RESUMO
SETTING: Tuberculosis control programmes of two health care centres in the central rainforest of Peru. OBJECTIVE: To evaluate if bodyweight gain (BWG) predicts treatment outcome in patients with pulmonary tuberculosis (PTB). DESIGN: Retrospective cohort study of adults with PTB diagnosed between 1995 and 2004. BWG was assessed after month 1 of treatment, after the initial phase and at the end of treatment. Patients were stratified into two BWG categories, < or = 5% and >5%. Failures and relapses were grouped together as unsuccessful treatment outcome. RESULTS: A total of 650 patients were included: 7.2% (n = 47) had an unsuccessful outcome. Unsuccessful outcome was associated with BWG < or = 5% at the end of treatment (RR 2.05, 95%CI 1.10-3.80), but not at the completion of month 1 (RR 0.99, 95%CI 0.52-1.88) or at completion of the initial phase (RR 1.46, 95%CI 0.82-2.57). Median BWG at completion of the initial phase was higher in cured patients (P = 0.007). BWG < or = 5% at end of treatment (RR 2.35, 95%CI 1.17-4.72), initial sputum smear 2+ (RR 2.48, 95%CI 1.14-5.31) and positive smear microscopy at month 2 (RR 4.0, 95%CI 1.30-12.31) were independent predictors of unsuccessful treatment outcome. CONCLUSION: BWG < or = 5% at the end of treatment, high bacterial load and lack of sputum conversion correlate with unsuccessful treatment outcome in this setting. New discriminative cut-offs for BWG are proposed.
Assuntos
Antituberculosos/uso terapêutico , Tuberculose Pulmonar/tratamento farmacológico , Aumento de Peso , Adulto , Distribuição de Qui-Quadrado , Feminino , Humanos , Masculino , Peru/epidemiologia , Valor Preditivo dos Testes , Curva ROC , Estudos Retrospectivos , Estatísticas não Paramétricas , Resultado do Tratamento , Tuberculose Pulmonar/epidemiologiaRESUMO
Se estudiaron 18 pacientes consecutivos (14 hombres y 4 mujeres, edad media 65 años) referidos para estudio GSPECT con Tc-99m MIBI después de esfuerzo ergométrico / reposo siguiendo protocolo de 1 dia. Las imágenes fueron sumadas y procesadas para la evaluación SPECT de perfusión miocardio (PM). GSPECT fue además procesado para calcular la FEVI(por ciento) usando el programa sincronizado cuantitativo (QGS). La VGRI en reposo se realizo 48-72 hrs. después de administrar con 925 MBq (25 mCi) de Tc-99m-ASH usando DTPA como agente quelante bifuncional. La ASH-DTPA fue preparada a temperatura ambiente, agregando a 2 ml de ASH al 2por ciento, 20 mg de DTPA y 1 mg de una solución estándar de cloruro estanoso y después el Tc-99m recién eluido del generador. La VGRI fue adquirida en posición anterior y en la mejor vista septal oblicua izquierda (OAI) durante 10 min. La FEVI (por ciento) en OAI fue computada manualmente dibujando regiones de interes (ROI) en la imagen de fin de diástole y sístole. En la VGRI también evaluamos visualmente la calidad de las imágenes cardiovasculares, y en la imagen de fin de diástole del ventriculograma en posición anterior, mediante ROI colocadas en el Ventrículo izquierdo (VI), hígado, pulmón y en el tercio superior del abdomen ( irradiación de fondo), se calculó la relación de actividad entre ellos. Resultados: A todos los pacientes se les realizó GSPECT después del ejercicio ergométrico máximo. Se utilizó QGS para calcular la FEVI(por ciento) tanto posejercicio en los pacientes con estudio SPECT de PM normal (n = 10) como en los con PM. anormal (n = 8) en quienes la FEVI(por ciento) fue estimada en reposo. No hubo diferencias significativas entre la FEVI (por ciento) con QGS y VGRI ( 55.5 ñ 13.4 vs 56.5 ñ 14.2 respectivamente). Ambos métodos se correlacionaron significativamente ( r = 0.78, p = 0.0001) y concordaron para identificar los pacientes con FEVI (por ciento) superior o inferior al 50 por ciento (índice kappa = 0.76). No se observaron diferencias estadísticamente significativas entre la FEVI(por ciento) calculada en la VGRI en reposo y QGS post ejercicio (n = 10) (62,5 ñ 8.3 vs 63 ñ 11.3), o la estimada reposo con ambos métodos. (n = 8) (VGRI 48.6 ñ 16.7, QGS 46.2 ñ 9.7 ), observándose correlación significativa entre la VGRI y QGS independientemente de que la FEVI(por ciento) fuera estimada después del ejercicio(r = 0.74, p =0.013) o en reposo(r = 0.75, p = 0.03)...
