bronquitis desde la infancia. En la adolescencia fue diagnosticada con inmunodeficiencia común variable; se le prescribió gammaglobulina intravenosa, antimicrobianos de amplio espectro y macrólidos. A los 22 años se le realizó trasplante de células progenitoras hematopoyéticas por continuar con infecciones severas. A los 4 meses del trasplante se le diagnosticó hipotiroidismo e insuficiencia ovárica. Durante los siguientes 3 años no presentó infecciones, pero a los 25 años manifestó púrpura trombocitopénica inmune, que persistía al momento de este informe con enfermedad de Raynaud e infecciones reincidentes de vías respiratorias altas. Es tratada con gammaglobulina intravenosa y profilaxis con claritromicina, sin esteroides ni danazol. Conclusiones: Dada la alta tasa de morbimortalidad asociada y falla en la reconstitución inmunológica, el trasplante de células progenitoras hematopoyéticas deberá ser cuidadosamente evaluado en pacientes con infecciones sin respuesta al tratamiento o con enfermedades linfoproliferativas.

  2. [THE FRENCH ANATOMICAL XAVIER BICHAT (1771 - 1802). FUNDATOR OF DOCTRINE OF TISSUES. BIOGRAPHICAL MEMORY BEFORE HIS GRAVE].

    PubMed

    Pérez García, José Manuel

    2014-01-01

    It is reminded to Marie Francois Xavier Bichat (1771-1802), French physician who figure in the pages of the history of the Universal Medicine. With him begins the anatomic mentality in the nineteenth century, which in 1801 introduced the concept of tissue in his book "Anatomie Generale". With unprecedented nature is disclosed his tomb in Paris' Pere Lachaise cemetery visited by the author, fact that motivated before it about his memories and historical work, which appears in the communication, as a tribute to his memory.

  3. A case of acute oesophageal necrosis (AEN) in a hypothermic patient. The grave prognosis of the black oesophagus.

    PubMed

    Salem, George A; Ahluwalia, Sumit; Guild, Ralph T

    2015-01-01

    Acute oesophageal necrosis, also known as black oesophagus, is a rare, and potentially lethal syndrome which is often diagnosed incidentally during upper endoscopy for evaluation of upper gastrointestinal bleed. It is characterised by diffuse circumferential black mucosal discolouration in the distal oesophagus secondary to necrosis that may extend proximally to involve variable length of the oesophagus. One theory of pathogenesis is that the relatively low perfusion state in the distal areas of the oesophagus makes it susceptible to mucosal injury. We present a case of acute oesophageal necrosis in a 62year-old lady with history of alcoholic cirrhosis who presented with haematemesis and severe hypothermia, and was eventually found to have acute oesophageal necrosis.

  4. Higher Education over a Lifespan: A Gown to Grave Assessment of a Lifelong Relationship between Universities and Their Graduates

    ERIC Educational Resources Information Center

    Gallo, Maria L.

    2013-01-01

    Graduation day often includes an oration by a Vice-Chancellor or President reminding the newest cohort of alumni to "keep in touch" with their alma mater. Often, graduates dismiss this invitation instead of embracing this lifelong opportunity. As the only constant -- and constantly growing -- stakeholder group of higher education…

  5. Interactive effects of temperature and pCO2 on sponges: from the cradle to the grave.

    PubMed

    Bennett, Holly M; Altenrath, Christine; Woods, Lisa; Davy, Simon K; Webster, Nicole S; Bell, James J

    2017-05-01

    As atmospheric CO2 concentrations rise, associated ocean warming (OW) and ocean acidification (OA) are predicted to cause declines in reef-building corals globally, shifting reefs from coral-dominated systems to those dominated by less sensitive species. Sponges are important structural and functional components of coral reef ecosystems, but despite increasing field-based evidence that sponges may be 'winners' in response to environmental degradation, our understanding of how they respond to the combined effects of OW and OA is limited. To determine the tolerance of adult sponges to climate change, four abundant Great Barrier Reef species were experimentally exposed to OW and OA levels predicted for 2100, under two CO2 Representative Concentration Pathways (RCPs). The impact of OW and OA on early life-history stages was also assessed for one of these species to provide a more holistic view of species impacts. All species were generally unaffected by conditions predicted under RCP6.0, although environmental conditions projected under RCP8.5 caused significant adverse effects: with elevated temperature decreasing the survival of all species, increasing levels of tissue necrosis and bleaching, elevating respiration rates and decreasing photosynthetic rates. OA alone had little adverse effect, even under RCP8.5 concentrations. Importantly, the interactive effect of OW and OA varied between species with different nutritional modes, with elevated pCO2 exacerbating temperature stress in heterotrophic species but mitigating temperature stress in phototrophic species. This antagonistic interaction was reflected by reduced mortality, necrosis and bleaching of phototrophic species in the highest OW/OA treatment. Survival and settlement success of Carteriospongia foliascens larvae were unaffected by experimental treatments, and juvenile sponges exhibited greater tolerance to OW than their adult counterparts. With elevated pCO2 providing phototrophic species with protection from elevated temperature, across different life stages, climate change may ultimately drive a shift in the composition of sponge assemblages towards a dominance of phototrophic species.

  6. Monoclonal approach to investigate whether the idiotypic network plays a role in the formation of Graves' autoantibodies

    SciTech Connect

    Hill, B.L.

    1987-01-01

    A monoclonal antibody (LE4) specific for a thyrotropin (TSH) epitope shared by beta subunits of bovine (b), ovine (o), and human (h) TSH was obtained by immunization of mice with mixtures of purified bTSH and hTSH. LE4 also bound the beta subunits of bovine, ovine, and human lutropin (LH), and human chorionic gonadotropin (hCG) but not the beta subunits of porcine LH and TSH. Preliminary studies with deglycosylated (dg) bTSH and dg-hCG indicated that part of the epitope may be carbohydrate. Preincubation of LE4 with (/sup 125/I)bTSH inhibited the binding of the hormone to TSH receptor of bovine thyroid membranes in a dose-dependent manner. LE4 also inhibited TSH-induced mitogenesis of FRTL-5 cells. We conclude that LE4 binds to a site on the bTSH molecule that participates in high affinity binding of hormone to TSH receptor.

  7. Industrial biotechnology for the production of bio-based chemicals--a cradle-to-grave perspective.

    PubMed

    Hatti-Kaul, Rajni; Törnvall, Ulrika; Gustafsson, Linda; Börjesson, Pål

    2007-03-01

    Shifting the resource base for chemical production from fossil feedstocks to renewable raw materials provides exciting possibilities for the use of industrial biotechnology-based process tools. This review gives an indication of the current developments in the transition to bio-based production, with a focus on the production of chemicals, and points out some of the challenges that exist in the large-scale implementation of industrial biotechnology. Furthermore, the importance of evaluating the environmental impact of bio-based products with respect to their entire life cycle is highlighted, demonstrating that the choice of the raw material often turns out to be an important parameter influencing the life cycle performance.

  8. Brulure grave du membre inferieur par l’association d’eau chaude et de citrullus colocynthis

    PubMed Central

    Fejjal, N.; Gharib, N.E.; El Mazouz, S.; Abbassi, A.; Belmahi, A.

