RESUMEN
OBJECTIVES: To review our experience and assess the role of TC99m MIBI thyroid scintigraphy in patients with well-differentiated thyroid carcinoma. DESIGN: Cross sectional descriptive study comparing the results of TC99m MIBI and TC99m pertechnetate scintigraphy with histology. SETTING: Ga-Rankuwa Hospital, a tertiary referral centre, MEDUNSA, South Africa. SUBJECTS: Between October 1998 and January 2000, 63 patients presenting with a single thyroid nodule were included in this study. INTERVENTION: All patients included in the study were subjected to fine needle aspiration, thyroid function tests, TC99m pertechnetate and TC99m MIBI scintigraphy. Following surgery all specimens were sent for pathological examination. MAIN OUTCOME MEASURES: The outcome of the study was measured comparing the results of pre-operative TC99m MIBI and TC99m pertechnetate scintigraphy with final histology. RESULTS: 41 of these 63 patients were found to have benign disease and 22 patients had malignant disease. In the malignant group there were 17 females and five males. The age of the patients ranged from 28 years to 85 years in the carcinoma group. Thirteen patients had follicular carcinoma, six patients had papillary carcinoma, two patients had Hurthle cell carcinoma and one patient had medullary carcinoma. TC99m MIBI correctly predicted malignancy in 21/22 patients in contrast with TC99m pertechnetate scintigraphy which diagnosed malignancy in 17/22 patients. The sensitivity of MIBI was 95% and its specificity was found to be 63%. The sensitivity and specificity of TC99m pertechnetate, however, was 77% and 29% respectively. CONCLUSION: TC99m MIBI scintigraphy can be used in association with Fine Needle Aspiration (FNA) in the pre-operative evaluation of thyroid carcinoma.
Asunto(s)
Carcinoma/diagnóstico por imagen , Radiofármacos , Tecnecio Tc 99m Sestamibi , Neoplasias de la Tiroides/diagnóstico por imagen , Adenocarcinoma Folicular/diagnóstico por imagen , Adenoma Oxifílico/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma/diagnóstico , Carcinoma Medular/diagnóstico por imagen , Carcinoma Papilar/diagnóstico por imagen , Estudios Transversales , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cintigrafía , Neoplasias de la Tiroides/diagnósticoRESUMEN
The posterior interosseous nerves of 58 cadaver forearms of black South Africans were dissected to study their order of branching. In 43 specimens (74%), the most common order of branching was: extensor carpi radialis brevis; supinator; extensor digitorum; extensor carpi ulnaris; extensor digiti minimi; abductor pollicis longus; extensor pollicis brevis; extensor pollicis longus and extensor indicis. In 15 specimens (26%) different variations of the nerve were observed, some of which are reported for the first time. The knowledge of these variations could be useful during operations in the vicinity of the nerve, and when repairing a nerve injury or forecasting the location of a compressive lesion.
Asunto(s)
Nervio Radial/anatomía & histología , HumanosAsunto(s)
Anemia Hipocrómica/diagnóstico , Ferritinas/sangre , Talasemia/complicaciones , Transferrina/metabolismo , Adolescente , Adulto , Anemia Hipocrómica/etiología , Niño , Preescolar , Femenino , Hemoglobinas/metabolismo , Heterocigoto , Humanos , Hierro/metabolismo , Masculino , Persona de Mediana Edad , Factores SexualesAsunto(s)
Anemia Hipocrómica/sangre , Anemia Macrocítica/sangre , Anemia Megaloblástica/sangre , Hemoglobina A2/metabolismo , Hemoglobina A/metabolismo , Adolescente , Adulto , Anemia Hipocrómica/etiología , Anemia Megaloblástica/etiología , Niño , Preescolar , Diagnóstico Diferencial , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Talasemia/sangreRESUMEN
The efficacy of serum folate (SF), red blood cell folate (RCF), and serum B12 in diagnosing folate and B12 deficiency, and the effect of iron overload on hemoglobin, were studied in 157 cases of homozygous beta thalassemia (HBT). The patients had lower SF compared with normal subjects (NS) (P less than 0.001) and higher RCF than their parents (P less than 0.001) and NS (P less than 0.001). Forty percent of patients had both low SF (less than 3 ng/mL) and high RCF (greater than 600 ng/mL). Homozygous beta thalassemia patients are known to have folate deficiency. Yet, both folate and B12 deficiency status were similar in the authors' patients and NS. These deficiencies apparently were less in patients compared with their parents, who shared the same nutritional milieu (P less than 0.001). Mean hemoglobin in patients with iron overload (transferrin saturation, TS greater than 50%) was lower than in those without (P less than 0.005). The following is concluded: (1) diagnosis of folate and B12 deficiency based on SF, RCF and serum B12 is vitiated in HBT and needs a therapeutic trial; (2) iron overload of a magnitude indicated by TS greater than 50% can aggravate anemia in HBT.
