RESUMEN
Thyroid orbitopathy (TO) is an autoimmune disease that is complicated by ocular surface disorders, leading to discomfort. Dry eye is very prevalent in patients with TO. Recent studies on the pathogenesis of dry eye have focused on the inflammatory process, and some supporting evidence has been discovered. Because TO is a disorder of autoimmune origin, we assumed that the association between TO and dry eye is related to inflammation. Inflammation of the ocular surface in TO-related dry eye has not been well studied. In this study, we assessed cellular inflammation of the ocular surface and the cytokine profiles in patients with TO-related dry eye. Conjunctival impression cytology (CIC) was assessed with an immunofluorescent assay. TO-related dry eye was diagnosed by using the Schirmer test, tear break-up time, thyroid function, and clinical signs. CIC was combined with immunological staining of interleukin-1a (IL-1a), IL-1b, and IL- 6. The immunological impression cytology (IC) grade was compared to the clinical activity score of TO. All TO patients with dry eye were positive for IL-1a, IL-1b, and IL-6. However, the normal controls were also positive for IL-1a. A trend was observed between the clinical inflammatory score and immunological IC grade. This study was the first to delineate the immunological IC of TO-related dry eye. Our study aimed to investigate the pathogenesis of dry eye in TO. Our findings suggest that the conjunctival cytokines IL-1a, IL-1b, and IL-6 may play a role. The results of this study will be useful for future studies of additional inflammatory cytokines, and the levels of these cytokines could be used as an outcome to assess the efficacy of treatment, such as anti-cytokine or immunosuppression therapy, in patients with TO-related dry eye or other ocular surface inflammatory disorders.
Asunto(s)
Enfermedades Autoinmunes/diagnóstico , Conjuntiva/patología , Síndromes de Ojo Seco/diagnóstico , Enfermedades de la Tiroides/diagnóstico , Adolescente , Adulto , Anciano , Enfermedades Autoinmunes/inmunología , Enfermedades Autoinmunes/metabolismo , Estudios de Casos y Controles , Conjuntiva/metabolismo , Técnicas Citológicas , Síndromes de Ojo Seco/inmunología , Síndromes de Ojo Seco/metabolismo , Epitelio/metabolismo , Epitelio/patología , Femenino , Humanos , Técnicas Inmunológicas , Mediadores de Inflamación/metabolismo , Masculino , Persona de Mediana Edad , Enfermedades de la Tiroides/inmunología , Enfermedades de la Tiroides/metabolismo , Adulto JovenAsunto(s)
Cardiomiopatía Hipertrófica/patología , Síndrome de Dificultad Respiratoria del Recién Nacido/fisiopatología , Ruidos Respiratorios/fisiopatología , Atrofia , Encéfalo/patología , Cardiomiopatía Hipertrófica/fisiopatología , Deficiencia de Citocromo-c Oxidasa , Diagnóstico Diferencial , Femenino , Humanos , Recién Nacido , Mitocondrias Cardíacas/patologíaRESUMEN
The Radiation Therapy Oncology Group (RTOG) and the Eastern Cooperative Oncology Group (ECOG) conducted a phase III trial in patients with malignant gliomas to evaluate 4 treatment arms: 1) 60 Gy to the whole brain; 2) 60 Gy plus 10-Gy boost; 3) 60 Gy plus carmustine (BCNU); and 4) 60 Gy plus semustine plus dacarbazine. Between September 1974 and March 1979, 626 patients with malignant gliomas were treated on protocol RTOG 7401/ECOG 1374. Each institution chose a subset of the treatments to which the patients would be randomized. Patients were stratified according to subset and randomized to the 4 treatment arms. There were no differences in survival among treatment arms. For patients greater than 60 years of age, the addition of chemotherapy to radiation therapy did not improve survival. For patients aged 40-60 years, there was a statistically significant increase in overall survival when BCNU was added to 60 Gy (P less than .01), with an increase in 2-year survival from 8% to 23%. This beneficial effect of BCNU is apparent in both histological groups (astrocytoma with atypical or anaplastic foci and glioblastoma multiforme). Although few confirmatory autopsies are available, long-term survival in patients with astrocytomas with atypical and anaplastic foci who were treated with 60 Gy plus BCNU (5-yr survival, 22%) suggests no significant late CNS toxicity, compared to 60 Gy alone (5-yr survival, 15%). This is confirmed by comparable neurological function in long-term survivors.
Asunto(s)
Neoplasias Encefálicas/terapia , Glioma/terapia , Adulto , Factores de Edad , Neoplasias Encefálicas/mortalidad , Carmustina/efectos adversos , Carmustina/uso terapéutico , Ensayos Clínicos como Asunto , Terapia Combinada , Estudios de Seguimiento , Glioma/mortalidad , Humanos , Persona de Mediana Edad , Dosificación Radioterapéutica/efectos adversosRESUMEN
Liver biopsy was performed to exclude anatomic obstruction of the biliary tract in five prematurely born infants who had developed conjugated hyperbilirubinemia during intravenous alimentation with a protein hydrolysate. Each was being treated after having undergone a segmental intestinal resection for necrotizing enterocolitis. Bacterial and viral infections, metabolic disorders, and isoimmune hemolytic disease were excluded as possible causes of jaundice. Light microscopic and ultrastructural analysis disclosed cholestasis and hepatocellular injury without significant inflammatory reaction. Jaundice abated following permanent discontinuation of parenteral alimentation. The jaundice and cholestasis are interpreted to be hepatotoxic effects because of (1) their temporal relationship to the treatment and (2) the presence of hepatocellular damage.