    2011-01-01

    Summary Les auteurs rapportent le cas d’un patient brûlé gravement à cause de l’usage de Citrullus colocynthis comme plante médicinale avec de l’eau chaude. Ceci a abouti à une carbonisation de son pied et à son amputation. Les auteurs font une mise au point sur cette plante et sur sa toxicité. PMID:22262968

  9. From cradle-to-grave at the nanoscale: gaps in U.S. regulatory oversight along the nanomaterial life cycle.

    PubMed

    Beaudrie, Christian E H; Kandlikar, Milind; Satterfield, Terre

    2013-06-04

    Engineered nanomaterials (ENMs) promise great benefits for society, yet our knowledge of potential risks and best practices for regulation are still in their infancy. Toward the end of better practices, this paper analyzes U.S. federal environmental, health, and safety (EHS) regulations using a life cycle framework. It evaluates their adequacy as applied to ENMs to identify gaps through which emerging nanomaterials may escape regulation from initial production to end-of-life. High scientific uncertainty, a lack of EHS and product data, inappropriately designed exemptions and thresholds, and limited agency resources are a challenge to both the applicability and adequacy of current regulations. The result is that some forms of engineered nanomaterials may escape federal oversight and rigorous risk review at one or more stages along their life cycle, with the largest gaps occurring at the postmarket stages, and at points of ENM release to the environment. Oversight can be improved through pending regulatory reforms, increased research and development for the monitoring, control, and analysis of environmental and end-of-life releases, introduction of periodic re-evaluation of ENM risks, and fostering a "bottom-up" stewardship approach to the responsible management of risks from engineered nanomaterials.

  10. 76 FR 39007 - Native American Graves Protection and Repatriation Act Regulations- Definition of “Indian Tribe”

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-05

    ... and Repatriation Act Regulations-- Definition of ``Indian Tribe'' AGENCY: Office of the Secretary... definition of ``Indian tribe,'' because it is inconsistent with the statutory definition of that term. DATES... definition of ``Indian tribe'' into NAGPRA verbatim from the Indian Self Determination and...

  11. Hands-on Space Experiments from Cradle to Grave: The Role of the Sounding Rocket Program in Developing Human Infrastructure

    NASA Astrophysics Data System (ADS)

    Chakrabarti, S.

    2005-12-01

    Sounding rockets in university research provide a unique opportunity to train future space scientists and engineers. Besides fitting the typical schedule of a student, they allow a small group of students to be involved in all aspects of a space project from its inception through execution to a conclusion involving scientific discovery. Furthermore, universities with sounding rocket programs are cradles of innovations where the interdisciplinary nature of space experimentation is nurtured. These programs have formed the core research of many of the current Principal Investigators of NASA Space Science Missions. Additionally, they typically involve a large number of undergraduate students who gain in-depth experience into well-defined and critical components of a space mission. Researchers involved in sounding rocket experiments typically develop the science payload consisting of one or more instrument with the NASA Sounding Rocket Program Office (SRPO) providing all support necessary to make the science program a success. Unlike satellite missions, the sounding rocket experiments offer an opportunity to take more risks in terms of their science return. Some of these risks come in the form of new technology invention and development. Sounding rockets, with their flexible schedule and fewer formal procedural requirements, thus play an important role in maturing technology and developing new capabilities for satellite missions. The Student Launch Program was designed by NASA to provide a new opportunity where space science took a back seat to education and training. The program required that the proposing team provide components such as the nose cone, power and telemetry systems, which are typically provided to rocket experimenters by SRPO. The students involved in such programs thus gained invaluable experience with "mini-satellite" missions. We believe that they are essential for the long-term vitality of the space program and maintaining a technology-savvy workforce of the 21st Century. In this talk we will highlight the unique aspects of several sounding rocket experiments. We will also describe a Student Launch Program where the proposal was developed as a class project in the astronomy department at Boston University and the flight hardware were built through the Senior Design Projects class in the College of Engineering.

  12. The search for "Yvonne": a case example of the delineation of a grave using near-surface geophysical methods.

    PubMed

    Nobes, D C

    2000-05-01

    Shallow electromagnetic (EM) and ground-penetrating radar (GPR) surveys were conducted in an area north of Auckland, New Zealand to assist the search for human remains. The body had been buried for almost 12 years in a plantation forest that was irregularly disrupted and modified by tree harvesting and the partial removal of stumps. EM identified anomalous areas of potential interest, because a target need only be nearby to generate an EM response. GPR was then used to map subsurface layering, layering disruption, and buried objects, immediately adjacent to an EM anomaly. Because of the nature of the site, numerous geophysical anomalies were present. GPR was particularly sensitive to site disturbance resulting from the forestry operations. An isolated EM anomaly on the fringes of an expanded survey area was coincident with the location of the body. Whether for criminal investigations or for archaeological work, a combination of geophysical techniques is recommended.

  13. 78 FR 31570 - Prospective Grant of a Start-Up Exclusive Patent License Agreement: Treatment of Graves' Disease...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-24

    ... directed to: Lauren Nguyen-Antczak, Ph.D., Licensing and Patenting Manager, Office of Technology Transfer... turned on, and (b) inverse agonists that turn off active TSHR. Both categories of antagonists may...

  14. A Metabolic Inhibitory Cocktail for Grave Cancers: Metformin, Pioglitazone and Lithium Combination in Treatment of Pancreatic Cancer and Glioblastoma Multiforme.

    PubMed

    Elmaci, İlhan; Altinoz, Meric A

    2016-10-01

    Pancreatic cancer (PC) and glioblastoma multiforme (GBM) are among the human cancers with worst prognosis which require an urgent need for efficient therapies. Here, we propose to apply to treat both malignancies with a triple combination of drugs, which are already in use for different indications. Recent studies demonstrated a considerable link between risk of PC and diabetes. In experimental models, anti-diabetogenic agents suppress growth of PC, including metformin (M), pioglitazone (P) and lithium (L). L is used in psychiatric practice, yet also bears anti-diabetic potential and selectively inhibits glycogen synthase kinase-3 beta (GSK-3β). M, a biguanide class anti-diabetic agent shows anticancer activity via activating AMP-activated protein kinase (AMPK). Glitazones bind to PPAR-γ and inhibit NF-κB, triggering cell proliferation, apoptosis resistance and synthesis of inflammatory cytokines in cancer cells. Inhibition of inflammatory cytokines could simultaneously decrease tumor growth and alleviate cancer cachexia, having a major role in PC mortality. Furthermore, mutual synergistic interactions exist between PPAR-γ and GSK-3β, between AMPK and GSK-3β and between AMPK and PPAR-γ. In GBM, M blocks angiogenesis and migration in experimental models. Very noteworthy, among GBM patients with type 2 diabetes, usage of M significantly correlates with better survival while reverse is true for sulfonylureas. In experimental models, P synergies with ligands of RAR, RXR and statins in reducing growth of GBM. Further, usage of P was found to be lesser in anaplastic astrocytoma and GBM patients, indicating a protective effect of P against high-grade gliomas. L is accumulated in GBM cells faster and higher than in neuroblastoma cells, and its levels further increase with chronic exposure. Recent studies revealed anti-invasive potential of L in GBM cell lines. Here, we propose that a triple-agent regime including drugs already in clinical usage may provide a metabolic adjuvant therapy for PC and GBM.

  15. Beyond the material grave: Life Cycle Impact Assessment of leaching from secondary materials in road and earth constructions.

    PubMed

    Schwab, Oliver; Bayer, Peter; Juraske, Ronnie; Verones, Francesca; Hellweg, Stefanie

    2014-10-01

    In industrialized countries, large amounts of mineral wastes are produced. They are re-used in various ways, particularly in road and earth constructions, substituting primary resources such as gravel. However, they may also contain pollutants, such as heavy metals, which may be leached to the groundwater. The toxic impacts of these emissions are so far often neglected within Life Cycle Assessments (LCA) of products or waste treatment services and thus, potentially large environmental impacts are currently missed. This study aims at closing this gap by assessing the ecotoxic impacts of heavy metal leaching from industrial mineral wastes in road and earth constructions. The flows of metals such as Sb, As, Pb, Cd, Cr, Cu, Mo, Ni, V and Zn originating from three typical constructions to the environment are quantified, their fate in the environment is assessed and potential ecotoxic effects evaluated. For our reference country, Germany, the industrial wastes that are applied as Granular Secondary Construction Material (GSCM) carry more than 45,000 t of diverse heavy metals per year. Depending on the material quality and construction type applied, up to 150 t of heavy metals may leach to the environment within the first 100 years after construction. Heavy metal retardation in subsoil can potentially reduce the fate to groundwater by up to 100%. One major challenge of integrating leaching from constructions into macro-scale LCA frameworks is the high variability in micro-scale technical and geographical factors, such as material qualities, construction types and soil types. In our work, we consider a broad range of parameter values in the modeling of leaching and fate. This allows distinguishing between the impacts of various road constructions, as well as sites with different soil properties. The findings of this study promote the quantitative consideration of environmental impacts of long-term leaching in Life Cycle Assessment, complementing site-specific risk assessment, for the design of waste management strategies, particularly in the construction sector.