Asunto(s)
Deficiencia de Ácido Fólico/etiología , Hierro/farmacología , Talasemia/sangre , Deficiencia de Vitamina B 12/etiología , Transfusión Sanguínea , Niño , Preescolar , Humanos , LactanteRESUMEN
Serum ferritin, serum iron, and unsaturated iron binding capacity were studied in 64 patients with beta homozygous thalassemia (BHT), 120 patients with beta heterozygous thalassemia, and 46 normal subjects. Incidence of iron overload seen in 32 BHT cases was similar in untransfused and transfused cases. Among heterozygotes, iron stores were depleted in 24 (20%), mostly females (70.8%). Only male heterozygotes but not normals were iron deficient. In 18 (75%) heterozygotes with depleted iron stores, transferrin saturation (TS) was normal. It was also normal in 8 (25%) BHT patients and 5 (100%) heterozygotes with iron overload. In 13 (35.1%) BHT patients, it was raised in the absence of iron overload. It was concluded that iron deficiency in heterozygotes is of greater magnitude, especially in females, than hitherto known in India. Transferrin saturation is not a good indicator of either iron depletion or overload. Iron supplementation is recommended in heterozygous beta thalassemia in infants, children, and expectant mothers in geographic areas with high incidence of iron deficiency.
Asunto(s)
Ferritinas/sangre , Deficiencias de Hierro , Talasemia/sangre , Niño , Preescolar , Femenino , Heterocigoto , Homocigoto , Humanos , Lactante , Hierro/sangre , Masculino , Factores Sexuales , Talasemia/genética , Transferrina/metabolismo , Reacción a la TransfusiónAsunto(s)
Deficiencia de Ácido Fólico/genética , Heterocigoto , Talasemia/genética , Deficiencia de Vitamina B 12/genética , Adolescente , Adulto , Niño , Preescolar , Eritrocitos/metabolismo , Femenino , Ácido Fólico/sangre , Humanos , Masculino , Persona de Mediana Edad , Talasemia/sangre , Vitamina B 12/sangreAsunto(s)
Anemia Hipocrómica/sangre , Heterocigoto , Hierro/sangre , Talasemia/sangre , Adolescente , Adulto , Anemia Hipocrómica/genética , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Talasemia/genéticaRESUMEN
It is well established that infection with Giardia lamblia can cause malabsorption although the pathogenesis of this is unknown. Transport studies were made on the intestinal segments of male albino rats infected with Giardia cysts obtained from human stools to investigate this pathogenesis. The results were compared with those seen in a normal group and in a control group that was fed with a Giardia-free stool suspension. There was a significant fall in the transport of glucose and glycine, both of which were actively absorbed. On the other hand, potassium, which diffuses passively in a bidirectional manner across the bowel wall, was not affected. Furthermore, it was observed that the transport mechanism was deranged in the presence of an entirely normal small intestinal mucosa, as judged by light microscopy. It is concluded that Giardia trophozoites interfere with the active transport mechanisms of the small intestinal mucosa. This defect could result either from structural damage to the substrate carriers or from an alteration in cell maturation.
Asunto(s)
Giardiasis/metabolismo , Absorción Intestinal , Animales , Giardiasis/complicaciones , Giardiasis/patología , Glucosa/metabolismo , Glicina/metabolismo , Técnicas In Vitro , Mucosa Intestinal/patología , Intestino Delgado/metabolismo , Intestino Delgado/patología , Síndromes de Malabsorción/etiología , Masculino , Potasio/metabolismo , RatasAsunto(s)
Modelos Animales de Enfermedad , Giardiasis/etiología , Animales , Heces/parasitología , Giardia/patogenicidad , Humanos , RatasRESUMEN
Following a standard test meal, tryptic activity was measured in the duodenal aspirate in 26 cases of giardiasis. Twenty normal subjects were studied to serve as controls. The mean of tryptic activity values in the control and giardiasis group was 17.1 muEq/min/ml (S.D. +/- 1.4) and 12.3 muEq/min/ml (S.D. +/- 6.9) respectively. The difference in the two groups was highly significant (p less than 0.01). Out of 10 patients who showed decreased tryptic activity, 9 were restudied after eradication of the parasite and the tryptic activity returned to normal in all of them. The post treatment values were significantly higher than the pretreatment values (p less than 0.01).