Assuntos
Humanos , Masculino , Feminino , Tomografia Computadorizada de Emissão de Fóton Único , Disfunção Ventricular Esquerda , Ventriculografia com Radionuclídeos/métodos , Tecnécio Tc 99m Sestamibi , Volume Sistólico/fisiologiaRESUMO
We report a 35 years old female with left lobe thyroid hemiagenesis who initially was euthyroid and then developed hyperthyroidism due to Graves disease. Hemiagenesis of the thyroid gland is a rare anomaly with an uncertain incidence; up to now 256 cases have been reported. The detection is often made by either clinical symptoms of thyroid dysfunction, by imaginological studies or surgical/pathological procedures. No explanation has been given for the development of this anomaly; left lobe aplasia and predominance of occurrence in women have been most frequently reported.
Assuntos
Doença de Graves/complicações , Glândula Tireoide/anormalidades , Adulto , Antitireóideos/uso terapêutico , Feminino , Doença de Graves/diagnóstico , Doença de Graves/tratamento farmacológico , Humanos , Propiltiouracila/uso terapêutico , Cintilografia , Glândula Tireoide/diagnóstico por imagem , UltrassonografiaRESUMO
BACKGROUND: To stabilize Graves disease and deplete the preformed hormone, the use of antithyroid drugs prior 131I therapy has been suggested, specially in those patients with severe thyrotoxicosis and in the elderly. However, PTU may reduce the effectiveness of 131I. AIM: To study the effects of PTU pretreatment before 131I administration. SUBJETS AND METHODS: A retrospective analysis of the medical records of patients with Graves disease treated with 131I from 1989 to 1997 was made. Of 244 patients with adequate follow-up for at least 12 months after 131I treatment, 142 had not been pretreated and 102 had received PTU prior to 131I therapy. Pretreated patients were distributed according to the number of days that PTU was discontinued before receiving 131I, forming four groups (a = 5 d, b = 6-14 d, c = 15-30 d and d = 31-60 d). Radioiodine was delivered according to our protocol of 120 microCi per gram of thyroid tissue, as estimated by clinical examination. Therapy was considered successful when laboratory evidence of euthyroidism or hypothyroidism after one year of treatment was obtained and as a failure when undetectable TSH values persisted after 12 months of treatment with 131I. RESULTS: All groups were comparable as to age, gender, goiter size, and 24 h radioiodine uptake. Control of hyperthyroidism was achieved in 76% of the non pretreated group. A similar percentage was observed in groups (b), (c) and (d). However, the disease was controlled in only 50% of group (a) patients (p < 0.003). CONCLUSIONS: The therapeutic efficacy of 131I is significantly reduced when the PTU is stopped for only a few days prior to the use of radioiodine. We postulate that PTU has to be discontinued for at least 10 days before radioiodine administration.
Assuntos
Antitireóideos/uso terapêutico , Doença de Graves/radioterapia , Radioisótopos do Iodo/uso terapêutico , Propiltiouracila/uso terapêutico , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
Multiple endocrine neoplasias (MEN) are syndromes inherited as autosomal dominant. The application of the techniques of molecular biology has made possible the identification of the genes causing MEN 1 and 2. The gene responsible for MEN 1 belongs to the family of tumor suppressor genes and encodes for a protein named MENIN whose function remains to be elucidated. The identification of mutant MEN 1 gene carriers who are at risk of developing this syndrome requires frequent biochemical screening for the development of endocrine tumors. MEN 2 is a consequence of mutations in the Ret proto-oncogene (c-Ret). This gene encodes for a tyrosine kinase receptor thought to play a role in the development of neural crest-derived tissue. Members of kindred with either MEN 2A or MEN 2B should be screened by direct DNA testing early in life for mutations in c-Ret. Those with the mutation should be advised to have thyroidectomy at five years of age in children with MEN 2A and earlier in children with MEN 2B. Some cases of sporadic MTC are actually MEN 2A or Familial MTC after c-Ret testing is done, therefore routine application of this test is recommended in all cases of apparent sporadic MTC.