  16. Storm deposits as graves in Early Life: the Fezouata Lagerstätte case (Lower Ordovician, Morocco)

    NASA Astrophysics Data System (ADS)

    Vaucher, Romain; Pittet, Bernard; Hormière, Hélène; Martin, Emmanuel L. O.; Lefebvre, Bertrand

    2016-04-01

    The Fezouata Shale (Early Ordovician, Morocco) is renowned in the palaeontological community for its Konservat-Lagerstätte (Tremadocian in age) that yielded thousands of exceptionally well-preserved fossils (EPF) from the Great Ordovician Biodiversification Event. Lower Ordovician deposits in the central Anti-Atlas Mountain (Zagora area) are expressed by the Fezouata Shale and the Zini Formation. They consist in ca. 900m of siltstones and sandstones deposited in an epicontinental sea at the periphery of the Gondwanaland. Sedimentologic field analysis and sequence analysis were achieved on ten stratigraphic sections in order to constrain the palaeoenvironmental context of the Fezouata Biota and to predict the location (geographically and stratigraphically) of new Lagerstätten. Sedimentary structures (cm- to m-scale symmetrical ripples) and geometries (lobe, lobe-channel) point to storm dominance on the sedimentation but peculiar sedimentary features suggest a tide modulation. Thus, a wave-dominated tide-modulated model of deposition recording proximal offshore to shoreface environments for the Fezouata Shale and shoreface to foreshore environments for the overlying Zini Fm is proposed. Layers yielding EPF are argillaceous siltstones (with wave ripples of cm-scale wavelength) always overlain by fine-grained sandstones (distal storm deposits, few cm-thick, several m-long, with cm- to dm-scale hummocky cross-stratifications). Fast burying by storm deposits appear to be of prime importance to initiate the exceptional preservation of the soft tissues of animals in the fossil record. According to the model of deposition it correspond to environments close to the storm weather wave base. Lower Ordovician succession was deposited during a 2nd order cycle, although 3rd and 4th order cycles were also identified. Encoding these different orders of sea level fluctuations giving a value of "1" for the deepest part of sequences (for each order) and a value of "0" for the shallowest, a reconstruction of the sea level fluctuation is then proposed. This reconstruction clearly highlights the stratigraphic position of the today discovered Lagerstätte. It also suggests that a second, younger (Floian in age) stratigraphic interval has very comparable sedimentary conditions in terms of facies and sea level, and has the potential for being a new Lagerstätte in the Fezouata Shale.

  17. Osmotic demyelination syndrome complicating diabetes with anti-glutamic acid decarboxylase antibodies and Graves' disease: A case report.

    PubMed

    Tajitsu, Machiko; Yamada, Tsutomu; Cao, Xia; Fukui, Ayako; Nagai, Junko; Yambe, Yuko; Murase, Takashi; Okada, Hisashi

    2016-01-01

    ODS associated with hyperglycemia is rare, with few reports.Immune responses have been recently reported as a mechanism of ODS onset. In the present case, an autoimmune predisposition may have contributed to ODS pathogenesis.

  18. Beyond the material grave: Life Cycle Impact Assessment of leaching from secondary materials in road and earth constructions

    SciTech Connect

    Schwab, Oliver; Bayer, Peter; Juraske, Ronnie; Verones, Francesca; Hellweg, Stefanie

    2014-10-15

    Highlights: • We model environmental impacts of leaching from secondary construction material. • Industrial wastes in construction contain up to 45,000 t heavy metals per year (D). • In a scenario, 150 t are leached to the environment within 100 years after construction. • All heavy metals but As, Sb and Mo are adsorbed by 20 cm subsoil in this scenario. • Environmental impacts depend on material, pollutant, construction type, and geography. - Abstract: In industrialized countries, large amounts of mineral wastes are produced. They are re-used in various ways, particularly in road and earth constructions, substituting primary resources such as gravel. However, they may also contain pollutants, such as heavy metals, which may be leached to the groundwater. The toxic impacts of these emissions are so far often neglected within Life Cycle Assessments (LCA) of products or waste treatment services and thus, potentially large environmental impacts are currently missed. This study aims at closing this gap by assessing the ecotoxic impacts of heavy metal leaching from industrial mineral wastes in road and earth constructions. The flows of metals such as Sb, As, Pb, Cd, Cr, Cu, Mo, Ni, V and Zn originating from three typical constructions to the environment are quantified, their fate in the environment is assessed and potential ecotoxic effects evaluated. For our reference country, Germany, the industrial wastes that are applied as Granular Secondary Construction Material (GSCM) carry more than 45,000 t of diverse heavy metals per year. Depending on the material quality and construction type applied, up to 150 t of heavy metals may leach to the environment within the first 100 years after construction. Heavy metal retardation in subsoil can potentially reduce the fate to groundwater by up to 100%. One major challenge of integrating leaching from constructions into macro-scale LCA frameworks is the high variability in micro-scale technical and geographical factors, such as material qualities, construction types and soil types. In our work, we consider a broad range of parameter values in the modeling of leaching and fate. This allows distinguishing between the impacts of various road constructions, as well as sites with different soil properties. The findings of this study promote the quantitative consideration of environmental impacts of long-term leaching in Life Cycle Assessment, complementing site-specific risk assessment, for the design of waste management strategies, particularly in the construction sector.

  19. [Peripheral nervous system and speech disorders].

    PubMed

    Ferri, Lluís

    2014-02-24

    Introduccion. Las afectaciones de la neurona motora inferior en la infancia, de etiologia congenita o adquirida, provocan dificultades en la respuesta motriz del habla en un periodo especialmente critico para el desarrollo del lenguaje. El interes por esta patologia radica en su baja incidencia, en su comorbilidad con otras afectaciones cerebrales y en su pronostico incierto. Objetivo. Hacer una revision de las alteraciones motoras del habla, de la valoracion funcional y de la intervencion logopedica en la disartria flacida. Desarrollo. Se plantea la caracterizacion clinica de las alteraciones en la produccion verbal de origen periferico, concretamente de la disartria flacida y sus manifestaciones respiratorias, fonatorias, de resonancia, de articulacion y de prosodia. Seguidamente, se esboza la valoracion funcional y se plantean las lineas de intervencion para su tratamiento. Conclusiones. Las manifestaciones clinicas de la disartria flacida son muy heterogeneas y van desde leves dificultades articulatorias a graves trastornos que limitan gravemente la capacidad para la expresion verbal. En la mayoria de los casos, la exploracion funcional proporciona hallazgos valiosos para su identificacion y tipificacion, para determinar la necesidad de valoraciones complementarias y para establecer el programa idoneo de intervencion logopedica. La participacion guiada de la familia y el abordaje interdisciplinar son factores que contribuyen decisivamente a mejorar estos procesos.

  20. [Silicosis and industrial bronchitis by exposure to silica powders and cement].

