RESUMO
OBJECTIVES: To evaluate the usefulness of iodine-123 metaiodobencylguanidine (123I-MIBG) in the study of the cardiac autonomic neuropathy in insulin-dependent diabetic patients, by means of: a) analysis of heart to mediastinic ratio and tomographic images with 123I-MIBG; b) comparison with conventional non-invasive cardiac reflex test, and c) analysis of left ventricle ejection fraction. POPULATION AND METHODS: Ten patients submitted for cardiac evaluation with 123I-MIBG were compared with a control group of 11 patients. In both groups we excluded the presence of coronary pathology by means of an exercise test. We carried out planar and SPECT studies, using 123I-MIBG, and the calculation of the ejection fraction by equilibrium ventriculography. RESULTS: The uptake of 123I-MIBG in diabetic patients was significantly smaller than the control group in the calculated index (heart to mediastinic ratio: 1.64 +/- 0.20 vs 2.00 +/- 0.26; p < 0.001; SPECT index: 44.87 +/- 8.37 vs 55.54 +/- 3.96; p < 0.001). In polar images we noted a more reduced uptake in the diabetic group in the inferior wall (p = 0.020). Patients with cardiac sympa-thetic dysinnervation demonstrated less uptake in both indexes (p < 0.05 and 0.005, respectively), essentially in the inferior wall and in basal and medium territories (p < 0.05). No differences in respect to the ejection fraction parameter were found. CONCLUSIONS: Despite the small sample population, insuli-dependent diabetic patients in show a significant reduction of the uptake of 23I-MIBG, more accentuated in the base. Scintigraphy using 123I-MIBG can be an approach to investigate the pattern and the natural history of the sympathetic innervation in these patients.
Assuntos
3-Iodobenzilguanidina , Diabetes Mellitus Tipo 1/diagnóstico por imagem , Neuropatias Diabéticas/diagnóstico por imagem , Coração/inervação , Doenças do Sistema Nervoso Periférico/diagnóstico por imagem , Compostos Radiofarmacêuticos , Sistema Nervoso Simpático/diagnóstico por imagem , Adulto , Feminino , Humanos , Masculino , CintilografiaRESUMO
BACKGROUND: A prospective study was carried out to compare the evolution of thyroid hormones, thyroglobulin (Tg) and immunoglobulins inhibiting the binding of thyrotropin to its receptor (TBII) in patients with Graves disease treated with antithyroid drugs, radioactive iodine and subtotal thyroidectomy. METHODS: Ninety-five patients with Graves disease were studied, being distributed according to clinical criteria: Group I (n = 35) patients treated with antithyroid drugs; Group II (n = 30) patients who received 131I; and Group III (n = 30) patients treated with subtotal thyroidectomy. The thyroid hormones, Tg, antithyroglobulin antibodies and TBII were determined by radioimmunoassay (RIA), prior to treatment, and at 1, 3, 6, 12, 24, and 36 months of follow up, except in those patients from Group III who were followed up to 24 months. RESULTS: The rate of reactivation at 12 months did not significantly differ among the three groups. At 24 months a higher percentage of reactivations was observed in Group I (42%), versus Group II (16%, p < 0.001) and Group III (13%, p < 0.005). At 36 months reactivation was 30% in Group I, versus 5% in Group II (p < 0.01). Upon comparison of the TBII values among the three groups, the highest basal values corresponded to Group III with significant differences being found versus Group I (p < 0.05) and Group II (p < 0.001). TBII concentrations in the three groups studied remained high at 6 and 12 months with no significant differences being observed. Negativization was shown in the TBII at 24 months in Group II with a significant difference being seen versus Group I and III. At 36 months negativization was seen in the TBII in Group I with significant differences with respect to Group II. CONCLUSIONS: The rate of reactivation following antithyroid treatment is greater to that obtained in groups treated with iodine or surgery. The earliest negativization of TBII was obtained with radioiodine.
Assuntos
Doença de Graves/imunologia , Doença de Graves/fisiopatologia , Glândula Tireoide/fisiopatologia , Adolescente , Adulto , Idoso , Antitireóideos/uso terapêutico , Autoanticorpos/sangue , Feminino , Doença de Graves/sangue , Doença de Graves/terapia , Humanos , Imunoglobulinas Estimuladoras da Glândula Tireoide , Radioisótopos do Iodo/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tireoglobulina/sangue , Glândula Tireoide/imunologia , Tireoidectomia , Tiroxina/sangue , Fatores de TempoRESUMO
A great majority of patients suffering non insulin dependent dependent diabetes mellitus (NIDDM) can be efficiently controlled with diet, not requiring oral antidiabetic drugs or insulin. The main objective, given the tight relationship between obesity and this type of diabetes, is to decrease caloric intake as well as reducing the amount of saturated fats from the diet in an attempt to delay the onset of cardiovascular manifestations of the disease. Accumulated experience suggests that an increase in carbohydrate intake (60% of the diet) most of which should be food rich in fiber should be recommended given the proven efficacy in improving the control of in blood sugar and lipids. We advocate on the consumption of dry vegetables, and we think that this different attitude in their use is of major importance in NIDDM.