RESUMEN
Sudden deafness is a medical emergency, for which etiopathology is ill-known and no therapeutic consensus exists. This study is aimed at demonstrating that a greater audiometric gain can be achieved if trimetazidine, a major cellular anti-ischemia agent, is associated with hemodilution, than when the treatment is based on hemodilution only. 42 patients suffering from sudden deafness were all treated with hemodilution before their 7th day of deafness, half of them being given 3 tablets of trimetazidine daily in addition and the other half placebo, during one month. The results of this double-blind trial demonstrate an additional audiometric gain of 10% in the trimetazidine group for all frequencies, as well as a higher percentage of total recovery, ie. 63% vs. 47% in the placebo group. No particular sensitivity to treatment was noted according to the shape of the audiometric curve or in the case of initial cophosis, known to be of poor prognosis. The statistic significance was not established due to the small number of cases. The association of trimetazidine and hemodilution therefore seems to be an interesting therapeutic approach for sudden deafness, owing to the clinically appreciable audiometric improvement we have noted.
Asunto(s)
Pérdida Auditiva Súbita/terapia , Hemodilución/métodos , Trimetazidina/uso terapéutico , Adulto , Anciano , Audiometría , Método Doble Ciego , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , PlacebosRESUMEN
A hitherto unrecognized thyroid antibody, which reacts with a thyroid cell surface antigen expressed on passaged thyroid cells, was identified in serum from patients with thyroid-associated ophthalmopathy using antibody-dependent cell-mediated cytotoxicity (ADCC) tests. The antibody was detected in 14 of 23 patients with Graves' hyperthyroidism (Gh) and associated ophthalmopathy, in 3 of 4 patients with Hashimoto's thyroiditis (HT) and ophthalmopathy, but in only 1 of 16 patients with Gh without clinically evident eye disease and 4 of 37 patients with HT without eye disease. The ADCC test also was positive in 2 of 30 patients with thyroid cancer, both of whom had had Gh and ophthalmopathy in the past. There was no correlation, in patients with ophthalmopathy, between the levels of the antibody (expressed as percent specific lysis) and the titers of antithyroid microsomal antibody measured using a hemagglutination assay. Based on the results of blocking experiments using mouse monoclonal antibodies against human thyroid peroxidase, now known to be the thyroid microsomal antigen, the corresponding antigen was not thyroid peroxidase. Moreover, the new antigen was expressed on cultured and passaged thyroid cells which do not express the microsomal antigen. In patients with ophthalmopathy there was a close correlation between the degree of lysis of passaged thyroid cells and that of eye muscle cells, and ADCC activity against passaged thyroid cells was absorbed by preincubation of positive serum samples with eye muscle and thyroid cell, but not other cell, monolayers. The reaction of a newly identified cytotoxic thyroid antibody with a shared epitope on eye muscle cells thus appears to be a possible mechanism for the development of ophthalmopathy in patients with Gh and, less often, HT.
Asunto(s)
Citotoxicidad Celular Dependiente de Anticuerpos , Antígenos de Superficie/inmunología , Autoanticuerpos/análisis , Enfermedad de Graves/inmunología , Músculos Oculomotores/inmunología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Reacciones Cruzadas , Femenino , Enfermedad de Graves/etiología , Humanos , Masculino , Microsomas/inmunología , Persona de Mediana Edad , Glándula Tiroides/inmunologíaRESUMEN
A case of facial palsy first unilateral then bilateral, due to Lyme disease, is reported. This disease, transmitted by ticks, is caused by a spirochete (Borrelia burgdorferi) known as the etiologic agent since 1982.