    PubMed

    Méndez-Vargas, María Martha; Báez-Revueltas, Fabiola Berenice; López-Rojas, Pablo; Tovalín-Ahumada, José Horacio; Zamudio-Lara, José Othón; Marín-Cotoñieto, Irma Araceli; Villeda, Francisco

    2013-01-01

    Objetivo: asociar la exposición a polvos inorgánicos en trabajadores de una cantera y una cementera y la generación de alteraciones pulmonares. Métodos: estudio transversal con 32 trabajadores expuestos a polvos inorgánicos en una cantera y 57 en una cementera. Se les realizaron pruebas de función respiratoria y telerradiografías de tórax. Se midieron polvos totales. Resultados: existieron diferencias demográficas significativas entre las dos líneas de producción: los empleados de la cantera fueron más jóvenes, menos altos y ligeramente más delgados. La proporción de enfermos fue significativamente diferente entre las dos áreas: en la cementera fue menor que en la cantera. Aun cuando los trabajadores de la cantera tuvieron una antigüedad menor, presentaron problemas pulmonares más graves. Conclusiones: la cantidad de sílice libre que se maneja en la cantera afecta gravemente la salud de los trabajadores, ya que con un promedio de tres años de antigüedad laboral presentaban silicosis. Por ello, deben establecerse mejores programas de higiene industrial para el control de los polvos.

  1. Campylobacter jejuni: A rare agent in a child with peritoneal dialysis-related peritonitis.

    PubMed

    Tural Kara, Tugce; Yilmaz, Songul; Ozdemir, Halil; Birsin Ozcakar, Zeynep; Derya Aysev, Ahmet; Ciftci, Ergin; Ince, Erdal

    2016-10-01

    La peritonitis es un problema grave en los niños que reciben diálisis peritoneal. La bacteria Campylobacter jejuni es una causa infrecuente de peritonitis. Un niño de 10 años de edad con insuficiencia renal terminal causada por síndrome urémico hemolítico atípico ingresó a nuestro hospital con dolor abdominal y fiebre. El líquido de la diálisis peritoneal era turbio; en el examen microscópico se observaron leucocitos abundantes. Se inició tratamiento con cefepime intraperitoneal. En el cultivo del líquido peritoneal se aisló Campylobacter jejuni, por lo que se agregó claritromicina oral al tratamiento. Al finalizar el tratamiento, el resultado del cultivo del líquido peritoneal era negativo. Hasta donde sabemos, no se había informado previamente peritonitis por C. jejuni en niños. Conclusión. Si bien la peritonitis por C. jejuni es rara en los niños, debe considerarse como factor etiológico de la peritonitis.

  2. [Guidelines for the diagnosis and management of heart failure and cardiogenic shock. Informe del Grupo de Trabajo de Insuficiencia Carddiacade la Sociedad Espanñola de Cardiología].

    PubMed

    Navarro-López, F; de Teresa, E; López-Sendón, J L; Castro-Beiras, A

    1999-01-01

    Guidelines for the Diagnosis and Management of Heart Failure and Cardiogenic Shock have been developed by the Working Group on Heart Failure of the Spanish Society of Cardiology, in collaboration with other Scientific Sections and members of the society. The aim of this report is to promote a more consistent and effective clinical practice according to the principles of evidence based medicine or the recommendations widely accepted by the scientific community. At the same time the aim is to give guidance for epidemiological surveys, heart failure registers clinical assays and clinical quality assessment, and to contribute to cost containment. These twelve guidelines have been designed for doctors in general practice as well as specialists. Criteria for diagnosis and classification of heart failure (systolic and diastolic heart failure, left or right, acute or chronic) are defined. The more appropriate use of clinical or high technology laboratory studies are recommended as well as the most efficient strategies nowadays for the management of chronic stable, unstable or refractory heart failure, or acute heart failure and cardiogenic shock.

  3. Amiodarone therapy in chronic heart failure and myocardial infarction: a review of the mortality trials with special attention to STAT-CHF and the GESICA trials. Grupo de Estudio de la Sobrevida en la Insuficiencia Cardiaca en Argentina.

    PubMed

    Pinto, J V; Ramani, K; Neelagaru, S; Kown, M; Gheorghiade, M

    1997-01-01

    Amiodarone appears to reduce sudden death in patients with left ventricular dysfunction resulting from an acute MI or a primary dilated cardiomyopathy, particularly if complex ventricular arrhythmias are present. Amiodarone's beneficial effect on mortality in these patients could be unrelated to its antiarrhythmic effects. Multiple factors could account for the improvement in mortality such as the drug's antiischemic effects, neuromodulating effects, its effect on left ventricular function and on heart rate. Moreover, patients with LV dysfunction who have survived an episode of sudden death would potentially benefit from amiodarone therapy. Future trials are needed to determine the precise subsets(s) of patients who would benefit from the drug and the most efficacious dosing regimen for the drug. Based on available data, amiodarone is the only antiarrhythmic agent which has not been shown to increase mortality in patients with chronic heart failure.

  4. Class III antiarrhythmic agents in cardiac failure: lessons from clinical trials with a focus on the Grupo de Estudio de la Sobrevida en la Insuficiencia Cardiaca en Argentina (GESICA).

    PubMed

    Doval, H C

    1999-11-04

    The results of previous clinical trials, in a variety of clinical settings, showed that class I agents may consistently increase mortality in sharp contrast to the effects of beta blockers. Attention has therefore shifted to class III compounds for potential beneficial effects on long-term mortality among patients with underlying cardiac disease. Clinical trials with d-sotalol, the dextro isomer (devoid of beta blockade) of sotalol, showed increased mortality in patients with low ejection fraction after myocardial infarction and in those with heart failure; whereas in the case of dofetilide, the impact on mortality was neutral. Because of the complex effects of its actions as an alpha-adrenergic blocker and a class III agent, the impact on mortality of amiodarone in patients with heart failure is of particular interest. A meta-analysis of 13 clinical trials revealed significant reductions in all-cause and cardiac mortality among patients with heart failure or previous myocardial infarction. Among these were 5 controlled clinical trials that investigated the effects of amiodarone on mortality among patients with heart failure. None of these trials was large relative to the beta-blocker trials in the postinfarction patients. However, the larger 2 of the 5 amiodarone trials produced discordant effects on mortality, neutral in one and significantly positive in the other. Some of the differences may be accounted for by the differences in eligibility criteria and baseline characteristics. Future trials that may be undertaken to resolve the discrepancies may need to allow for the newer findings on the effects of concomitant beta blockers, implantable devices, and possibly, spironolactone. All these modalities of treatment have been shown in controlled clinical trials to augment survival in patients with impaired ventricular function or manifest heart failure. Additional trials, some of which are currently in progress, compare amiodarone with implantable devices and other therapeutic interventions, and should help to clarify the optimal management strategy for patients with underlying heart failure.

  5. [First report of complete genome sequence and phylogenetic analysis of Human Bocavirus 1 isolated in Argentina].

    PubMed

    Cardozo Tomas, Agustina; Ghietto, Lucia Maria; Insfran, Constanza; Wasinger, Nicolas; Marchesi, Ariana; Adamo, Maria Pilar

    2015-01-01

    Antecedentes. El Bocavirus humano (HBoV) es un parvovirus descripto por primera vez en 2005, asociado a cuadros leves y graves de infección respiratoria aguda (IRA), una de las principales causas de morbimortalidad en la población infantil en todo el mundo. Al presente se han identificado 4 genotipos, nombradas HBoV1 a 4, de los cuales el primero es el que se asocia a IRA con predominancia. Objetivo. Obtener el genoma completo de HBoV respiratorio aislado localmente. Métodos. Se diseñaron primers para fragmentos superpuestos del genoma completo de HBoV, empleando las herramientas informáticas ClustalW y NCBI Primer-Blast. Los fragmentos se amplificaron por PCR convencional y se secuenciaron mediante tecnología capilar BigDye Terminator. La edición de las secuencias y análisis filogenético se realizó con el programa MEGA v6. Resultados. Se obtuvo la secuencia genómica completa de HBoV1 cepa 307AR09, aislada de secreción respiratoria de paciente pediátrico con bronquiolitis. La misma fue depositada en la base de datos GenBank con número de acceso KJ634207. El análisis filogenético con secuencias genómicas completas de los 4 genotipos obtenidas en distintas regiones del mundo muestra similitud cercana al 100% con la secuencia original descubierta en Suecia (DQ000495), así como el agrupamiento de los 4 genotipos en 2 clusters de alta homología interna: HBoV1-HBoV3 y HBoV2-HBoV4. Conclusiones. Se aportan datos locales para futuros desarrollos tecnológicos destinados tanto a la investigación como al diseño de métodos diagnósticos para la práctica médica. Por otra parte, los resultados sustentan la propuesta de redistribución taxonómica de los 4 genotipos en 2 especies.

  6. [Anthracycline-induced cardiotoxicity: report of fatal cases].

    PubMed

    Vargas-Neri, Jessica Liliana; Castelán-Martínez, Osvaldo Daniel; de Jesús Estrada-Loza, María; Betanzos-Cabrera, Yadira; Rivas-Ruiz, Rodolfo

    2016-01-01

    Introducción: las antraciclinas son fármacos eficaces en el tratamiento de pacientes pediátricos con cáncer. Sin embargo, la cardiotoxicidad inducida por antraciclinas (CIA) es una reacción adversa grave que afecta la sobrevida de niños y jóvenes. Casos clínicos: el caso 1 estuvo constituido por una paciente de nueve años con linfoma de Hodgkin estadio IV con 12 ciclos de quimioterapia con epirrubicina y una dosis acumulada de 576 mg/m2. Después del último ciclo de quimioterapia, la paciente ingresó con respuesta inflamatoria sistémica, astenia y adinamia. El ecocardiograma reportó una FEVI de 22 %, FA de 11 % e insuficiencia mitral moderada. La paciente falleció dos días después con diagnóstico de cardiomiopatía dilatada secundaria a antraciclinas. El caso 2 fue el de una paciente de 15 años con linfoma no Hodgkin tipo Burkitt estadio IV, con dos ciclos de quimioterapia con epirrubicina y una dosis acumulada de 90 mg/m2. Después del último ciclo, la paciente presentó diversos focos infecciosos. El ecocardiograma reportó una FEVI de 49 %, una FA de 20 % y dilatación del ventrículo izquierdo con aplanamiento septal. La paciente falleció 13 días después del diagnóstico de cardiomiopatía dilatada por antraciclinas. Conclusión: la CIA es un problema en los pacientes pediátricos que reciben antraciclinas. El monitoreo durante y después de la quimioterapia es indispensable para detectar el inicio del daño cardiaco a fin de brindar una intervención oportuna que evite la evolución a una insuficiencia cardiaca.

  7. [Adverse effects with ambulatory intravenous immunoglobulin administration in adult patients with common variable immunodeficiency].

    PubMed

    Rodríguez-Mireles, Karen A; Galguera-Sauceda, Angélica; Gaspar-López, Arturo; López-Rocha, Eunice G; Campos-Romero, Freya; Del Rivero-Hernández, Leonel; Amaya-Mejía, Adela; Galindo-Pacheco, Lucy; O'Farril-Romanillos, Patricia; Segura-Méndez, Nora Hilda

    2014-01-01

    Antecedentes: la inmunodeficiencia común variable es la inmunodeficiencia primaria sintomática más frecuente, afecta a 1 por cada 25,000 a 75,000 sujetos. Se distingue por la ausencia o disminución de anticuerpos. Su tratamiento consiste en el reemplazo de anticuerpos con inmunoglobulina humana y la vía de administración más frecuente es la intravenosa, a dosis de 400 a 800 mg/kg de peso/dosis cada tres a cuatro semanas. Los efectos adversos asociados con la administración de inmunoglobulina intravenosa (IgIV) ocurren incluso en 25% de todas las infusiones realizadas, las reacciones severas afectan a menos de 1% de los pacientes. Entre las reacciones adversas severas están la insuficiencia renal aguda, que sobreviene 1 a 10 días después del inicio de tratamiento con IgIV. En nuestro centro elaboramos e implementamos un esquema ambulatorio para la aplicación de IgIV que permite su administración en un promedio de 3 h, sin efectos adversos graves. Objetivos: describir los efectos adversos y evaluar la frecuencia de insuficiencia renal secundaria a la aplicación ambulatoria de IgIV en pacientes adultos con inmunodeficiencia común variable. Material y método: estudio descriptivo y prospectivo en el que participaron pacientes adultos con diagnóstico definitivo de inmunodeficiencia común variable, que recibían IgIV a dosis de sustitución cada tres semanas, a quienes se realizó exploración física, somatometría, determinación sérica de creatinina, albúmina y urea, depuración de creatinina en orina de 24 horas, cálculo de la tasa de filtración glomerular por la fórmula CKD-EPI y evaluación de la función renal inmediata, así como la asociada con la administración acumulada de IgIV a través del cálculo de la tasa de filtración glomerular. Los resultados se analizaron con estadística descriptiva para el reporte de los efectos en la función renal y la dosis acumulada de IgIV. Resultados: se determinó la frecuencia de reacciones adversas

  8. Gold from the tomb of Scribe Beri: a comparative analytical approach to the New Kingdom gold grave goods from Riqqa (Egypt)

    NASA Astrophysics Data System (ADS)

    Troalen, Lore; Guerra, Maria Filomena

    2016-03-01

    The gold necklace and penannular earrings from tomb 296 at Riqqa, containing the coffins of a female and of a male, the latter a scribe named Beri of the reign of Tuthmosis III (eighteenth Dynasty Egypt), were analysed by PIXE, XRF, and EDS, together with eight penannular earrings from other find-spots of the same period. Analysis of jewellery items from tomb 296 at Riqqa revealed the use of high-purity gold alloys and electrum alloys, while the other earrings investigated were found to be made of electrum with high Ag content. Two earrings conserved in different museums were shown to be originally a pair. PIXE mapping revealed the extensive use of a hard soldering technique for the joints, with the solders being obtained by the addition of Cu to the base alloy. The presence of PGE inclusions indicated the use of alluvial gold, but the variability of their composition could be ascribed to the recycling of gold from different origins, in the case of some objects.

  9. Frequent D-loop polymorphism in mtDNA enables genotyping of 1400-year-old human remains from Merowingian graves.

    PubMed

    Zeller, M; Mirghomizadeh, F; Wehner, H D; Blin, N

    2000-01-01

    Improvements of DNA extraction and amplification techniques presently enable DNA analysis of ancient DNA (aDNA) from samples which range from several hundred years of age up to possibly 5000 years. Taking advantage of the abundance of mitochondrial DNA and its polymorphic D-loop sequence, ten individuals from multiple burial sites of the Merowingian culture (South Germany), estimated to be about 1400 years old, were genotyped to determine possible kinship. Moreover, gonosomal DNA markers from the X- and Y-chromosome were applied for sex determination of the remains. In all individuals investigated, deviations from the Anderson mtDNA consensus sequence were observed, all representing substitutions (7 transitions and 3 transversions). Although such mutations have been reported from recent populations, our study constitutes the first description of these mtDNA mutations from numerous aDNA samples recovered from multiple burial sites. The results obtained by molecular anthropology can aid in describing kinship relations and burial customs of ancient remains.

  10. The grave is wide: the Hibakusha of Hiroshima and Nagasaki and the legacy of the Atomic Bomb Casualty Commission and the Radiation Effects Research Foundation.

    PubMed

    O'Malley, Gerald F

    2016-07-01

    Following the atomic bomb attacks on Japan in 1945, scientists from the United States and Japan joined together to study the Hibakusha - the bomb affected people in what was advertised as a bipartisan and cooperative effort. In reality, despite the best efforts of some very dedicated and earnest scientists, the early years of the collaboration were characterized by political friction, censorship, controversy, tension, hostility, and racism. The 70-year history, scientific output and cultural impact of the Atomic Bomb Casualty Commission and the Radiation Effects Research Foundation are described in the context of the development of Occupied Japan.

  11. Mercy Killings in Combat: Ending the Suffering of Gravely Wounded Combatants -- A Brief History, Applicable Law, Recent Prosecutions, and Proposals for Much Needed Change

    DTIC Science & Technology

    2006-04-01

    French [Soldiers] went berserk." The killing was indiscriminate—men, women, children , Christians, Muslims, young , old—all were butchered by the...were kidnapped, including two young women and three children . Id. at 285-86. At camp that night, the Native Americans celebrated their victory by...dancing with the scalps take at Fort Parker, they beat the children with their bow, tortured the young women, and raped them throughout the night in front

  12. From cradle to grave: tracking socioeconomic inequalities in mortality in a cohort of 11 868 men and women born in Uppsala, Sweden, 1915–1929

    PubMed Central

    Juárez, Sol P; Koupil, Ilona

    2016-01-01

    Background Ample evidence has shown that early-life social conditions are associated with mortality later in life. However, little attention has been given to the strength of these effects across specific age intervals from birth to old age. In this paper, we study the effect of the family's socioeconomic position and mother's marital status at birth on all-cause mortality at different age intervals in a Swedish cohort of 11 868 individuals followed across their lifespan. Methods Using the Uppsala Birth Cohort Multigenerational Study, we fitted Cox regression models to estimate age-varying HRs of all-cause mortality according to mother's marital status and family's socioeconomic position. Results Mother's marital status and family's socioeconomic position at birth were associated with higher mortality rates throughout life (HR 1.18 (95% CI 1.12 to 1.26) for unmarried mothers; 1.19 (95% CI 1.12 to 1.25) for low socioeconomic position). While the effect of family's socioeconomic position showed little variation across different age groups, the effect of marital status was stronger for infant mortality (HR 1.47 (95% CI 1.23 to 1.76); p=0.04 for heterogeneity). The results remained robust when early life and adult mediator variables were included. Conclusions Family's socioeconomic position and mother's marital status involve different dimensions of social stratification with independent effects on mortality throughout life. Our findings support the importance of improving early-life conditions in order to enhance healthy ageing. PMID:26733672

  13. A Personal and Collaborative Journey of Change: Lessons Learned about Leadership, Mentoring and Motivation from an Educational Community's Work with Donald Graves

    ERIC Educational Resources Information Center

    Jasinski, Barbara Plummer

    2013-01-01

    Change is often expected as the logical outcome of large scale investments in professional development, yet research studies (e.g., Tyack & Cuban, 1995; Lipson, Mosenthal & Woodside-Jiron, 2000; Schraw & Olafson, 2002) note wide variations in instructional practice despite such efforts. This qualitative inquiry was designed to…

  14. Alloimmunisation fœto-maternelle Rhésus grave à propos d'un cas et revue de la littérature

    PubMed Central

    Zineb, Benkerroum; Boutaina, Lachiri; Ikram, Lazrak; Driss, Moussaoui Rahali; Mohammed, Dehayni

    2015-01-01

    L'incompatibilité fœto-maternelle Rhésus peut être à l'origine d'un syndrome hémolytique dont l'expression clinique est l′anémie fœtale éventuellement compliquée par une anasarque fœto-placentaire ou à l'extrême une mort fœtale in utéro. Nous rapportons l'observation d'un cas d'allo immunisation Rhésus à 34 SA ayant aboutit un hydrops foetalis, l'extraction fœtale par césarienne en vue d'une exsanguino-transfusion a été réalisée, mais le nouveau né est décédé au cours de l'exsanguino-transfusion. Le dépistage des femmes à risque et l'utilisation d'Immunoglobulines anti D ont permis une réduction importante de l′incidence des accidents d'incompatibilité. La mesure du pic systolique de vélocité dans l'artère cérébrale moyenne a bouleversé la surveillance et la prise en charge prénatale des anémies fœtales secondaires à une allo-immunisation Rhésus. Son utilisation dans la surveillance des cas d'allo-immunisation Rhésus permettrait ainsi de réserver les procédures invasives (cordocentèse) comme geste thérapeutique qui permet la transfusion fœtale in utéro. Grâce à une collaboration multidisciplinaire cohérente, l'extraction fœtale peut être programmée, ce qui permet une prise en charge adéquate et rigoureuse, même des nouveaux nés avec atteinte sévère. PMID:26889318

  15. Identification, Geochemical Characterisation and Significance of Bitumen among the Grave Goods of the 7th Century Mound 1 Ship-Burial at Sutton Hoo (Suffolk, UK)

    PubMed Central

    Bowden, Stephen A.; Hacke, Marei; Parnell, John

    2016-01-01

    The 7th century ship-burial at Sutton Hoo is famous for the spectacular treasure discovered when it was first excavated in 1939. The finds include gold and garnet jewellery, silverware, coins and ceremonial armour of broad geographical provenance which make a vital contribution to understanding the political landscape of early medieval Northern Europe. Fragments of black organic material found scattered within the burial were originally identified as ‘Stockholm Tar’ and linked to waterproofing and maintenance of the ship. Here we present new scientific analyses undertaken to re-evaluate the nature and origin of these materials, leading to the identification of a previously unrecognised prestige material among the treasure: bitumen from the Middle East. Whether the bitumen was gifted as diplomatic gesture or acquired through trading links, its presence in the burial attests to the far-reaching network within which the elite of the region operated at this time. If the bitumen was worked into objects, either alone or in composite with other materials, then their significance within the burial would certainly have been strongly linked to their form or purpose. But the novelty of the material itself may have added to the exotic appeal. Archaeological finds of bitumen from this and earlier periods in Britain are extremely rare, despite the abundance of natural sources of bitumen within Great Britain. This find provides the first material evidence indicating that the extensively exploited Middle Eastern bitumen sources were traded northward beyond the Mediterranean to reach northern Europe and the British Isles. PMID:27906999

  16. Plasmodium vivax induced hemolytic uremic syndrome: An uncommon manifestation that leads to a grave complication and treated successfully with renal transplantation.

    PubMed

    Jhorawat, Rajesh; Beniwal, Pankaj; Malhotra, Vinay

    2015-01-01

    We are reporting a case of hemolytic uremic syndrome, a rare manifestation of Plasmodium vivax malaria. A young driver was admitted with acute febrile illness, decreased urine output, anemia, thrombocytopenia, jaundice, and increased serum lactate dehydrogenase. He showed a partial response to antimalarial drugs. However, he was readmitted with worsening renal parameters. His kidney biopsy revealed chronic thrombotic microangiopathy. He remained dialysis dependent and later underwent renal transplantation successfully, with excellent graft function at 1-year.

  17. A Grave Outcome of Posterior Reversible Encephalopathy Syndrome in a Patient Receiving Avastin (Bevacizumab) for Metastatic High-Grade Serous Ovarian Cancer

    PubMed Central

    Elmalik, Hind H.; ElAzzazy, Shereen; Salem, Khaled S.; Bujassoum, Salha

    2015-01-01

    A 45-year-old female developed neurological symptoms and elevated diastolic blood pressure while on bevacizumab (Avastin) and gemcitabine for recurrent carboplatin-resistant high-grade serous ovarian cancer. A brain MRI diagnosed our patient with posterior reversible encephalopathy syndrome. We are discussing her presenting symptoms in this paper as well as the management and the outcome. We emphasize the importance of keeping this rare but very serious complication in all patients receiving bevacizumab. PMID:26351436

  18. Formes hémorragiques graves de la fièvre de la vallée du Rift: à propos de 5 cas

    PubMed Central

    Salem, Mohamed Lemine Ould; Baba, Sidi El Wafi Ould; Fall-Malick, Fatimetou Zahra; Boushab, Boushab Mohamed; Ghaber, Sidi Mohamed; Mokhtar, Abdelwedoud

    2016-01-01

    La fièvre de la vallée du Rift (FVR) est une arbovirose due à un virus à ARN appartenant à la famille de Bunyaviridae (genre phlebovirus). C'est une zoonose touchant principalement les animaux mais pouvant aussi contaminer l'homme, soit directement par la manipulation des viandes ou avortons d'animaux malades ou indirectement par la piqure de moustiques infectées (Aèdes sp, anophèles sp, Culex sp). Dans la majorité des cas, l'infection humaine à FVR est asymptomatique, mais elle peut également se manifester par un syndrome fébrile modérée d’évolution favorable. Néanmoins, certains patients peuvent développer un syndrome hémorragique et/ou des lésions neurologiques d’évolution mortelle. Nous décrivons l’évolution de cinq cas de patients atteints de la FVR, admis dans le service de médecine interne du Centre Hospitalier National de Nouakchott (Mauritanie), le mois d'Octobre 2015 et présentant tous, un syndrome hémorragique dans un contexte fébrile. L’évolution n’était favorable que pour 2 des cinq patients. Les 3 autres sont décédés, deux dans un tableau de choc hémorragique et dans un état de choc septique. PMID:27642413

  19. Evolution de la reanimation transfusionnelle du blesse hemorragique grave au sein des forces militaires americaines (Evolution of US Military Transfusion Support for Resuscitation of Trauma and Hemorrhagic Shock)

    DTIC Science & Technology

    2013-04-15

    propice aux avancées médicales. En milieu militaire, les capacités logistiques et l’organisation efficace permettent de rapidement diffuser de nouvelles...Prat N., Pidcoke H. F., Sailliol A., Cap A. P., 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND...ADDRESS(ES) United States Army Institute of Surgical Research, JBSA Fort Sam Houston, TX 8. PERFORMING ORGANIZATION REPORT NUMBER 9. SPONSORING

  20. From cradle to grave via the dissection room: the role of foetal and infant bodies in anatomical education from the late 1700s to early 1900s.

    PubMed

    Dittmar, Jenna M; Mitchell, Piers D

    2016-12-01

    The preponderance of men in the narrative of anatomical education during the 1800s has skewed the historical perception of medical cadavers in favour of adult men, and stifled the conversation about the less portrayed individuals, especially children. Although underrepresented in both the historical literature and skeletal remains from archaeological contexts dated to the 1800s, these sources nevertheless illustrate that foetal and infant cadavers were a prized source of knowledge. In the late 1700s and 1800s foetal and infant cadavers were acquired by anatomists following body snatching from graveyards, from the child's death in a charitable hospital, death from infectious disease in large poor families, or following infanticide by desperate unwed mothers. Study of foetal and infant remains from the 1800s in the anatomical collection at the University of Cambridge shows that their bodies were treated differently to adults by anatomists. In contrast to adults it was extremely rare for foetal and infant cadavers to undergo craniotomy, and thoracotomy seems to have been performed through costal cartilages of the chest rather than the ribs themselves. However, many infants and foetuses do show evidence for knife marks on the cranium indicating surgical removal of the scalp by anatomists. These bodies were much more likely to be curated long term in anatomical collections and museums than were adult males who had undergone dissection. They were prized both for demonstrating normal anatomical development, but also congenital abnormalities that led to an early death. The current findings show that the dissection of foetal and infant cadavers was more widespread than previous research on anatomical education suggests. This research details the important role of the youngest members of society in anatomical education during the long 19th century, and how the social identity of individuals in this subgroup affected their acquisition, treatment and disposal by elite medical men of the time.

  1. [Metabolic myopathies].

    PubMed

    Papazian, Óscar; Rivas-Chacón, Rafael

    2013-09-06

    Objetivo. Revisar las miopatias metabolicas manifestadas solamente por crisis de mialgias, calambres y rigidez musculares con dificultad para contraer los musculos afectados y el examen neurologico normal entre las crisis en niños y adolescentes. Desarrollo. Estas miopatias metabolicas se deben a deficits enzimaticos heredados en forma autosomica recesiva del metabolismo de los carbohidratos y lipidos. El resultado final es una reduccion del trifosfato de adenosina principalmente a traves de la fosforilacion oxidativa mitocondrial con disminucion de la energia disponible para la contraccion muscular. Las secundarias a trastornos del metabolismo de los carbohidratos se producen por ejercicios de alta intensidad y breves (< 10 min) y las secundarias a trastornos de los lipidos, por ejercicios de baja intensidad y prolongados (> 10 min). Los deficits enzimaticos en el primer grupo son de miofosforilasa (glucogenosis V), fosfofructocinasa muscular (glucogenosis VII), fosfoglicerato mutasa 1 (glucogenosis X) y beta enolasa (glucogenosis XIII), y en el segundo, de carnitina palmitol transferasa tipo II y de acil-CoA deshidrogenasa de cadena muy larga. Conclusiones. Las caracteristicas diferenciales de los pacientes en cada grupo y dentro de cada grupo permitiran el diagnostico clinico presuntivo inicial en la mayoria y solicitar solamente los examenes necesarios para corroborar el diagnostico. El tratamiento de las crisis consiste en hidratacion, glucosa y alcalinizacion de la orina. Las medidas preventivas son evitar el tipo de ejercicio que induce las crisis y el ayuno. No existe cura o tratamiento especifico. El pronostico es bueno con la excepcion de casos raros de insuficiencia renal aguda debido a la elevacion sanguinea de la mioglobina producto de una rabdomiolisis grave.

  2. 75 FR 74109 - Post Office Closing

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-30

    ... informs the public that an appeal of the closing of the Graves Mill, Virginia post office has been filed... for review of the closing of the Graves Mill Post Office located in Graves Mill, Virginia. The petition, which was filed by Douglas M. Graves (Petitioner), is postmarked November 15, 2010, and...

  3. [Prevalence of malnutrition in not critically ill older inpatients].

    PubMed

    Fernández López, María Teresa; Fidalgo Baamil, Olga; López Doldán, Carmen; Bardasco Alonso, María Luisa; de Sas Prada, María Trinidad; Lagoa Labrador, Fiz; García García, María Jesús; Mato Mato, José Antonio

    2015-06-01

    Introducción: los cambios fisiológicos propios del envejecimiento, junto con distintos procesos patológicos, predisponen a los ancianos a la aparición de complicaciones nutricionales, siendo el estado nutricional un factor pronóstico importante. El objetivo del estudio es conocer la prevalencia de desnutrición en los mayores de 65 años en nuestro centro, tanto al ingreso como al alta. Métodos: realizamos un estudio transversal, observacional. Para ello evaluamos 174 pacientes mayores de 65 años que ingresaron de forma consecutiva, mediante la aplicación del Nutritional Risk Screening 2002 (NRS- 2002) y el Mini Nutritional Assessment Short Form (MNA-SF) en las primeras 48 horas de ingreso. Los pacientes oncológicos también se evaluaron mediante la Valoración Global Subjetiva Generada por el Paciente (VGS-GP). Al alta se realizó de nuevo el NRS-2002. Resultados: el 29,31% de los pacientes estaban en situación de riesgo nutricional según los resultados del NRS-2002 al ingreso. Este porcentaje aumentaba hasta el 57,89% al alta. El MNA-SF objetivó alteración nutricional en el 70,35% (54,65% riesgo de desnutrición, 15,7% desnutrición). Según el NRS-2002 el 34,14% de los pacientes con cáncer presentaban riesgo nutricional; sin embargo, la VGS-GP mostraba deterioro nutricional en el 56,41% de los casos (46,15% desnutrición moderada y 10,26% desnutrición grave). Existen grupos de pacientes (los de mayor edad, los ingresados de forma urgente, los que presentan insuficiencia cardíaca) con mayor riesgo de deterioro nutricional durante el ingreso (p < 0,05). Conclusiones: el porcentaje de pacientes mayores de 65 años en riesgo nutricional en nuestro centro es muy alto, tanto al ingreso como al alta. Se hace necesario el cribado nutricional sistemático.

  4. Grave infarctus mésentérique par occlusion artérielle mésentérique supérieure chez un patient atteint de la maladie de Buerger

    PubMed Central

    Ratbi, Moulay Ibrahim; Abissegue, Ghislain Yves; Tarchouli, Mohamed; Tajedine, Mohammed Tariq

    2014-01-01

    La thromboangéite oblitérant ou maladie de Buerger, est une artérite inflammatoire non-artériosclérotique touchant classiquement les réseaux vasculaires périphériques des membres. Elle atteint principalement les hommes jeunes tabagiques et sans autres facteurs de risques cardiovasculaires. Les atteintes des artères digestives sont très rares et souvent fatales si elles ne sont pas évoquées et prises en charge précocement. Nous rapportons l'observation d'un jeune patient tabagique chronique qui s’était présenté aux urgences dans un tableau de péritonite aigue négligée due a un infarctus entero-mésentérique massif. L'origine était une ischémie mésentérique due à une thrombose de l'artère mésentérique supérieure. L’étude anatomopathologique avait objectivée une atteinte des artères digestive due à la maladie de Buerger. PMID:25918562

  5. Informe: Agua potable - la EPA necesita adoptar medidas adicionales para garantizar que los pequeños sistemas de agua comunitarios señalados como graves infractores logren cumplir con las normas

    EPA Pesticide Factsheets

    Informe #16-P-0108, 22 de Marzo de 2016. La EPA puede proteger mejor al público del agua potable contaminada, lo que incluye a casi 200,000 personas en Puerto Rico que todavía carecen de agua potable segura.

  6. Anévrysme de l'aorte ascendante associé à une insuffisance aortique massive: complication rare et grave de la maladie de Behçet

    PubMed Central

    Chetoui, Abdelkhalek; El Malki, Hicham; Bahous, Mohamed; Rhissassi, Jaafar; Sayah, Rochde; Laaroussi, Mohamed

    2015-01-01

    L'atteinte artérielle au cours de la maladie de Behçet survient chez 2 à 12% des patients et se traduit par des lésions oblitérantes et/ou anévrysmales prédominant sur les gros troncs. Les complications cardiaques sont plus rares (1 à 6%) touchant les trois tuniques. En revanche, les anévrysmes de l'aorte ascendante associés à une insuffisance aortique restent une complication très rare de la maladie de Behçet. Nous rapportons l'observation d'un jeune patient de 35ans suivie pour une maladie de Behçet compliquée d'un anévrysme de l'aorte ascendante associé à une régurgitation aortique massive. Le diagnostic a été posé sur les données cliniques radiologiques de l’échocardiographie et de la tomodensitométrie puis confirmé à l'examen histologique de la pièce. Le traitement était chirurgical et a consisté en un remplacement total de la racine de l'aorte à cœur ouvert selon la technique de Bentall afin d’éviter le risque de rupture ou de dissection. L’évolution à 18 mois de l'intervention était favorable. Le traitement médical associant la corticothérapie et les immunosuppresseurs est la règle en postopératoire pour éviter les récidives. PMID:26491528

  7. Pontage fémoro-fémoral croisé avec tunnulisation périnéale sous-scrotale pour une infection grave du triangle de scarpa

    PubMed Central

    Mrad, Melek Ben; Miri, Rim; Kaouel, Karim; Derbel, Bilel; Tarzi, Mariem; Ghedira, Faker; Kalfat, Tawfik; Mizouni, Hbiba; Khayati, Adel

    2015-01-01

    Nous décrivons dans cet article une technique de revascularisation des patients ayant une infection de prothèse vasculaire sus-crurale au niveau dutriangle de scarpa, et qui minimise le risque d'infection récurrente du greffon. Cette technique consiste en un pontage fémoro-fémoral croisé avec un tunnel périnéal sous-cutané loin du scarpa infecté que le tunnel classique sus-pubiensous-cutané ne permet pas. Nous rapportons le cas d'un patient âgé de 52 ans, artéritique, multi-opérés, admis pour infection du scarpa droit sur un pontage fémoro-fémoral prothétique perméable, le patient a eu une explantation de ce pontage et une revascularisation par un pontage périnéal sous-scrotal veineux loin du site infectieux; l’évolution a été excellente et le pontage est encore perméable après deux ans de suivi. Le pontage fémoro-fémoral périnéal est une procédure exceptionnellement réalisée, mais qui peut constituer une vraie option thérapeutique de revascularisation chez les patients avec une infection du scarpa. PMID:26955419

  8. Tétraplégie révélatrice d'une méningomyélite grave à pneumocoque: à propos d'un cas et revue de littérature

    PubMed Central

    Nebhani, Tahir; Bakkali, Hicham; Belyamani, Lahcen

    2015-01-01

    L'atteinte médullaire est une complication rare des méningites à streptocoque pneumoniae. notre observation clinique décrit le cas d'une Jeune femme immunocompétente qui s'est présentée au service d'accueil des urgences pour tétraplégie dont les investigations ont mis en évidence une méningite à pneumocoque. Le traitement était basé sur l'antibiothérapie plus une corticothérapie concomitante. L’évolution était marquée par la persistance des séquelles neurologiques. PMID:26113898

  9. 47 CFR 15.119 - Closed caption decoder requirements for analog television receivers.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... ♪ Music note 38 à A Lower-case a with grave accent 39 Transparent space 3A è E Lower-case e with grave..., and from the Electronic Industries Association, Washington, DC. (m) Labelling and consumer...

  10. 47 CFR 79.101 - Closed caption decoder requirements for analog television receivers.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... ♪ Music note 38 à A Lower-case a with grave accent 39 Transparent space 3A è E Lower-case e with grave..., and from the Electronic Industries Association, Washington, DC. (m) Labeling and consumer...

  11. 47 CFR 15.119 - Closed caption decoder requirements for analog television receivers.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... ♪ Music note 38 à A Lower-case a with grave accent 39 Transparent space 3A è E Lower-case e with grave..., and from the Electronic Industries Association, Washington, DC. (m) Labelling and consumer...

  12. T3 test

    MedlinePlus

    Triiodothyronine; T3 radioimmunoassay; Toxic nodular goiter - T3; Thyroiditis - T3; Thyrotoxicosis - T3; Graves disease - T3 ... example, Graves disease ) T3 thyrotoxicosis (rare) Toxic nodular goiter Taking thyroid medicines or certain supplements (common) Liver ...

  13. 36 CFR 12.10 - Floral and commemorative tributes.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... INTERIOR NATIONAL CEMETERY REGULATIONS § 12.10 Floral and commemorative tributes. The placement on a grave... statue, vigil light, or other commemorative object on a grave, or the securing or attaching of any...

  14. 40 CFR 11.4 - Definitions.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... unauthorized disclosure could reasonably be expected to cause exceptionally grave damage to the national security. Examples of “exceptionally grave damage” include armed hostilities against the United States...

  15. 36 CFR 12.10 - Floral and commemorative tributes.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... INTERIOR NATIONAL CEMETERY REGULATIONS § 12.10 Floral and commemorative tributes. The placement on a grave... statue, vigil light, or other commemorative object on a grave, or the securing or attaching of any...

  16. 36 CFR 12.10 - Floral and commemorative tributes.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... INTERIOR NATIONAL CEMETERY REGULATIONS § 12.10 Floral and commemorative tributes. The placement on a grave... statue, vigil light, or other commemorative object on a grave, or the securing or attaching of any...

  17. 40 CFR 11.4 - Definitions.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... unauthorized disclosure could reasonably be expected to cause exceptionally grave damage to the national security. Examples of “exceptionally grave damage” include armed hostilities against the United States...

  18. 78 FR 34429 - Proposed Information Collection (Application for Standard Government Headstone or Marker for...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-07

    ... comments on the information needed to obtain a government headstone, grave marker or medallion. DATES... 40-1330 to apply for Government provided headstones or markers for unmarked graves. b. A...

  19. 75 FR 15493 - Proposed Information Collection Activity: Proposed Collection; Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-29

    ... comments on the information needed to obtain a government headstone, grave marker or medallion. DATES... 40-1330 to apply for Government provided headstones or markers for unmarked graves. b. A...

  20. 36 CFR 12.10 - Floral and commemorative tributes.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... INTERIOR NATIONAL CEMETERY REGULATIONS § 12.10 Floral and commemorative tributes. The placement on a grave... statue, vigil light, or other commemorative object on a grave, or the securing or attaching of any...